ADEQUACY OF ACCESS TO HEARING SERVICES
The family are dreading Nicole turning 21 when she will lose
Australian Hearing support...
Quoted in Quota International of the Leisure Coast, Submission 22, p.
This chapter examines the adequacy of access to hearing services in
Australia, including assessment and support services, and hearing technologies.
The issue of access is at the heart of everyday challenges for people
with a hearing impairment. From access to audiological and clinical help, to
obtaining the most appropriate assistive technology, to watching television,
the committee understands that access issues of all sorts are never far from
the consciousness of people with a hearing impairment.
The single most common issue raised with the committee during this
inquiry was the eligibility criteria for Australian Government Hearing Services
Program services and support, and in particular the eligibility cut off age of
twenty-one years. The committee heard evidence of the distress and financial
hardship this policy can cause, as well as other unintended consequences, such
as people having to go without hearing aids and specialist audiological support.
Evidence was presented to the inquiry from both hearing health
practitioners and their clients about accessibility to, and quality standards
of, hearing assessments in Australia. The committee also heard concerns about
the level of support that is available to assist people with a hearing
impairment and their families adjust to life with hearing loss.
The committee heard about the issues some sectors of the community have
experienced accessing the different technologies that are available to hearing
impaired Australians. Evidence was also raised about the difficulties people
with a hearing impairment sometimes have accessing services which other
Australians take for granted, such as television and movies.
Access to hearing services
Eligibility for Australian Government
Hearing Services Program support
As has already been noted, the issue of access to government services,
and particularly to Australian Government hearing services, was of interest to
most people making submissions to this inquiry.
The Australian Government provides hearing services through the Office
of Hearing Services (OHS). Support is available to eligible Australians under
the Hearing Services (Voucher) Payments and the Community Service Obligation
Australian Government Hearing Services Program
Payments are made to
hearing service providers for the delivery of services under the voucher
system to eligible clients. The services include hearing assessments, the
cost of the hearing device and its fitting, and the government contribution
to the maintenance and repair of hearing devices.
Eligibility requirements to
receive the services are as follows:
Australian Citizens and
Permanent Residents 21 years or older and:
- the holder of a
Centrelink or Department of Veterans Affairs (DVA) Pensioner Concession
- the holder of a Gold
Repatriation Health Card (DVA) issued for all conditions;
- receiving Sickness
Allowance from Centrelink;
- the holder of a White
Repatriation Health Card (DVA) issued for conditions that include
- a dependent of a person
in one of the above categories;
- a member of the
Australian Defence Force; or
- undergoing an Australian
Government funded vocational rehabilitation service and referred by their
Service Obligation (CSO):
Funds are allocated to
Australian Hearing for the delivery of services under the CSO to meet the
hearing needs of special needs groups. The CSO program, including National
Acoustic Laboratories (NAL), is provided by Australian Hearing under an
agreement with the Australian Government.
Clients under these
categories receive the same services as those provided to voucher clients but
receive additional services to address their specific needs.
Special needs groups
- all children and young
adults under 21 years of age (including replacement of cochlear implant
- eligible complex adult
- eligible Indigenous
- eligible clients who live
in remote areas; and
- an Aboriginal person or
Torres Strait Islander who is over 50 years; or a participant in a
Community Development Employment Projects Program.
Program details from the
Department of Health and Ageing website, viewed 8 April 2010, http://www.health.gov.au/hear
State and territory governments provide some hearing health services,
such as screening, prevention activities, hearing assessments through community
health centres, workers' compensation services and cochlear implantation at
Eligibility for Australian
Government Hearing Services among 21 to 65 year olds
Many submitters raised in evidence the fact that Australian Government
Hearing Services Program support is available to all Australians up to 21 years
of age and then, with the exception of people living on a Disability Support
Pension, they are cut off. The committee heard that approximately 700 people
lose their eligibility each year when they turn 21.
The general view expressed to the committee could be summarised by this submitter:
[For people aged between 21 and 65 who are ineligible for Office
of Hearing Services support] hearing aids are treated like luxury devices...they
are not, they are essential requirements...If a pair of glasses cost the same as
hearing aids, would the [eligibility] policy be the same?
The committee heard about a number of issues facing former clients of
Australian Hearing when they turn 21. Australian and New Zealand Parents of
Deaf Children (ANZPOD) explained in their submission that the nature of private
audiological practice is different to that of government services:
[Former Australian Hearing clients turning 21] need to find
an audiologist in the private sector who understands the issues of congenital
deafness and has the knowledge and skills in the complexities of their needs.
Most private audiologists are experienced in acquired hearing loss and the
appropriate audiologist is almost impossible for our children to find.
The experience of another submitter also picked up on this point:
[When I turned 21] I enquired from all my deaf friends of
audiologists they used, but most people went without the support of an
audiologist for as long as possible after losing the services of [Australian
One former Australian Hearing client related her feelings on losing the
support of Australian Hearing at age 21:
Suddenly at the age of 21 years old, I found it difficult to
find the means to obtain batteries and maintaining my cochlear implant equipment
on...my own. A piece of rechargeable cochlear implant battery can cost up to $500
or a couple of hundreds if I need to replace a part...At only 23 years old, this
is a lifelong commitment, and in order to remain integrated with the Hearing
world, it is expensive and perhaps a little unfair that I should have to pay
when a normal hearing person does not have to deal with those emotional and
Another person shared her experiences:
Suddenly at the age of 21, just when I was unemployed and studying
full time at university, I was told I could no longer get any services through
Australian Hearing; I developed extremely low self esteem and avoided social
situations. I was constantly worried and panicky which affected those around me
such as my parents and friends. When my hearing aids broke during crucial
situations I felt like giving up because there was no one to turn to and no
money to cover the cost of new ones.
The greatest challenge facing 21 year olds is that they are not yet
established in their careers, and indeed are often studying or in low paid
jobs. Losing access to Australian Hearing support could have long term
consequences for individuals and for society at large, as one witness told the
I think it [i.e. cutting off Australian Hearing services at
age 21] constitutes a disservice to Australia and the Australian community
simply because, after all, if people cannot participate effectively in the
workplace then you have lost production, lost opportunities and lost ability to
function in the wider community. This has a very significant flow-on effect.
The Shepherd Centre was passionate in their remarks to the committee on
If this committee can achieve anything the one group that
needs really special attention—and you are beginning to hear it—is young adults
who go through Australian Hearing until they are 21 and are then left to their
own devices to find their way through their education and their vocation
unaided in terms of any financial support. If they had a degree of hearing loss
that warranted considerable support from Australian Hearing for 21 years then
it seems to me to follow that they need some support to get themselves
established in their careers. It seems to me to be a travesty that these
children are unable to get any support whatsoever unless they end up as a
pensioner, which is not really where you want them to be...It is in society’s
interest to keep those young adults performing to their peak and
People with hearing loss aged between 21 and 65 who are not eligible for
Australian Government Hearing Services Program support have the option of
taking out private health insurance to help meet the costs of purchasing and
maintaining hearing devices. The committee noted in chapter four that the cost
of private health insurance for hearing devices is high and benefits are
perceived to be low, which does little to ease the cost issues faced by young
people and retirees.
The committee heard from Mr Tony Abrahams that a no-fault National
Disability Insurance Scheme could hold part of the answer for hearing impaired
Australians who are ineligible for Australian Government support:
The basic principles behind a no-fault national disability
insurance scheme are that we as a community would provide any individual with
impairment...a voucher to exchange for access services that that individual was
able to choose from a free market, [which] will enable them to participate in
the workforce, get a job, earn an income, get off the disability support
pension and pay tax—and they will pay it back.
Evidence suggests that many former clients of Australian Hearing would
be willing to pay a fee for Australian Hearing services after they turn 21 to
continue the quality of care and the professional relationships they had built
up, sometimes over their lifetime.
The committee would like to note that many people testified to the high
quality of service they and their families receive from Australian Hearing, and
that their issue was with eligibility conditions and not the service itself.
The following comments from one individual submission are typical:
...I cannot speak highly enough of the hearing services offered
to [my 15 year old daughter] as a child living in Melbourne. At all points along
the pathway from her diagnosis of a profound hearing loss just before her first
birthday until now, we have been helped by caring professionals and supported
financially by the Australian Government through Australian Hearing and the
Cochlear Implant Clinic at the Royal Victorian Eye and Ear Hospital.
The committee heard evidence that increasing access to OHS support for
older workers would have economic benefits for those individuals and for the
country in general. The Hearing Care Industry Association (HCIA) noted that employment
rates for people with a hearing impairment between the ages of 45 and 65 are up
to 20 per cent lower than for non-hearing people.
As has been noted in chapter three of this report, lost earnings is the biggest
single cost of hearing impairment to Australia at around $6.7 billion per year.
