September 2001 - RNID supporters deluge their MPs with 300,000 postcards demanding a change to digital. An Early Day Motion is signed by 215 MPs.
November 2001 - The Institute of Hearing Research shows that patients at first wave sites report a 41 per cent improvement in hearing over analogue aids.
Christmas Eve 2001 - The Government announces £20 million to roll out the programme to 30 more sites and promises that the whole audiology service in England will go digital by March 2003.
March 2002 - RNID chief executive James Strachan is asked by the Department of Health to chair the team negotiating contracts for digital aids. The cost is further driven down to around £70.
Even government ministers, in their less gung-ho moments, admit to a technological gap between public- and private-health provision in Britain. If you can pay, you get access to state-of-the-art equipment.
If you can't or won't, you have to make do with last year's model - or in the case of some of our hospitals, last century's.
This was the case until recently for the two million people in this country who had NHS hearing aids. Some 95 per cent of them had old-fashioned, one-size-fits-all analogue devices. Meanwhile, if you had up to £2,500 to spend you could buy an advanced digital model which could be fine-tuned to bring out the best in your remaining hearing patterns.
If it were possible to make such ultra-modern aids available through the NHS, it would make a huge impact on the lives of millions of people.
It would constitute nothing short of a revolution. It was this vision that inspired the Royal National Institute for Deaf People (RNID) and its chief executive James Strachan to start a digital hearing aids campaign.
However, unlike all too many visions to do with our state-funded health service, this one is at least half way to being realised.
Through a high-profile campaign - named by MPs in a recent poll as the most effective of its type - the RNID has persuaded the Department of Health to supply digital aids to everyone who needs one in England. And now the charity is working with the Department of Health to project manage the implementation of the scheme through NHS audiology departments. It is the first time, Strachan believes, that a voluntary organisation has delivered a substantial programme of modernisation within the health service.
Having broken the mold, he would now like to see the same techniques and principles applied to other areas of NHS equipment provision.
The techniques the RNID used for the campaign were not rocket science.
After the 1997 General Election, there was an official NHS review ordered of audiology services. The RNID was involved, but soon despaired of the bureaucratic and narrow process. It had detected, however, a willingness on the part of Labour ministers to contemplate more radical change, both in ideas and processes.
After commissioning detailed research and undertaking discussions with health professionals, technical experts and hearing aid manufacturers, it launched its campaign with ads in Parliamentary magazines and mail-shots to all MPs. Under the banner "Have You Moved With The Times?", the initiative highlighted both the practical and politically symbolic benefits of changing to digital.
With an overwhelming case on the technical benefits of digital, the RNID also built a strong financial argument. It managed to extract from manufacturers a pledge to supply devices once priced at £2,500 to the NHS for £150 each.
The charity demonstrated to the makers that they could do better in commercial terms servicing the vast publicly funded market at a fraction of the cost they charged the pricey but tiny private market. In parallel to this, the RNID also released a damning report on the state of NHS audiology departments. It had become, it said, a "Cinderella service", under-funded, demoralised and failing.
"We sold a lot of our campaigning on the simple-to-understand technological hook,
says Strachan. "The digital revolution is sexy and captures people's imagination. That was the moving with the times slant to the campaign. But make no mistake, unless you modernise and support the service available in NHS audiology departments, you'll get nowhere. As part of our project managing of the scheme we are also tackling issues to do with poor structures and shortage of skilled personnel. We are even making sure each department has the computers needed to fine-tune a digital aid."
The first breakthrough came in January 2000. The Government announced that 20 NHS hospitals would take part in a pilot, project-managed by the RNID in partnership with the Department of Health, to supply digital aids.
Just under £5 million was committed in the first year, and £6 million for the second, with £25 million pledged to roll out the project by 2003/4.
Within 18 months there was such overwhelming evidence of the success of that first wave, that the RNID began to step up its campaign again to demand a firm commitment to roll out the project. In September 2001, its supporters deluged their MPs with 300,000 postcards demanding the change to digital. The following month 215 MPs signed an Early Day Motion calling for digital provision to be introduced across the country. On Christmas Eve, the Government announced £20 million to roll out the programme to 30 more sites and promised that the whole audiology service in England would go digital by the time of the March 2003 spending review.
In March of this year, Strachan was asked by the Department of Health to chair the team negotiating the national roll-out contracts. From his office in the Department of Health building, he has driven down the cost further to £75.
