2. Hearing Health Policy and Reports

Still waiting to be heard… Report and Government Response

2.1
The Standing Committee on Health, Aged Care and Sport 2017 report entitled Still Waiting to be heard… (Hearing Health Report) included 22 recommendations with the aim of improving hearing health services in the short term and hearing wellbeing into the future.
2.2
Of particular note, the Committee recommended:
The development of a national strategy to address hearing health in Aboriginal and Torres Strait Islander communities and a significant increase in the provision of hearing services for remote Aboriginal and Torres Strait Islander communities (Recommendations 1 and 2).
Increased support to hearing impaired Australians of working age who are unemployed or with a low income (Recommendation 11).
A prohibition on the use of sales commissions by providers taking part in the Australian Government’s Hearing Services Program (HSP) (Recommendation 12).
Australian Hearing’s continued role as the sole provider of audiological services to young children following the introduction of the National Disability Insurance Scheme (NDIS) (Recommendation 14).
The implementation of a universal hearing screening program for children in their first year of school (Recommendation 16).
Hearing health becoming a National Health Priority Area (Recommendation 22).
2.3
On 14 August 2018, the Australian Government provided its response to the Hearing Health Report (Government Response). Of the 22 recommendations made by the Committee, Recommendation 1 was supported, which was that a national strategy be developed to improve Aboriginal and Torres Strait Islander hearing health.1 The Government supported a further six recommendations in principle only2, and noted a further 11 recommendations.3 Four of the Hearing Health Report recommendations were not supported by the Government, which are:
that audiology and audiometry be included as eligible services for access to the Free Interpreting Service (Recommendation 4);
prioritising funding for hearing health research that focuses on balance disorders, genetic and stem-cell based treatments, and longitudinal research relating to adults undergoing treatment for hearing impairment (Recommendation 8);
the registration of audiology and audiometry professions under the Australian Health Practitioner Regulation Agency framework (Recommendation 13); and
that hearing health is made a National Health Priority Area (Recommendation 22).

Stakeholder Views on the Government Response

2.4
Following the release of the Government Response, in February 2019, First Voice and Hear for You expressed concern that the Australian Government had not agreed to all recommendations in the Hearing Health Report.4 First Voice further stated that it was ‘disappointed that a lot of … activity has been in terms of discussions and noting, rather than actually creating change on the ground.’5
2.5
The Deafness Forum of Australia made a similar point and stated that it was ‘disappointed that the government had not taken an opportunity to commit to a national approach to hearing health care as part of its response to the Committee’s report and recommendation.’6
2.6
Cochlear also expressed disappointment and frustration regarding the Government Response, in relation to the Government’s inactivity on a national strategy and lack of support for a national awareness and education campaign. Cochlear stated:
Cochlear was disappointed with the government's response to the report, as were many others in the hearing sector. In particular, we were frustrated by, first, the failure to commit to a genuinely national strategy for hearing health, and, second, the lack of support for a national awareness and education campaign. These are the two essential ingredients for ensuring a consistent level of care, support and respect for deaf and hard-of-hearing Australians, wherever they might live.7

Department of Health Annual Report 2017-18

2.7
The Department of Health Annual Report 2017-18 was presented to Parliament on 15 October 2018.8 The Annual Report stated that in 2018-19 the Department will be ‘delivering a range of important strategies, including … a national approach to hearing loss.’9
2.8
In addition, the Department of Health Annual Report 2017-18 stated that in relation to hearing services, ‘the Department met the performance target related to this program’. This assessment was based on the Department of Health meeting the demand for the HSP Voucher Program in 2017-18.
2.9
In 2017-18, the Voucher Program provided hearing services to 733 400 people at a cost of $449.2 million.10

Extract from the Department of Health Annual Report 2017-18, p. 82:

2.10

Extract from the Department of Health Annual Report 2017-18, p. 95:

Further Announcements Regarding Hearing Health

2.11
Since the release of the Hearing Health Report in 2017, a number of initiatives have been announced and/or implemented in relation to hearing health. These include:
the development of a Roadmap for Hearing Health;
funding for Aboriginal and Torres Strait Islander hearing health; and
an online hearing screening program for school children.
2.12
These are outlined below and discussed further in Chapter 3.