HCIA added that:
If Australia were to move towards world’s best practice, it
should examine uncoupling access to hearing services and the pension age, so
that people in the 45 to 64 age group (or part of that age group) could access
hearing services at a time when they are highly motivated to use such services
and thus remain productive for as long as they can.
The National Seniors Association (NSA) also argued that lost
productivity among older Australians could be eased if eligibility to OHS
support was extended to those younger than 65 years,
as did Services for Australian Rural and Remote Allied Health (SARRAH)
and Deafness Forum of Australia.
Access to hearing services in
regional and remote areas
Another prominent issue arising from the evidence in regard to accessing
hearing services was the difficulty of accessing services outside urban
centres. The committee heard evidence that one of the main obstacles to
provision of hearing services in regional and remote areas was attracting and
retaining qualified staff. Connect Hearing claimed in their submission that:
The spread of hearing services is unbalanced between regional
and metropolitan areas. This is in part due to the difficulties attracting and
retaining hearing care professionals in regional and rural areas and also due
to socio-economic factors making servicing rural areas less attractive to
hearing service providers. Within Connect Hearing, there is currently a three
month waiting list for services in regional New South Wales (NSW), but in
Sydney 95 per cent of services could be provided within 5 working days.
Attracting and retaining qualified staff is a major issue in Central
Australia, according to audiologist Rebecca Allnutt:
[Audiology] is a master’s degree now. It is two years and it
is very expensive—when I did it, it was only one year and it was a postgrad
degree. There are very limited places, and new grads are tending to stay in the
cities. We are competing with a very productive private market that [is]
offering new graduates a lot of money to stay in town. We are dealing with
hearing aid companies that are very wealthy. Trying to get young grads to come
out and work here [i.e. Central Australia], we are finding very difficult.
Dr Stuart Miller, President of the Australian
Society of Otolaryngology Head and Neck
Surgery (ASOHNS) noted that attracting Ear, Nose and Throat (ENT) surgeons and
other hearing health professionals to regional areas should be a priority for
Professor Robert Cowan of the HEARing Cooperative Research Centre (CRC) in
Victoria agreed that placing qualified audiologists in regional areas is an
...part of the problem is the regional disparity. This is a
phenomenon in Australia: everyone wants to work in the cities; no-one wants to
work in the country. Rural audiology services cry out for people. If any
funding was going to go to scholarships for people to train with audiologists,
I would think they should then be linked to country service.
Farmsafe Australia noted that public hearing health services in remote
and rural areas focus on children and Indigenous Australians. Whilst
acknowledging that this focus is 'important and appropriate', Farmsafe pointed
out that 'it has left a considerable cohort of individuals within the
agricultural sector and rural communities more broadly, under serviced.'
While there have been some assessment programs for the agricultural
sector in New South Wales (NSW), South Australia, Tasmania and Queensland, only
NSW through the Rural Noise Injury Prevention Program is currently functional.
Farmsafe Australia proposed that the extension of such a program is crucial to
efforts to prevent hearing loss in the agriculture sector, and that a core
feature of this program must be the provision of screening and preventive
advice in localities that are farmer-friendly, such as agricultural shows.
Further, the Hearing Impaired and Deaf Kindred Organisation Network (HIDKON)
reported that the Farm Noise and Hearing Network which involves hearing
screenings and information provision at rural field days, country shows and
events is on the brink of folding due to a lack of funding and support.
Recognising that services are difficult to access in regional areas, Mr Patrick Gallagher
of Attune Hearing described to the committee different ways that organisation
provides regional services:
At the moment...we are in the process of developing a model
that will enable us to take services to communities. For example, we were
recently in Bamaga, in North Queensland, as a pro bono initiative. In fact my
colleague Jenny Stevens, who is an audiologist, went there with one of our
surgeons and others from the health sector to provide services on a visiting
To give another example, in Longreach we provide training, on
our time, to Indigenous health workers. We travel to provide that service
because we do not yet have a stand-alone clinic in Longreach. We see that as
part of our provision of support back to the community.
Other initiatives which aim to provide services in remote areas include
the Deadly Ears project in Queensland
and the Earbus initiative in Western Australia.
These initiatives are discussed in detail in chapter eight of this report.
The committee heard evidence that hearing services provided by state and
territory governments are sometimes provided on a very small scale, making them
hard to access. For example:
Publicly funded audiology services are very limited in
Tasmania. Audiology services are provided one day a week at the Royal Hobart
Hospital in the south of the State. With the exception of a cochlear implant
clinic, no other audiology assessment or rehabilitation services are provided
in the [state] public sector.
Some services previously offered in other states are being reduced. For
example one submission claimed whilst audiology services in NSW are still
provided, the number of audiology departments has been reduced, and hours of
staffing reduced also.
In Victoria too, there was evidence that services have been reduced:
Audiology departments in many regional hospitals have been
closed for several years now and, although some hospitals are now reinstating
paediatric audiological services, there are still large areas of Victoria with
no service within a reasonable travelling distance.
Another issue that was raised with the committee in relation to rural
and remote access was the lack of access to patient assisted travel schemes for
people consulting audiologists.
Australian Hearing noted that whilst 'Most States have programs to meet
the cost of travel for families who need to access diagnostic services if their
infant fails the initial hearing screening' that support does not extend to the
families of older children who have to travel to attend audiological diagnoses.
The committee heard evidence that the Patient Assisted Travel Scheme (PATS)
does not provide assistance with travel for allied health appointments,
PATS is available for medical practitioner appointments however, and the
committee heard that where possible appointments with audiologists are made to
coincide with medical practitioner appointments so that patients can have
access to PATS assistance.
The problems of accessing suitable services for hearing impaired
children living in remote and rural areas were highlighted during the inquiry.
Children with hearing impairment may require a range of services including
speech therapy and instruction in Auslan, as well as support for the family.
There are major difficulties in providing these services outside large
population centres. Ms Sheena Walters, Deaf Society of NSW, commented:
I think the service models that would be required in urban
areas or where there are large populations compared to regional areas would be
completely different. I think that realistically to expect that the services or
the skills will be available in those areas is difficult in Australia, but
certainly using technology is something that is becoming more and more
prevalent and advantageous for kids out in those areas.
In Sydney the committee visited the Royal Institute of Deaf and Blind
Children (RIDBC) at North Rocks. The RIDBC is Australia's largest and oldest
private provider of educational services to deaf children. It is also a major
player in developing innovative educational programs to fill the gaps in the
education of children who are deaf or blind and also those with additional
disabilities. One of those innovative programs is the use of remote service
delivery technologies. This program was pioneered by the RIDBC and currently
serves more than 150 children and families in remote locations through the
Teleschool program. That program provides for the delivery of both early intervention
and specialist school age services through a range of video-conferencing and
remote access technologies.
Professor Gregory Leigh, Chair, RIDBC, stated that the Teleschool
operates 'on the premise that children need good access, particularly at the
early intervention level, to quality intervention regardless of where they
happen to be'. 
Children with hearing impairment are able to access high quality therapeutic
and educational intervention based in Sydney through one of a number of
different technologies such as ISDN based point-to-point technologies, and
internet-based protocols. This has enabled a large number of families to access
the Sydney centre with video conferencing equipment installed in their homes,
cellular network based video conferencing technology and satellite technology. Over
150 children in various rural, typically remote areas of Australia are now receiving
regular – weekly or fortnightly – early intervention that is analogous to the
early intervention they would receive were they located in Sydney. In addition,
RIDBC supports some children internationally because of an arrangement with the
Sydney Cochlear Implant Centre.
Professor Leigh commented:
It has been very, very successful. Matched with the fact that
the organisation provides for those families to visit Sydney at least once a
year, that means that the quality of intervention that those families are
receiving has really been brought up to a level much, much more similar, if not
arguably in some cases better than their city based counterparts.
Professor Leigh noted that the RIDBC if funded mainly through donation
with about one quarter of its funds being provided by the Commonwealth and
Access to hearing services for
people from non-English speaking background
The National Ethnic Disability Alliance (NEDA) raised with the committee
several issues that impact on people from non-English speaking backgrounds
(NESB) who are attempting to access hearing health support services.
The first of these issues is that existing support services are often
provided only in English, and in written form. This can be a barrier for people
who have poor English comprehension and literacy skills.
NEDA also claimed that some people experience a lack of cultural sensitivity
among healthcare professionals generally.
Insensitivity was also identified specifically in relation to parents of deaf
children. NEDA pointed to a report for the Victorian Deaf Society which:
...claims that NESB parents of deaf children have been advised
by health professionals not to teach their child their mother tongue. This has
resulted in the cultural and linguistic isolation of deaf children from their
family and ethnic community. The report heavily emphasizes that NESB children
who are deaf be taught their mother tongue as well as English.
NEDA also noted that poverty is a common experience for new immigrants
to Australia, and that many are unable to access government support, including
health and welfare support. The extra costs associated with hearing loss are a
particular burden on these vulnerable members of the community.
