The differences – and similarities – between hearing care accessibility in the NHS and private healthcare

BIHIMA interviewed our Clinical Director, Dr Donal Collins about his experience working in hearing health care, the differences between NHS and private care and how he is striving to make access to hearing care more readily available for everyone.

I’m a retired GP, having spent 27 years with the NHS. I had a special interest in Ear, Nose and Throat (ENT) cases for 22 years and in the latter half of my career I held senior leadership roles, including running an ENT clinic in Fareham. In 2020, I set up my own enterprise with my business partner, delivering an insulin sensitivity service (Type 2 diabetes remission work using food as medicine) and ear wax removal.

BIHIMA: How did the change from NHS to private healthcare come about for you?

Our ENT clinic was incredibly successful – too successful, in the end. The service was born out of ENT consultants needing a more efficient way to support patients with hearing loss. Hospital waiting times were long and coupled with the fact that patients would often miss their appointments (due to miscommunication or external factors), it meant that the service was faltering. Queries about delayed or missed appointments were unsurprisingly high and dealing with these took time away from GPs and admin staff. After discussing the idea for six months we finally landed on the outcome: there needed to be a service in the community that was led by clinicians and responsive to patient needs.

Once launched, we were able to cut down waiting times substantially. A routine wait was around two weeks, but if a GP called us saying that a patient needed immediate support, we we able to see them the next day.

Sadly, after 19 years we were shut down: our funding was cut due to financial pressures at (what was then known as) the Clinical Commissioning Group with overspending, and it was claimed that we were creating inequality in the area. While patients in Fareham had a good experience with us, this meant that those living in nearby Portsmouth had to wait longer, creating a variation in services. We were improving waiting times for our local community but we created an unequal service across the geography because other areas could not do the same. The NHS does not like variation because it means not all patients have equal access to the same services, so one way of creating an equitable service across the area was to close our clinic. It was really sad at the time, and only once we’d closed did we realise how valued the service was by patients and GPs alike.

I think there are several reasons, but ultimately it does start with waiting times. If a patient is told that they’re going to have to wait weeks or months even for an initial appointment, there’s a hefty chance that they’re not going to bother. They think ‘well if I can’t be seen, what’s the point?’ They wait to see if it will get better tomorrow, but then tomorrow never comes. As a result, they assume that nothing can be done – they resign themselves to that (false!) fact.

There’s also a lack of awareness and education out there about what can be done. And this doesn’t just reside in NHS care, we see this in our practice as well. It is said that 25% of the adult population has ear wax that needs removing. At BarlowCollins, we serve a radius of around 200,000 adults and this statistic would suggest that 50,000 people in our area need ear wax removals. Even if you halved that, it would be 25,000. The actual number of people that we are supporting is around 2,500.

This crosses over to people’s opinion of hearing instruments. They don’t have a particularly positive press. Or, when they do, it’s from advertorials that typically overpromise on their results. While a hearing instrument is unlikely to restore your hearing back to how it was, it will absolutely improve it. But it takes time to adapt, and this is something that needs to be shared on a wider scale. It’s like driving a car – you won’t nail it the first time. And much like driving that car, the younger you start, the easier it will be. If people wait until they have lived with poor or damaged hearing for a long time, the adjustment will be tougher. So there’s also something there about speaking to younger patients at their level.

We need more people to understand that yes, they can improve their hearing and yes, they should take action to do something about it. It isn’t just about hearing things better. Hearing loss has a huge impact on mental health and loneliness, majorly impacting people’s quality and enjoyment of life. We see this sense of loneliness in people with hearing loss firsthand. As a private clinic, we are able to offer longer appointments. There are some patients who regularly return to us before they actually need to and we believe it’s due to the time and compassion they receive from another person; it’s evidence of the growing number of cases of loneliness in the community.

Around two or three years ago, all GP practices stopped offering ear wax removals and it is no longer provided by the NHS. Essentially, this came down to funding. As practices got busier, decisions were made about what would (and wouldn’t) be done based on resourcing. This continues to create huge pressures on secondary care; unless you have a serious medical problem, you won’t be seen in relation to your ear wax.

This change brought with it a fair deal of animosity. People didn’t understand why something they had always been able to get regularly before now came with a price tag attached. But it’s swings and roundabouts, really. Yes, ear wax removals come with an additional cost, but patients now have far more control over their appointments. They’re longer, can be booked more last minute and you can be pickier with the time.

I wanted ear wax removal to be an important part of my practice because I know the difference it can make to someone’s hearing. Hearing loss has many causes, but the wonderful thing about it is that you can mostly do something to improve the situation. It’s what makes my job so rewarding. Rather than walking with a patient as they get worse – which is frequently the case in healthcare – you get the joy and satisfaction of genuinely moving them to a better place, often with relative ease.

Finances, of course. When I set up the company, it was one of our core values that we would never refuse a patient care if they needed it. If they couldn’t afford it, they could either pay what they could or we would do it for free.

For the first two and a half years, this was barely used. In the past two to three weeks, it’s been used around ten times. Clearly, the cost of living crisis is coming into play here; and as we all know, this is only going to get worse. As long as we don’t move into a loss, we will keep offering this to whoever needs it.

Absolutely. It mirrors the whole system. Inequality within poorer socioeconomic demographics, those living chaotic lifestyles, homeless individuals, people with addictions – these are just some of the groups that have less of an ability to either say they need help, or to have the system listen to them (or both).

I think many people are hoping for a top down solution, but they’ll be waiting a long time. Instead, it needs to be bottom up. We need a deeper community understanding. More awareness and perhaps more charities linking up with one another and with local healthcare practitioners. Essentially, we need to embarrass those at the top into some kind of action and accountability.

I suppose that hearing care – whatever method you opt for – isn’t just for the patient, it’s for everyone around them too. For example, if someone is wearing a hearing instrument, then the people in their lives will recognise this and know that conversation and communication will now be far easier. The benefits go wider than the individual. It really is hearing care for everybody.