Roadmap for Hearing Health

2.13
In July 2018, the Government established a Hearing Health Sector Committee (consisting of hearing health stakeholders11) to develop a Roadmap for Hearing Health. The Roadmap ‘sets out future directions and priorities for the hearing sector that will lead to short (next two years), medium (three to five years) and long-term (five to seven years) improvements in hearing health for all people in Australia.’12
2.14
The six ‘domains’ or areas of focus of the Roadmap are:
‘Enhancing Awareness and Inclusion;
Closing the Gap for Aboriginal and Torres Strait Islander Ear and Hearing Health;
Preventing Hearing Loss;
Identifying Hearing Loss;
Providing Support; and
Enhancing the Sector’s Workforce.’13
2.15
In addition to outlining a range of actions under each domain, the Roadmap listed eight ‘high priority’ actions, which are:
1
‘A public awareness campaign is delivered;’
2
‘An integrated national approach to ear health checks of children aged zero to six is agreed;’
3
‘The availability of Auslan services is increased;’
4
‘The quality of hearing health and care in aged care facilities is lifted;’
5
‘A comprehensive audit of the workforce delivering hearing health services is undertaken;’
6
‘Supports in the education system are increased;’
7
‘There is a smooth transition for clients from the HSP to the NDIS;’ and
8
‘Additional support for people on low incomes is made available.’14
2.16
The final draft of the Roadmap for Hearing Health was considered by the Hearing Health Sector Committee in February 2019, before being provided to the Minister for Indigenous Health and Minister for Senior Australians and Aged Care, the Hon. Ken Wyatt AM MP (the Minister).15
2.17
The Roadmap for Hearing Health was then considered by the Council of Australian Governments (COAG) Health Council on 8 March 2019. At this meeting, the COAG Health Ministers referred the Roadmap ‘to the Australian Health Ministers' Advisory Council for review and reporting back in November 2019.’16

Aboriginal and Torres Strait Islander Hearing Health

2.18
In the 2018-19 Federal Budget the Government allocated $30 million for hearing assessments for Aboriginal and Torres Strait Islander preschool children.17
2.19
In August 2018 the Minister for Indigenous Health announced a $7.9 million Hearing for Learning initiative, to be established at 20 sites in the Northern Territory (NT).18
2.20
Hearing for Learning involves the employment and training of local Ear Health Project Officers to detect and treat ear disease and hearing problems in Aboriginal and Torres Strait Islander children.19
2.21
The initiative will be implemented by the Menzies School of Health Research and is funded over three years by the Australian Government ($3 million), NT Government ($2.4 million) and the Balnaves Foundation20 ($2.5 million).21

National Online Hearing Assessment for Children

2.22
In November 2018 the Minister, the Minister for Human Services and Digital Transformation, the Hon. Michael Keenan MP and Mr Trent Zimmerman MP, Chair, Standing Committee on Health, Aged Care and Sport, announced the national rollout of Sound Scouts, a software application (app) that delivers a user-friendly hearing test for school aged children.22
2.23
Australian Hearing has been provided with a $4 million grant to deliver the program, which will begin in 2019 and run for up to five years.23

Australian Hearing 2017-18 Annual Report

2.24
The Australian Hearing 2017-18 Annual Report was presented to Parliament on 17 October 2018.24 The Annual Report outlines that in 2017-18, Australian Hearing provided services to over 259 000 clients (more than any other year of its operations) with over 80 per cent of clients being ‘highly satisfied’ with its services.25 Australian Hearing’s total revenue for 2017-18 was $249.7 million, with a gross profit of $26.7 million.26

Extract from the Australian Hearing 2017-18 Annual Report, p. 35:

2.25

Australian Hearing Data on Aboriginal and Torres Strait Islander Hearing Health

2.26
Australian Hearing reported a 2.6 per cent increase in the number of its Aboriginal and Torres Strait Islander clients aged under 26 years, and a 9.6 per cent increase in its Aboriginal and Torres Strait Islander clients aged over 50 years.27
2.27
Australian Hearing also reported a ‘statistically significant reduction in the average age of first hearing aid fitting for Aboriginal and Torres Strait Islander children.’28
2.28
In 2008, the average age of the first hearing aid fitting for Aboriginal and Torres Strait Islander children was eight years of age, and in 2017 this had reduced to six years of age. Further, ‘the proportion of Aboriginal children receiving their first hearing aids before the age of five years has improved from one in ten in 2008 to one in four in 2017.’29

National Acoustic Laboratories

2.29
The Australian Hearing 2017-18 Annual Report outlines new strategic objectives for the National Acoustic Laboratories (NAL)30, which are to conduct research into five areas:
1
Precision Hearing Healthcare;
2
Alternative Delivery Models;
3
Unilateral Hearing Loss;
4
Mild and Normal Hearing Thresholds with Abnormal Difficulty in Noise; and
5
Hearing Safety at Indoor Live Venues.31
2.30
The NAL listed its 2017-18 accomplishments as including the publication of outcomes from the Year Five phase of the Longitudinal Outcomes of Children with Hearing Impairment project. The outcomes showed that ‘children who received early intervention [for hearing loss] have better language abilities, compared to those who received later intervention’, and that ‘many children had marked deficits in pre-reading skills … suggesting the need for targeted intervention.’32
2.31
Other listed accomplishments in 2017-18 by the NAL included that it:
‘developed 350 hearing assessment systems for a nation-wide health study of Aboriginal and Torres Strait Islander people conducted by the Australian Bureau of Statistics’;
‘commenced three Aboriginal and Torres Strait Islander projects’;
‘developed diagnostic equipment that allows a single audiologist to measure the hearing ability of babies using iOS technology and portable computers’;
‘completed research into the self-management of hearing loss’; and
‘conducted a systematic assessment of more than 20 one-size-fits-all earplugs targeted for music consumers in terms of noise-reducing ability, fit, comfort, appearance and sound quality.’33
2.32
In addition, the NAL ‘established initiatives … in several key areas: big data and machine learning, cognition and neural measures, behavioural insights, telemedicine and human-technology interaction.’34 The NAL also formed and continued partnerships with commercial and academic entities.35

Competitive Neutrality

2.33
In May 2018, the Productivity Commission released the results of the Australian Government Competitive Neutrality Complaints Office’s Investigation of Australian Hearing. The investigation found that ‘with a minor exception, Australian Hearing is complying with its competitive neutrality obligations.’ The investigation report further stated that ‘some areas of government … are providing a minor competitive advantage to Australian Hearing’, and recommended changes to address this.36
2.34
The Australian Hearing 2017-18 Annual Report stated that ‘Australian Hearing accepted all of the findings and recommendations of the review’.37

Concluding Comment

2.35
The Committee shares the concerns of hearing health stakeholders that not all recommendations in the 2017 Hearing Health Report were supported. At the same time, the Committee is pleased to see the Australian Government has worked with hearing health stakeholders to develop a Roadmap for Hearing Health. The Roadmap encompasses many of the findings and recommendations that were made in the Hearing Health Report and the Committee urges the federal, state and territory governments to take the Roadmap forward.
2.36
The Committee was pleased that $30 million was committed in the 2018-19 Federal Budget to hearing assessments for Aboriginal and Torres Strait Islander preschool children. In addition, figures provided in the Australian Hearing 2017-18 Annual Report indicate a number of encouraging trends, including an increase in the number of Aboriginal and Torres Strait Islander clients seen by Australian Hearing.
2.37
The Australian Hearing 2017-18 Annual Report also indicated that Aboriginal and Torres Strait Islander children identified as requiring hearing assistance, are being fitted with hearing aids at an earlier age, which will enable them to more fully participate in social and educational opportunities.
2.38
The development of a screening program for school aged children was a recommendation of the Committee in the Hearing Health Report. The Committee looks forward to following the implementation and evaluation process for the Sound Scouts online hearing assessment, which was announced in November 2018.


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