Dr Louisa Willoughby of the Victorian Deaf Society commented that whilst
the situation for non-English speaking deaf people newly arrived in Australia
is hard, in fact many are able to access support and hearing devices through
Australian Hearing provides support and resources to assist non-English
speaking people to access their services. These include provision of
interpreters at no cost to the client, provision of resource material in ten
languages, engagement with organisations representing non-English speaking
Australians and training for Australian Hearing staff in working with clients
from other cultures.
Access to assessment services
Universal screening for newborns
Many people providing evidence to this inquiry were highly supportive of
the Council of Australian Governments (COAG) commitment to introduce universal
newborn hearing screening by the end of 2010. The rationale behind the
initiative is that children who are diagnosed and receive intervention within
the first six months of life achieve better speech and language skills than
children who are diagnosed after six months.
Professor Harvey Coates cited research from South Australia which
suggests that there is a:
...$1.2 million saving for each baby detected with bilateral
severe or profound sensor neural hearing loss and habilitated before the age of
6 months. These savings [are] in future community costs particularly in education
and to a lesser degree in health and in savings in the provisions of pensions
and other special care programs.
In Western Australia for example since the first universal
newborn hearing program commenced in February 2000 over 120,000 babies have been
screened and the savings of the 130 babies detected with bilateral severe or
profound sensorineural hearing loss to the community has been in the order of
$140 million. If this is extrapolated ten times to the population of Australia
of its birth cohort then the savings of the universal newborn hearing screening
[initiative]...by the end of 2010 will be enormous.
Deafness Forum of Australia also noted the benefits of universal newborn
In those areas and communities where newborn hearing screening
is available, it has had a very positive impact in the community (both amongst
parents/families and professionals) in raising the awareness of potential
hearing loss in infants.
Professor Harvey Dillon gave evidence that the real proof that universal
newborn screening is having the desired impact was in the age take-up rate of
hearing aids for children:
We are pleased to say that the age at which there are more
children receiving a hearing aid for the first time than at any other age is
less than one year, which is showing how well universal screening is working in
the places where it is, which is now most of Australia.
Whilst supportive of the principle of universal hearing screening for
newborns, some submissions questioned the possibility of achieving such a goal
for all Australians in all parts of the country. Audiology Australia expressed
the view that 'regional inequities due to lack of qualified staff and
equipment' will impact on the extent and effectiveness of the initiative.
The committee also heard that even where universal newborn screening is
achieved, there are concerns about the capacity of systems to provide the
follow up necessary for the additional diagnoses and support for hearing
It is imperative that appropriate services to follow up and
manage the children diagnosed [under universal newborn screening] are also
One witness commented that resources for follow up diagnostics are not
provided in Victoria:
Audiological services in Victoria (and indeed across
Australia) are being asked to support Universal Neonatal Hearing Screening...without
...funding for the diagnostic component. Currently newly born babies are screened
for hearing loss in hospitals and...those that do not pass screening, are
referred for full diagnostic follow up. The screening component is fully funded
by the state of Victoria. The follow up diagnostic component receives no
funding and public audiology clinics support this important initiative without
any provision of resources.
Universal hearing screening for
children on commencement of school
The committee heard from a number of people and organisations about the
importance of screening children regularly during their early development
years. Professor Harvey Coates informed the committee that:
It is well known that [the rate of] permanent hearing loss
doubles by age five and triples by age 10 with acquired and progressive
sensorineural hearing loss. Therefore, at-risk children should not only have
the newborn hearing screening test, they should also have a test at six months,
a year and then annually until they go to school. For children who are ‘normal’
then the newborn hearing test, one at age one, one at three and then the school
tests would be adequate.
One witness expressed concern that universal newborn screening is
drawing resources away from screening other age groups:
I think [universal newborn screening] is fantastic; it is
what has been needed for a long time. But what I am noticing now is that the
community service—the nurses who used to provide that in the preschool
year—seems to be dropping off... And there are a lot of hearing losses in
children that develop from birth to year 4 or 5. So that screening component
should not be dropped.
Another witness commented that hearing screenings for older children
seem to have declined since the implementation of universal newborn hearing
Since the advent of newborn hearing screening
programs, there seems to be less support of other hearing screening programs.
Since newborn hearing screening will only identify approximately one third of
children who will eventually require hearing aid fitting it is essential that
access to primary hearing screening services be readily available. As a high
proportion of children are identified around ages 5-6 years it would be highly
beneficial if the school hearing screening program was reinstituted or if the
child health check undertaken at age 4 years included an objective hearing
This view was reinforced by Australian Hearing, which commented that
'most states no longer have school hearing programs'.
Professor Harvey Dillon explained to the committee the importance of screening
children as they start their schooling:
Typically, these children [i.e. hearing impaired children
aged six, seven and eight years of age who have not been previously diagnosed] will
be picked up because basically they are not doing well at school and someone
will notice they are having trouble coping in the classroom. That reinforces
for us how much better it would be if these children could be picked up in
preschool or right at the start of kindergarten, so they do not have that first
bad experience of one, two or three years of not coping. In fact, the number
who were picked up in those three age ranges is more than twice the number who
are picked up by universal [newborn] screening. That is because with some of
them the loss is too mild to have been able to be detected when they are a
baby. For others it will be a case of a progressive loss and for others there
will be hearing losses that have occurred through illness or injury during the
This view, that children should be screened again prior to, or on
commencement of, their first year of schooling, was shared by other witnesses
the Australian Newborn Hearing Screening Committee
and Audiology Australia.
Access to the Australian Government
Hearing Services Program for people in custody
The connection between hearing loss and increased engagement with the
criminal justice system has been noted at chapter four of this report. This
issue is of particular relevance for Indigenous Australians, for whom hearing
issues may be compounded by cultural and language communication issues, as discussed
in detail at chapter eight.
At the time of their submission to this inquiry (October 2009), Australian
Hearing remarked that young Australians in juvenile custody did not receive
Australian Hearing services. The Department of Health and Ageing (DOHA) has
since updated its advice on this issue. People who were already in receipt of
Commonwealth funded hearing services at the time they were incarcerated may
continue to receive these services. However when a person in custody is
diagnosed with hearing loss after their incarceration, the costs of
intervention and support are to be borne by the state or territory government.
Quality standards for hearing
assessments in the private sector
A number of people gave evidence that the absence of agreed standards in
audiological assessment may lead to incomplete diagnoses. Furthermore,
according to evidence before the committee, whilst most Australians would be
able to access free hearing screenings in the private hearing health sector,
they should be aware of the level of assessment they will receive:
There are claims of a ‘diagnostic assessment’ when it is just
a screening test...When you perform a hearing test, there are five components to
the hearing test: air conduction, bone conduction, middle ear, acoustic reflex
and speech discrimination. All those components may come together to identify
an underlying medical problem...If you do one component of that test it is very
limiting and only identifies hearing loss...It just says, ‘Yes, you’ve got
hearing loss.’ If you do not perform the full range of that diagnostic
assessment then you could miss some underlying medical pathology that is
causing that hearing loss.
In one example presented to the committee, a person claimed to have
received poor quality care, and been left out of pocket for her trouble:
I had to find a private audiologist [when I turned 21], three
of whom were not very good, and I bought hearing aids from each of them when
one would have been enough. Each hearing aid is about $3500 to $4000. One of
them also convinced me to buy an FM system for $1500 which I have never used,
because it was not correct for my hearing loss.
Donna Staunton, CEO of the HCIA, wrote to the committee condemning such
I...wish to place on record the Hearing Care Industry
Association’s total opposition to this kind of unethical and exploitative
behaviour. Our members aim to deliver world-class hearing healthcare to all
Australians. It has at the core of its mission, its clients and it aims to help
all Australians who are suffering from hearing loss to achieve a better quality
of life. In particular the Association’s members do not prescribe or provide
hearing aids unsuitable or unnecessary for particular clients. They prescribe
according to the client’s need, not their own and they do this after making a
fully informed, professional judgement.
Many submitters made a connection between the provision of free hearing
screenings and the sale of hearing aids.
In my [hearing impaired] husband's experience, most private
audiology practices are aligned with a particular brand (or brands) of hearing
aids and therefore their advice is heavily influenced by the need to promote
and sell those particular products. That means the client is rarely receiving
advice which is in his / her best interests or which meets his / her needs.
In a similar vein, the committee heard from one witness:
...I think [it] is very wrong is that, in a lot of instances,
the hearing aid industry indulge in a lot of misleading advertising. To people
who really do not know anything about hearing loss and people who are just
starting to lose their hearing, these advertisements give the impression that
if they get a hearing aid everything is going to be just right. I know a lot of
people who have done that and have then discarded the hearing aid because it
does not meet their expectation. I think all this advertising really needs to
be modified so that the situation is a little bit more realistic, rather than
just selling hearing aids for purely commercial purposes.