We don't just have to take the RNID's word on the significance of all this. The Times's business editor has held it up as "a blueprint for the way that Government does business", while the National Audit Commission in June hailed the digital hearing aid venture as the only initiative to have delivered results in the Government's stated focus area of disability equipment provision.
The key to success, observers believe, is that the RNID offered the NHS both time-honoured voluntary-sector expertise in delivering services and understanding particular user-groups, as well as private-sector expertise in risk management, project management and negotiation. This new partnership, then, is another take on the public-private debate in the NHS, but less controversial because the voluntary sector is the conduit to bring in that private-sector knowledge. "It is,
as Strachan puts it, "a somehow more publicly and politically acceptable channel."
One key plank of the campaign was to know the subject better than anyone else. And then there was the lobbying, using traditional methods, but using them very well indeed. Finally, there was focus. The charity not only had an unanswerable case; it was also willing to roll up its sleeves and do some of the dirty work. That means the charity will also take some of the rap if the project fails.
The history of third-sector involvement in the health service has rarely seen charities prepared to take such a risk. Strachan acknowledges the danger but believes that it had to be overcome in order to move beyond traditional constraints on voluntary-sector involvement. "I would say that what we are achieving proves that you can be very close - working in partnership as project managers - but, at the same time, preserve your independence and still be an extremely aggressive campaigner with the Government when the need arises."
It is perhaps too soon to reach a definitive verdict on such a claim, but the RNID is clearly walking a delicate line. It is neither responsible for the running nor the funding of audiology departments in the NHS. It simply project manages the digital aid initiative through these outlets.
If they are failing it will not, Strachan promises, hesitate to let health ministers know. It is a vital distinction to him, but one which his critics believe may not be so clear to the consumers who will, as a result, perceive the RNID as on the side of the system rather than their champion.
Other, more personal criticisms have been raised, not least that his close relationship with House of Lords minister Tessa Blackstone can't have harmed his cause. "That completely overlooks the fact that this campaign was well under way before Tessa and I even met,
he says, laughing it off. Then there is the accusation, all too familiar in the third sector, that one organisation has ridden rough-shod over sister bodies to claim all the glory for itself. Strachan insists though that the whole project was discussed and endorsed by other organisations working with the deaf, but adds that there had to be focus and leadership.
Other sniping has come, as one might expect, from hearing aid manufacturers, especially ones that have been less successful in bidding for the new contracts. One charge is that cheaper analogue aids were perfectly good enough for some people who will suffer unnecessary trauma in adjusting to advanced technology. This suggestion especially irks Strachan. "This piece of equipment brings benefits to all patients,
he says emphatically.
"For some it is massive, for others not so massive but none the less marked.
But don't let anyone kid you that it isn't something for everybody. These digital aids do things that analogue aids can't begin to do. They can be fine-tuned to each individual on a computer to suit his or her input audiogramme and to achieve a dynamic range tolerance as perfect as possible."
Although there is now a government commitment to roll out the RNID project throughout England, there are still battles to be waged. In Scotland, a different and more expensive digital hearing aid has been purchased for NHS patients but it has proved less effective with the under 2 per cent of patients who have received it. In Wales and Northern Ireland, they're still on analogue. And beyond such geographical issues, the problem of delivery still concerns the RNID. "There is a next stage,
"I can't be too specific yet, but clearly it is bananas to provide these things through an acute care hospital. We should be looking at methods of distribution that are much more user-friendly, whether they be though community health councils or even on the high street.'
The revolution has not, apparently, run its course quite yet.
DIGITAL HEARING AIDS FACTS AND STATS
- Two million people in the UK have a hearing aid. A further three million could benefit from wearing one.
- A third of analogue hearing aids are infrequently or never used largely because of the poor results they produce.
- Inexpensive beige, behind-the-ear analogue models account for half of the 500,000 hearing aids bought by the NHS each year.
- The latest digital hearing aids have produced significantly better results. But before the RNID campaign only 5 per cent of NHS patients had access to such models free of charge.
RNID CAMPAIGN TIMELINE
1997-1999 - RNID launches a campaign to have advanced digital hearing aids available to all through the NHS. It persuades manufacturers to supply them for £150 each.
1999-January 2000 - Under the banner "Have You Moved With The Times?", campaign literature is sent to all MPs highlighting the benefits of changing to digital. Meetings with ministers follow and create a positive climate.
January 2000 - The Government announces that 20 NHS hospitals will take part in a pilot to supply digital aids. The project will be managed by the RNID with the Department of Health.
July 2001 - The RNID begins to campaign for a commitment to roll out the project.