The committee heard evidence from Better Hearing Australia (Victoria)
that people with a hearing impairment are concerned about the independence of
advice they receive from hearing aid practitioners:
Many hearing aid practitioners offer free hearing tests, but
our experience with, and feedback from the public is that they have concerns
about engaging with an organisation that they believe wants to sell them a
hearing aid. This means that individuals are more inclined to delay having
their hearing checked until it becomes much worse, or they are “persuaded” to
do so by a family member. Easier access to free, and just as importantly
independent, hearing checks for all Australians would encourage people to take action
Attune Hearing suggested that the nature of audiology practice in
Australia had changed:
The hearing industry today is vastly different to what it was
3-5 years ago. A once small, privately owned ‘audiology’ industry has been
replaced by a corporately consolidated, hearing aid product driven industry.
Better Hearing Australia (Victoria) also commented that the culture of
selling products sometimes prevails over quality advice and service:
There seems to be a culture of selling products rather than
helping people deal with their problems...An inquiry about how much a hearing aid
would cost, netted the response, “How much can you afford”, and another client
was quoted a price which seemed very high so went elsewhere. When the original
practitioner called to see why he hadn’t been back, he explained that he had [found]
the same product for $2000 less, and was told they would match the price! He
asked the “sales person” if he was selling health services or used cars.
Attune Hearing provided the committee with a list of possible
consequences of free hearing screenings conducted inexpertly:
...At great cost to the
Commonwealth, many consumers have been fitted with hearing aids in circumstances
where they will never benefit from them...Consumers have not been properly,
diagnostically examined, such that serious medical indicators have been missed
with resulting serious medical consequences for the patient...Consumers often do
not maintain use of hearing aids because they did not receive adequate professional
counselling prior to fitting, or adequate follow up service or support (if
Evidence was provided to the committee that access to independent and
high quality audiological assessment would improve if audiologists were given
more capacity to provide audiological services under Medicare than is currently
A number of submitters remarked that a set of agreed standards for
audiological assessments would help healthcare consumers make more informed
choices about the services they need.
Nationally agreed standards may also help improve the overall quality of
audiological services and assessments currently provided. As Patrick Gallagher
of Attune Hearing stated to the committee:
I think [it is necessary to have] a properly regulated
industry with appropriate quality standards, so that there is an even playing
field. This industry is unregulated. I can sell a hearing aid on the street
downstairs. ...We are a business that provides services for a profit. We do not
hide behind that. We also provide services to clients in the medical community
that we struggle to support in financial terms. We are not here to cry poor but
we advocate a regulated set of standards in the for-profit sector so that there
is a level playing field. The bar needs to be raised...The industry has become
product focused. We are not knocking those that do it. We are not here to knock
the manufacturers...But our business is in the market competing for members of
the public. It is difficult to differentiate yourself in that market as a smaller
business when there are no appropriate standards. So we say, ‘Raise the bar.’
We say that a diagnostic test is a diagnostic test, not a screen.
Access to support services
The committee heard that diagnosis of hearing impairment at any age can
be a traumatic experience for the hearing impaired person and for the people
Access to appropriate support and advice at this time is very important, and
may have some bearing on the success of any subsequent intervention. However
many witnesses and submitters explained to the committee that they received
little support and resources to assist them, and would like to see this aspect
of hearing health improved.
Counselling support at the time of
hearing loss diagnosis
The North Shore Deaf Children's Association stated that 'Approximately
90% of children with a hearing loss are born to parents with little or no
experience of deafness'.
The committee heard that for these parents there is a great need for
independent support and advice at the time of birth, after the diagnosis
appointment, and as they consider intervention options after the diagnosis.
One submission commented that they found little support or advice to
The [Australian Hearing] audiologists were very nice but
there was no follow-up to assist us with the shock of being told [that their 8
month old son was hearing impaired]. There was no program to get us into early
intervention – no case worker support, no counselling – we were on our own. It
was some time before we could even discuss our son's disability without being
The evidence suggests that the shock of hearing loss diagnosis, and
subsequent need for quality support and advice, is no less when made later in
life for both the hearing impaired person and for their families:
My hearing loss was first discovered at age 11, and I was
given hearing aids without any sort of rehabilitation or support. It took me
ages to get used to them and to wear them. It was a traumatising experience as
When my daughter was first diagnosed [with hearing loss in
both ears] I asked many departments for information for [her] teachers, and the
only pamphlet I was given was so old it suggested pipes and cigarettes be
removed from the teacher's mouths when talking to deaf children.
One organisation commented on the link between universal newborn hearing
screening, increased diagnoses of hearing loss, and the increased need for
Parents fully support newborn hearing screening and
appreciate knowing that their child has a hearing loss early but they then need
guidance and support and access to services to ensure the best outcomes for
Parents of children newly diagnosed with hearing loss are provided with 'Choices',
a booklet produced by Australian Hearing.
The booklet presents information about the issues parents of children newly
diagnosed with hearing loss may be experiencing, and the things they may be
feeling. 'Choices' also provides practical information about the sorts
of testing the parents should anticipate, and the choices they will have for
One submitter expressed their opinion that audiologists are not well
trained to provide support for people to adjust to the changes their condition
requires, particularly around access to services and specialised equipment.
Support services in Australia are usually provided by volunteer
organisations, often run by parents of hearing impaired children. This
arrangement means that parents are most likely receiving the advice from people
who have been through a similar experience, and who will understand. However
there may be down sides, as Connect Hearing pointed out:
Support services are typically provided by volunteer groups
such as Better Hearing Australia or SHHH or by service groups such as Quota.
Because of this arrangement, support services are not universally available or
of a universal minimum standard.
The University of Melbourne Audiology and Speech Sciences department
suggested that families would benefit from the support of a single case manager
to help them navigate the services available.
There is a current gap in the clinical pathway for families
of children with diagnosed hearing loss. The diagnosis itself is often a
devastating and emotional experience and families are often left grieving while
they are given sometimes conflicting advice from up to seven agencies or
professionals that may claim part “ownership” of the case.
Many countries have established a family support scheme where
a case-manager becomes the main point of contact and helps coordinate the
necessary assessments and consultations until a degree of stability is reached.
It is generally agreed that this is a service that needs to be established in
the Australian context. Not many will agree, however, about who or how it
should be achieved.
For many people with hearing loss, interpreters can assist them to
access services and advice in a hearing world. Interpreters are not a panacea
however, as there are a range of issues that can impact on their accessibility
To access interpreter support a person needs to be fluent in both
English and Auslan, which is not always the case, sometimes to the
embarrassment of people with a hearing impairment:
I don’t use sign language, don’t understand it, and I am
always embarrassed when I have a medical appointment and the staff (if they
know I am hearing-impaired) assume I know sign language and get an interpreter
Interpreter services, like so many hearing health services, are not as
accessible in rural and regional areas as they are in the cities.
Another obstacle for widespread use of interpreters is the cost. The
Australian DeafBlind Council told the committee that they have little funding
to support their advocacy program, and that the cost of interpreters is their
We received a special one-off funding grant from the
Department of Human Services. It was $12,000 to cover the costs for
interpreters, as we require interpreters and they are the most expensive
expense we have.
The committee heard a considerable body of evidence about the particular
issues that arise when interpreters are used in an educational setting. A major
concern raised was the lack of required interpreter standards in Australia for
people interpreting in classrooms:
There is not actually any specific training for interpreters
to work in an educational setting. Currently, the department pays a teacher’s
aide, and they are not necessarily professionally qualified as interpreters, or
even fluent in Auslan. They have some degree of signing, however it is not
necessarily proficient signing, and there is no testing on their level of
Inexpert translation can be frustrating for hearing impaired students,
as one mother of a hearing impaired child explained:
One of the teachers has very poor limited sign skills and my
daughter is so frustrated in class, because she looks around and [knows] that
the other (hearing) students are going ahead with their work and she isn’t.
Deaf Australia NSW suggested a professional standard that could be
The solution we propose is the adoption of a benchmark for
fluency for staff employed to work with children who access the curriculum
using Auslan, whether teacher aides, learning support officers, interpreters or
teachers of the deaf. This benchmark should be [National Accreditation Authority
for Translators and Interpreters] Paraprofessional level accreditation or [National
Auslan Interpreter Booking & Payment Service / Australian Sign Language
Interpreters Association] Deaf Relay Interpreter Certification as a minimum.
The Department of Families, Housing, Community Services and Indigenous
Affairs (FaHCSIA) drew the committee's attention to its National Auslan
Interpreter Booking and Payment Service (NABS). Under this scheme, accredited
Auslan interpreters are provided to assist with any private medical
consultation which attracts a Medicare rebate, at no charge to the deaf person.
FaHCSIA also noted that not all deaf people use Auslan to communicate.
According to their submission, there are over 500 interpreters available under NABS,
and they have provided interpreters for over 60,000 private medical and
healthcare appointments since January 2005.
One submitter called for the establishment of:
...training, employment and government funding initiatives to
provide more Auslan qualified interpreters/aides for schools, hospitals and
government services and encourage uptake by [the] private sector where it is
most beneficial (i.e. counter staff, call centres, sales floors).
The issue of more general professional development for teachers with
hearing impaired students in their classroom is discussed, and recommendations
made, at chapter six of this report.
The committee also heard evidence about the use of interpreters to
assist people to access legal services. This issue is dealt with in chapter
Access to hearing technologies
A note on the scope of this inquiry
with regard to technologies
The committee would like to note that it is inquiring into issues which
impact on the ability of people with a hearing impairment to access appropriate
hearing technologies. A comprehensive survey of the many types of technologies
available would be a huge task in itself, and is beyond the scope of this
report. Information and clarifications about different technologies are provided
only where necessary to report on issues of access.
Under usage of hearing aids
According to the HCIA, 24 per cent of Australians who would benefit from
a hearing aid have one.
The association states this is 'quite good by international standards', but
falls short of international best practice levels enjoyed by Denmark, which has
45 per cent.
The committee heard that around 350,000 hearing aids are sold in
Australia each year, and that 75 per cent of those are paid for with public
Whilst provision of hearing aids may be high, the committee heard evidence that
usage may be low. The rate of non- or under-usage of hearing aids was estimated
by witnesses at between 20 and 40 per cent of all hearing aids provided with
public funding [therefore between 65,625 and 78,750 hearing aids may be under-used].
Catherine Westacott of Deafness Forum Australia emphasised the
importance of properly educating and counselling people when they are being
fitted with hearing aids, and believes this will increase usage levels.
Professor Robert Cowan suggested that inappropriate expectations may be
behind low hearing aid usage rates:
Everyone talks about hearing aids being in the top drawer,
and you would have heard that. The reason is that either people do not really
understand at the outset what the limitations of a hearing aid are or the
person who has fitted the device for them has not understood what their needs
are. A holistic approach addresses needs at the outset. Someone might not need
a hearing aid.
Professor Harvey Dillon agreed that motivation was a critical part of
improving usage levels, and that this be incorporated into hearing aid
We suggested that there be an element of testing of the
motivation of the person before they become eligible to get a hearing aid. In
fact, the Office of Hearing Services is in the process of putting that into
place. I believe it is going to start in July.
Neil and Susan Clutterbuck state in their submission that, in terms of
hearing aid performance, the hearing aid industry has been 'over-promising and
under-delivering' for a long time, and that this creates an unrealistic expectation
of performance which, when it is not met, reinforces negative perceptions.
The Clutterbucks are also sceptical about the extent to which the stigma
of wearing hearing aids discourages use, citing research which shows that more
people were unhappy about hearing aid performance than were concerned about
The committee heard evidence that the structure of Australian Government
Hearing Services Program funding has encouraged the sale and supply of hearing aids,
rather than targeting the needs of people with a hearing impairment. For
example Patrick Gallagher commented in his evidence that:
...a lot of this debate about hearing aids sitting in drawers
can be drawn from [lack of an outcomes focus to provision of hearing aids under
public funding]. If it is [only] about [selling] the product, it is about: how
do you get people on a seat to be fitted with a hearing aid? It doesn’t matter
[about outcomes]: it is a product sale. Firstly, if...a proper diagnostic test [is]
done as part of that process, people who need a hearing aid will get a hearing
aid. Secondly, if there is an interest post sale in providing ongoing services...then
there will be fewer hearing aids in drawers.
One audiologist who made a submission to the inquiry also remarked on
the need to emphasise counselling and rehabilitation in addressing hearing
loss, arguing that at present there is a 'device focus' in the OHS programs:
Whilst OHS has always allowed patients to opt for counselling
instead of a hearing device, such counselling is limited and restricts access
to devices. The counselling option results in only a small fee being paid to
the service provider. OHS does not currently allow any gap fee for services,
only for devices under the [top-up] scheme, making the offering of counselling
services a less financially viable option to [service] providers.
The Office of Hearing Services gave evidence to the committee that the
voucher program is being amended so that it will better target provision of
hearing aids to those in need. With the introduction of a Minimum Hearing Loss
Threshold from 1 July 2010, for the first time hearing aids will only be
provided to those with significant hearing loss:
The intention of the [Minimum Hearing Loss Threshold] measure
was to direct hearing services and...devices to people who have significant
hearing loss...That is so the devices, which are quite expensive to provide, are
not directed to [people with normal hearing]. We can redirect them to those who
really need a hearing device.
The committee heard evidence that some people are concerned about the
'top‑up' aspect of the voucher program, and in particular that people
accessing hearing services under the voucher program may be being pushed into
taking out top-up options unnecessarily.
Clients of the voucher program are able to access a wide range of
technologies at no cost to themselves.
The department, in consultation with a range of industry stakeholders, reviews
the list of approved hearing devices every 18 months to incorporate technological
In addition, clients have the option to purchase additional features to the
free aids at their own expense, known as 'topping up'. Additional features
might include enhanced user preferences, blue tooth connectivity or adaptable
As was noted above, some audiologists were critical of the voucher
scheme, arguing that it encourages hearing aid sales but not quality hearing
health care. The top-up option creates another incentive for hearing aid
manufacturers to push sales, as one submitter argued:
The voucher scheme has created a competitive marketplace for
large hearing aid providers to make large profits from this government funding...it
is disturbing to see large hearing aid providers 'cold calling' pensioners to
entice them to their clinic for a hearing test (paid for by the federal
government, whether or not it is indicated). Once the contacted person attends
for a hearing test, these companies will often also have sales targets both for
the number of people they manage to fit with hearing aids and for the level of
hearing aid (how expensive) they are able to sell the person (as top-up aids
with the additional contribution being made by the pensioner). I feel these practises
have had a negative impact on how hearing professionals are viewed by the
Noeleen Bieske of the Deafness Foundation gave evidence that people who
are sold top-ups often do not need them:
The audiologists are just fitting hearing aids...and a lot of
them are also saying, ‘The government hearing aids are no good; you need the
top-up.’ But...these people...really cannot afford to spend $2,000 or $3,000 extra
to top-up, and they do not need it. The government hearing aids are very good
for most of these people.
This view was shared by Self Help for Hard of Hearing People (SHHH)
Australia, which commented that:
The hearing devices available on the ‘free list’ are all high
quality products, and we wonder about the benefits of the ‘top-up’ regime, where
older people are pushed into buying expensive ‘top-up’ aids that may not
provide them with a better hearing outcome.
DVA also made a submission to the inquiry on the issue of veterans being
sold unnecessary top-ups:
DVA receives numerous queries or complaints from the veteran
community regarding the purchase of top-up hearing aids, that is aids which
have additional features that are not essential to meet clinical needs...it
appears that top-up devices are sometimes provided unnecessarily...DVA is concerned
about the unnecessary up-selling of hearing aids.
Professor Brian Pyman, also of the Deafness Foundation, added that in
An audiologist earns their income on the basis of the number
of hearing aids that they sell...
The HCIA defended the practice of hearing aid retailers in regard to top-ups,
claiming that the voucher program would not be viable without the extra income top-ups
In practice, manufacturers and retailers use the 'top-ups’ as
a cross subsidy. In other words, without a certain minimum percentage of 'top-up'
clients, the voucher system would not be viable or sustainable for providers to
provide “free to client” services. In general, providers in Australia need to
see around twice as many clients compared to providers in other industrialized
countries to operate a sustainable business given the current reimbursement
system and the split between 'top-ups' and 'free to client' devices.
Extending this point at a public hearing, Mr John Gimpel of the HCIA
added that '...if we were in business fitting [hearing devices supplied solely
under OHS] vouchers all day long we would not be in business'.
One audiologist gave evidence that the restricted eligibility to Office
of Hearing Services support is part of the reason the voucher scheme is not
viable on its own:
We are encouraged to create top-up revenue because we cannot
make up the revenue in private sales, [I]f we were able to create this larger client
base [i.e. by expanding program eligibility] we would not need to be pushing so
hard to make sales from low-income earners.
Hearing Aid Banks
Hearing aid banks are one avenue for people on low incomes who are not
eligible for OHS vouchers to obtain reconditioned hearing aids at little or no
cost. These are usually run on a small scale by volunteer or charity
organisations, such as Better Hearing Australia's Victorian branch, which
This free community assistance scheme aims to provide
assistance to people who require hearing aids, but are not in a position to access
the private system, and are ineligible for the Australian Government Scheme
through the Office of Hearing Services. Many low income people are helped,
including refugees and people who are unemployed. The resources are limited as
we rely on donations of behind the ear hearing aids, which are then cleaned,
reconditioned and fitted by a volunteer hearing aid practitioner.
The committee understands that the following organisations run hearing
aid banks in Australia:
- Better Hearing Australia (Victoria) – Victoria;
- H.E.A.R Services (Vicdeaf) – Victoria;
- Self Help for Hard of Hearing – New South Wales;
- Princess Alexandra Hospital – Queensland;
- Deafness Association – Northern Territory;
- Central Australian Aboriginal Congress – Northern Territory;
- Royal Adelaide Hospital – South Australia; and
- Hearinglink (Tasmanian Deaf Society) – Tasmania.
Professor Harvey Coates gave evidence that hearing bank-like activities
also take place in Western Australia (WA), though its coverage and extent are
So we started an ear alliance hearing aid bank, and we have
used hearing aids, some of which are from [the Office of Aboriginal and Torres
Strait Islander Health] and other groups, like the Office of Hearing Services...who
have sent them to us. We then distribute them to these communities so people
who would otherwise miss out have hearing aids.
NSA provided evidence about the limitations of the service:
Hearing aid banks face a range of challenges including
keeping up with the demand for services, maintaining and updating equipment
required for testing and reconditioning of hearing aids and building awareness
for the need for second hand hearing aids. Hearing aid banks play a small, but
pivotal role in assisting consumers who are otherwise ineligible to access free
or subsidised hearing aids. However hearing aid bank services are limited by
supply factors, with services generally unable to cope with increases in
demand. Additional funding is required for hearing aid banks to develop
awareness about the opportunity for people to hand in their second hand hearing
aids, and to assist hearing aid banks to keep up with technology demands.
SHHH Australia, whose hearing aid bank marked its 21st birthday in 2009,
explained that Health Care Card holders and low income earners are eligible for
hearing aids under its system, and that applicants pay $100 towards the cost of
the hearing aid.
This service provides 30 to 40 aids a year and does not advertise in an attempt
to reduce demand.
Rebecca Allnutt, an Alice Springs-based audiologist, told the committee
that hearing impaired prisoners in the Alice Springs Correctional Centre have
benefited from the hearing aid bank service run by Central Australian
SHHH Australia commented that in NSW demand for hearing aid bank
services far outstrips supply. In Queensland too, demand for hearing bank
services is higher than can be met. The hearing aid bank at the Princess
Alexandra Hospital remarked in Audiology Australia's submission that 'We are
only able to fit [approximately two] people per month and we have a 12-15 month
waiting list which has remained fairly constant for many years'.
Australian Hearing noted in its submission the existence of hearing aid
banks, and commented that:
The hearing aids are donated, usually by people who no longer
use their devices. Therefore the range of devices available through hearing aid
banks is limited and knowledge about the existence of these schemes amongst
those who could benefit is limited.
SHHH Australia commented that some of their donated hearing aids come
from deceased estates.
The committee notes that the Australian Hearing website directs visitors
wishing to donate old hearing aids to the nearest hearing aid bank.
Whilst most evidence was supportive of hearing aid banks, there were
some criticisms. These were mostly criticisms of a health system which makes a
hearing aid bank necessary, and of the obvious limitations of having to adapt
to an aid that was fitted to someone else, rather than criticisms of the
service itself. For example:
The Macquarie University Audiology Clinic runs a hearing aid
bank providing second hand hearing aids for sale. We feel this is a third world
solution because the aids cannot be tailored to the individual hearing loss.
Cochlear Implant Speech Processors
Many submitters remarked on the fact that cochlear implant speech processors,
the externally worn part of the cochlear implant, must be replaced every five
to 10 years.
Speech processors are estimated to cost between $8,000 and $10,000.
The committee heard evidence of an apparent inequity in the way the
Australian Government funds speech processors. All Australians under 21 years
of age are entitled to receive free replacements for lost, damaged or stolen
speech processors, and free upgrades based on clinical need. However adults who
are eligible for OHS services, by definition pensioners on low incomes, are not
entitled to replacement or upgrade processors, and must pay for them out of
their own pockets.
Australian Hearing noted that whilst they are not able to provide
replacement or upgrade speech processors to eligible adults, they are able to provide
maintenance and replacement parts for their existing processors.
The Cochlear Implant Clinic at the Royal Victorian Eye and Ear Hospital
pointed out in its submission that whilst hearing aids are replaced on a
clinical needs basis for those over 65, the same condition does not apply for
Adult clients of [Office of Hearing Services] are expected to
fund replacement themselves, and since all are pensioners this is not a
realistic or a fair request. This may lead to a situation where some patients
could be left without adequate hearing. The current cost of replacing a speech
processor is at least $8050. Most pensioners do not have access to this lump
sum given their limited finances.
ENT Cochlear Implant Surgeons Queensland noted the impact of a broken
speech processor on individual implantees:
...the reality of a broken speech processor for a cochlear
implantee, is that they have no auditory function at all, or to be blunt, they
are stone deaf.
Australian Hearing noted in its submission that Cochlear Ltd had
recently announced that four models of cochlear implant speech processors were
now considered obsolete.
One submitter estimated the life-long cost to a 21 year old person with
one implant averages out to $60 to $80 per week,
which is an unwelcome financial burden on low income earners.
The burden for people with two implants is even greater:
As a bilateral cochlear implantee I was facing an outlay of
approximately $17,000 every 5 years. How many people can afford this just to be
able to communicate in a society where the spoken word is the accepted form of
Australian Hearing gave evidence that the clinical costs associated with
cochlear implants, including the initial implant and ongoing clinical costs,
are covered by Medicare for all Australians, though clinical services connected
to hearing aids are only covered by Medicare for clients of the Australian
Government Hearing Services Program.
Closed captioning on television and
The committee heard evidence about the limited extent that captioning is
available to help people with hearing loss access television and DVDs.
Many submitters complained about the limited captioning currently
provided with television services in Australia. One submitter claimed that
relying on captioned television programs meant:
Only being able to watch TV between the hours of 5:30pm and
10:30pm as these are the only times that television networks are required to
caption programs. Not being able to watch all DVDs as they don't have English
Media Access Australia provided some useful data to the committee around
the extent of captioning in Australia:
Closed captioning, while at increasing levels on some
free-to-air television is too low to enable viewing of video for people with
hearing impairments in a number of areas:
Overnight free-to-air television is rarely closed captioned.
Almost no digital multi-channel programming is closed...captioned.
Sports television programming is rarely closed captioned.
Subscription television is closed captioned at a very low level. Only
44% of subscription television content, including repeats, is closed captioned.
Only 55% of DVD video is closed captioned.
Only 24 out of around 500 cinemas in Australia show closed captioned
According to advice provided on the website of the Department of
Broadband, Communications and the Digital Economy (DBCDE):
The Broadcasting Services Act 1992 (BSA) requires each
commercial television broadcasting licensee and each national broadcaster to
provide a captioning service for television programs transmitted during prime
viewing hours (6.00 pm until 10.30 pm) and television news or current affairs
programs transmitted outside prime viewing hours.
A number of types of programming are exempt from this
requirement. These include:
television programs that are not in English or mainly not in English
non-vocal music-only programs and incidental or background music
live sport coverage with unscheduled extended coverage that displaces a
programs broadcast on a digital multi-channel during the simulcast
period (unless previously broadcast with captions on the broadcasters
Codes of practice developed by sections of the broadcasting
industry in consultation with the broadcasting regulator, the Australian
Communications and Media Authority (ACMA), also require broadcasters to clearly
identify which programs have captions in their television guides and other
In a discussion report about access to electronic media for the hearing
and vision impaired, DBCDE noted that by December 2011, under agreements
between the free to air television broadcasters and the Australian Human Rights
Commission, 85 per cent of content broadcast between 6 am and midnight will be
One submitter related his frustration at the inaccessibility of many
DVDs due to lack of captioning:
...not all DVDs are captioned. It can be a daunting experience
when my son wants a DVD to watch and for me put it back on the shelf at the
video store. For him to throw a tantrum and for me to explain that this DVD is
not accessible. This should not happen. It is not fair on my son.
The committee notes that since 1 July 2007 all film and television productions
that receive public funding through Screen Australia have been required to
provide captioning for theatrical and DVD releases.
The committee further notes that since 1 January 2010, this requirement has
also applied to all Australian films which receive film investment funding.
One submitter argued the case for all publicly funded education and
information DVDs to have closed captions, as without them a significant
proportion of the population is unable to access public information.
The Deafness Forum of Australia added that 'research has shown that captioning
of educational materials not only improves communication access for deaf and
hearing impaired, but also improves literacy for all students'.
FaHCSIA drew the committee's attention to its Captioning Services
Program, which funds a service provider to deliver captioning and distribution
of community service and education DVDs for the hearing impaired.
In 2006 Access Economics estimated the annual cost of captioning in
Australia to be $18 million, with the largest element by far (at $14 million)
being free to air television captioning services.
Captions in cinemas
The committee heard evidence that people with a hearing impairment have
difficulty accessing movies because only very few cinemas provide captioning on
very few films. Ms Leonie Jackson summed up the frustration of many in her
I enjoy going to the movies. In order to access movies, I
need to wait until the cinema in the city is showing a film with open captions.
Most of the time, I miss out because they...pick films I do not want to see or
films are scheduled at times when I cannot attend as I work full time. Last
month, I was excited to see that the local cinema...[was] showing an
English-speaking film with open captions and audio description. I went to see
Public Enemy and enjoyed the experience like others. So you can imagine my
disappointment when a mere two weeks later, the cinema stopped advertising films
with open captions.
Another person was quoted in a similar vein by Deafness Forum Australia:
My friends have stopped asking me to go to the movies with
them because I can’t hear what is being said at our local cinema, and they
don’t want to drive all the way to George St to go to the movies.
Under a proposed voluntary agreement between Australian cinema owners
and the Australian Human Rights Commission, cinema owners sought a suspension of
the Disability Discrimination Act 1992 under section 55 of the Act while
cinemas are upgraded so that the number of Australian screens capable of
delivering captions can be increased to 35.
Critics noted that this target represents just 0.3 per cent of all movies
screened each week in Australia.
Protest group Action on Cinema Access staged a national rally on 13 February 2010
to protest against the proposed suspension of their capacity to lodge complaints
about restricted access to cinemas under the Disability Discrimination Act
1992. Protestors also called for full captioning and audio description for
all movies shown in Australia.
The committee notes that on 16 April 2009 the Human Rights Commission decided
that it would not grant an exemption under section 55 of the Disability
Discrimination Act 1992, as requested by cinema company owners. No further details
were available at the time this report was tabled.
Other assistive technologies
The committee heard that there are many other technologies available to
assist people with a hearing impairment.
Assistive devices, such as specialised alarm clocks and fire alarms are
essential in the day to day lives of those with hearing loss. In the words of
one hearing impaired man quoted by a submitter:
How soundly would you sleep in your hotel room if you knew
you would not be woken if the fire alarm went off?
DOHA noted that there is no funding assistance available for assistive
devices under the Australian Government Hearing Services Program.
The cost to individuals of assistive devices was drawn to the committee's
Apart from hearing aids, essential assistive devices are
expensive. These should have a tax deductible allowance for working people and
be at a minimal cost to those who are on pensions.
Better Hearing Australia supports people with a hearing impairment to
access assistive devices by providing advice and demonstrations of technologies
Hearing loops in public places
It will be useful to provide a description of a hearing induction loop
A loop system consists of a loop of wire around an area (eg a
room) that is connected to an amplifier. A signal (eg television, stereo, PA system
etc) goes to the amplifier, which drives a current through the loop. As the
current from the amplifier flows through the loop, it creates a magnetic field
within the looped area and transmits to the telecoil in a hearing aid or in a specifically
[designed] induction loop receiver within the looped area.
When a hearing aid user switches their hearing aid to the ‘T’
position on the hearing aid, the telecoil in the hearing aid picks up the changes
in the magnetic field and converts them back into alternating currents. The
alternating currents are amplified and converted by the hearing aid into sound.
The committee heard evidence that the provision of hearing induction
loops in many public places would be of great benefit to hearing aid users,
particularly in specific service environments. For example Ms Shona Fennell
commented in her submission that '[all] facilities caring for the elderly ought
to have hearing loops and assistive devices as a matter of course to make the
quality of life acceptable for them.'
Ms Nicole Lawder of Deafness Forum Australia described to the committee
the experience of accessing an induction hearing loop, and the difference it
can make for people:
The way a hearing loop works...is that you are not hearing what
the person is saying through the room with other background noises and paper
rustling. You turn your hearing aid over to the T switch and it is like a
little radio receiver in your ear. When someone speaks into the microphone—even
without amplification—that sound is going directly into your hearing aid, so you
are getting a much better quality, especially at something like conferences,
where people are talking to their neighbours and getting things out of their
bags. It can be quite difficult for the person with a hearing aid to follow
what is being said. So, they are really valuable in meeting rooms, theatres,
convention centres and all types of conference centres...Some people even have
them in their own car and lounge room and when they have their family there
they may wear a little lapel [microphone]. It is not amplifying the voice but
it is allowing the person with the hearing aid to hear much better what that
person is saying...Some families where there are three or four members with a
hearing loss find that looping their lounge or family room is really useful.
Judith Raxworthy, who has been deaf for 30 of her 61 years, stated that:
My greatest frustration is lack of hearing access to public
buildings, transport, entertainment and education. There is a serious lack of
access in any area where oral communication is used.
Yvonne Batterham described the somewhat ironic situation she found
herself in when she attempted to work for improved access:
Technology such as audio loops and captioning was slow to be
introduced. This was an unfair situation and so I decided to join the
disability access committee of my local council to broaden my knowledge of the
situation. I also attended a couple of council meetings and discovered that not
only did the room lack an audio loop but it did not even have a PA system. I
could not participate in the meetings.
Evidence was provided to the committee that theme parks and other public
venues do not always make themselves accessible to people with a hearing
Many of Australia’s iconic tourist destinations are
inaccessible to people who are Deaf or hearing impaired. Live performances at
places like the Australia Zoo in Queensland should have captioning and an area
with an audio loop so all can enjoy the proceedings.
At Seaworld or Movie World the theatres and where they have
the live shows with stuntmen doing all sorts of action could all quite easily
Better Hearing Australia acknowledge the value of making public venues
more accessible, and 'continually lobbies government, councils and the
community for audio loop installations in public venues...',
and some witnesses commented that hearing loops are increasingly common: 'Many
public halls, churches and cinemas now have installed induction loop systems to
benefit people who are hearing impaired.'
Deafness Forum of Australia noted the existence of portable hearing loop
units, which could be moved from counter to counter as needed in a customer
service situation. They note international examples where organisations are
required to supply induction loops. Barclay's Bank in the United Kingdom has
undertaken to install loops in all its branches. Church organisations in
Switzerland and Sweden are required to install loops in churches.
Deafness Forum of Australia made the following suggestion, which was
echoed throughout the evidence before the committee:
Any service desk or information desk should have at least one
audio loop installed to assist a hearing impaired person make an enquiry. If
the building or office has regular verbal announcements these should also be provided
in some visual format. All Australians have the right to access their
government and other public areas. Government offices and public buildings
should be showcasing best practice in the area of access as they are using
The committee notes that the House of Representatives Standing Committee
on Legal and Constitutional Affairs reported on proposed disability access
standards for the Building Code of Australia in June 2009.
The committee found, in regard to draft hearing access requirements, that the
proposed standards 'would provide a significant improvement over the existing
provisions of the Building Code',
and that it would be 'appropriate for future fitout standards to include
requirements for hearing augmentation systems as well as passive design
features...such as counters and reception desks'.
These standards have now been accepted, and will apply to all building
approvals of certain building classes lodged on or after 1 May 2011.
The committee heard evidence that having building regulations in place
may not be enough to ensure access to facilities. Richard Brading of SHHH
Australia explained to the committee:
If you look at public buildings that are currently being
built, certainly in New South Wales, which I know well, they get a huge list of
planning conditions that may include compliance with Australian standards but
when it comes to the final certification a lot of those things just get
forgotten or they put in the cheapest option that may never work and tick it
off because the people who certify these buildings do not know how to test it.
It would need a system where some accredited testing body or private technical
people who could be accredited tested these things to make sure they actually
work. It is very disappointing for people with a hearing impairment to be told
there is a loop and then no-one in the venue knows where the on-off switch is
and that sort of thing.
Mr Brading added that making a complaint may be the best way of achieving
We encourage people to make their own complaints in relation
to [lack of access for the hearing impaired]. Many of them do...The Deafness
Forum with great difficulty took one hotel in New South Wales to the tribunal
and eventually they very grudgingly put a loop in. The Deafness Forum was so
grateful they then held their conference there for the next couple of years.
As the committee noted at the start of this chapter, issues of access
are seldom far from a hearing impaired person's thoughts. The range of issues
and depth of passions the inquiry found around access issues testify to their
The committee heard from many people and organisations of the emotional
and financial distress that often follows when former child clients of
Australian Hearing lose their eligibility for support at age 21. The evidence
indicates that these people struggle to find the specialised support they need
in the private sector. It is obvious to the committee that the financial burden
of finding between $4,000 and $17,000 every three to five years for replacement
hearing devices is causing great distress to young people at a vulnerable stage
of their lives, and may be disadvantaging them in the pursuit of their
education, training and employment aspirations.
The committee accepts that whilst the cost burden of hearing impairment
is particularly acute for young people, it is also a burden on all low income
Australians. Evidence was heard from people in their thirties, forties and
fifties that the cost of hearing devices – so essential for working and
functioning in society - was a burden on themselves and their families.
The committee believes that the costs to the Australian Government of
expanding Australian Government Hearing Services Program eligibility to provide
assistance to more Australians, especially those on low incomes, would be
off-set by the improved productivity and contribution those people would be
able to make if their hearing needs were better met.
The committee is left in no doubt that access to hearing services in
remote and regional Australia can be a significant challenge, and that the
effect of this may be that people living in these areas with a hearing
impairment are not receiving the support they need. The evidence suggests that
the greatest challenge for providers of services in regional and remote areas
is attracting and retaining qualified staff.
The committee's visit to the Royal Institute of Deaf and Blind Children
(RIDBC) included participation in a teleconference session and speaking to the
family of a hearing impaired child. Even though the committee had limited time
to speak to the family, it was clear that the program was having a significant
impact on the ability of the family to assist their child to gain language
skills, to participate in family life and enhance the child's social
The program run by the RIDBC uses relatively inexpensive technology. By
teaming the range of specialists in Sydney with each family, the program
delivers services which address the needs of each child and provides much
needed support to families who would otherwise be unable to access such
The committee considers that further expansion of the program should be
considered by governments as a means of delivering specialist services in rural
and remote areas as an effective and efficient means of enhancing the lives of
children with hearing impairment and supporting their families.
The committee heard about the particular challenges of educating
children with hearing loss in rural and remote areas. RIDBC's innovative
Teleschool approach makes full use of new communication technologies to assist
families to access the best possible support for their children, regardless of
where they live. The Teleschool service delivery model should be considered by
all providers of education to children with hearing loss.
The committee is of the view that the hearing health industry,
professional associations and the higher education sector might consider the
problem of attracting qualified staff to rural and regional areas in the way
that teacher education programs address this issue. Graduate teachers in their
first year of teaching often undertake a term of rural or country service,
before they can teach in places that may be more desirable to them, such as in
the city. A similar 'country service' arrangement for graduate audiologists,
whilst not necessarily a long term solution, would at least direct much-needed professional
skills to rural areas in the short to medium term.
The committee found that the commitment by all Australian governments to
universal newborn hearing screening was widely welcomed by the hearing health
sector, and that there will be substantial long term benefits for individuals
and for the community as a whole to early diagnosis and intervention.
The committee heard that the incidence of hearing loss in children doubles
by age five and triples by age 10, and that these children are often only
identified as hearing impaired when teachers and parents notice they have
fallen behind academically, or are having behavioural issues. The committee believes
that the individual children concerned would benefit greatly if children's
hearing loss was diagnosed and managed when their schooling commences. The
committee also believes that, given the implications of undiagnosed hearing
loss for a person's life, society in general will benefit from earlier diagnosis
Whilst the committee is pleased to note that Office of Hearing Services
(OHS) support now remains available to all OHS clients who receive custodial
sentences, the shifting of responsibility to the states and territories for
those prisoners diagnosed after their incarceration seems inequitable, and is
likely to be confusing to administer. The committee believes that widespread,
easy access to hearing assessment and intervention is in the interests of
hearing impaired prisoners, and the community at large. The committee has made
recommendations in chapter eight that address this issue.
The committee was concerned at the reports of inappropriate services
being provided by some audiologists. The committee notes the Audiological
Society of Australia Professional Standards of Practice, and believes that
these standards should be promoted to help healthcare consumers understand the
nature of services being offered by individual providers, serve as a reference
point for hearing health professionals to benchmark their own practices, and
design their services and products.
The committee was moved by the evidence which detailed the shock and
emotional distress that sometimes accompanies initial diagnosis of hearing
loss. The committee believes that diagnosis of a hearing loss is always likely
to be a shock, and that there will always be a flow on impact for families.
However the evidence suggests that the impact of the news might be reduced if it
was related by someone with skills in counselling support. To that end, hearing
health practitioners could benefit from professional development which addressed
The committee heard that professional standards exist for sign language
interpreters for the deaf, but that there are no agreed standards for interpreters
working in an educational setting as interpreters or as aids. The committee
believes that deaf children are already disadvantaged in educational settings, and
that it is essential for high standards of support to be available.
Many people raised in evidence the issue of under-usage of hearing
aids in Australia. The seriousness of this issue is twofold: first, that people
who should be benefiting from a technological intervention are not doing so;
and second, that Australian Government resources may be spent on these un-used devices
which could be better spent elsewhere.
If under-use of hearing aids is as high as 30 per cent, as the committee
heard, then there is a pressing need to understand why people choose not to
wear their hearing aids, and what can be done to influence their future
behaviour. The committee believes that earlier diagnosis of hearing loss and
take-up of hearing aids may improve usage levels later in life, as people have
more time to adjust to wearing and using aids. The committee has made
recommendations in chapter six about research to understand and address this
The committee heard that one of the issues around under-use of hearing
aids may be the supply-driven nature of the voucher program. In other words,
that in the past there has been an emphasis on providing devices rather than
addressing need and achieving hearing health outcomes. The committee notes that
the OHS has responded to this by introducing a Minimum Hearing Loss Threshold
into eligibility requirements for a voucher from 1 July 2010. Testing of
voucher applicants' hearing against the new threshold is intended to help
target the provision of publicly funded hearing aids to those with the greatest
The committee heard from a number of sources that people are concerned
about being pressured into topping-up their hearing aid vouchers with
additional features. The committee's greatest concern is that people feel as
though they are pressured into taking top-up options which are not clinically necessary.
Evidence from representatives of the hearing aid industry was that promoting
top-ups on voucher devices is necessary if private practices are to be viable.
This seems to justify the concerns of consumers, as the incentive is strong to
push top-ups without necessarily having regard to clinical need.
The committee understands that people who are eligible for vouchers will
receive devices which meet their clinical needs at no cost to themselves, and
that having the option to top-up with optional features creates welcome flexibility
for consumers. However the committee agrees with the Hearing Care Industry
Association that up-selling hearing aids without clinical need to vulnerable
consumers is an unethical and exploitative practice. It is in the interests of people
with a hearing impairment, and hearing aid manufacturers and distributors that
such behaviour be identified and addressed.
Allegations by witnesses from the private audiology and hearing aid
industry that the OHS voucher program may in some way be financially
disadvantageous to the interests of private hearing services warrant
investigation by the OHS.
The committee would like to acknowledge the initiative and energy of
those people and organisations operating hearing aid banks. Without their
efforts and commitment, many Australians would have no access to hearing aids
and their lives would doubtless be the poorer for it. The committee believes
that if its recommendations are implemented, the most vulnerable members of our
society will have greater access to hearing aids through government support in
The committee acknowledges the technological advances represented by
the cochlear implant, and believes from the evidence before it that it is a great
benefit for those people who have received implants. Like so many hearing aid
technologies, the cost of cochlear implants is very high, in particular the
cost of repairing, maintaining and replacing the cochlear implant speech
The replacement costs of speech processors are met for Australian
Hearing clients less than 21 years of age. However for clients of the OHS aged
over 21 years, these replacement costs are not met. The committee was told that
this situation appears inequitable. The implication of the policy is that older
people who are eligible for OHS services, who by definition are usually on low
incomes, can afford up to $17,000 every three to five years. This is plainly
not the case, as the committee has often heard.
The committee acknowledges that the prevalence of hearing loss will
increase, particularly among older Australians, and that speech processors are
expensive items. Nevertheless, the committee believes that the policy should be
reviewed with an eye to aligning the speech processor replacement policy for
all eligible clients of Australian Government Hearing Services Programs.
The committee acknowledges that inadequate facilities are a source of
frustration for many hearing impaired would-be movie-goers. Few things
highlight the services that non-hearing impaired Australians take for granted
as neatly as going to see a movie.
Similarly, the issue of limited access to television programs and DVDs
through captioning emerged as a source of frustration for people with a hearing
The committee acknowledges the work that the Department of Broadband,
Communications and the Digital Economy is already undertaking to improve access
for the hearing impaired to television, DVDs and the movies. The committee also
acknowledges the active role that the Australian Human Rights Commission has
taken in these issues. The committee urges the department and the commission to
note the issues that have been raised in this inquiry in the hope that they
will guide future negotiations and regulation in the area of access to media
for people with a hearing impairment.
The committee heard that there are still many circumstances where people
with a hearing impairment will experience difficulty accessing public services
due to a lack of facilities, such as induction hearing loops. Access to public
services is a fundamental precondition for living an independent and productive
life. As was pointed out to the committee, communication is a problem not just
for the hearing impaired, but also for the people with whom they want to
Relatively inexpensive and easily portable hearing loop technology
exists to enable all services, including government services, banks and
retailers, to welcome and assist hearing impaired Australians. With the rate of
hearing impairment forecast to grow to one in four Australians, it is unacceptable
that all organisations with a public shopfront are not easily accessible to people
with a hearing impairment.
The committee recommends that eligibility for the Australian Government
Hearing Services Voucher Program be extended to include all Australians,
subject to eligibility and a means test.
The committee recommends that former child clients of Australian Hearing
remain eligible for Australian Hearing support until the age of 25. This
eligibility is to be subject to a means test. Former child clients of
Australian Hearing who do not meet the means test are to have the option to
access Australian Hearing support on a fee-for-service basis until the age of
The committee recommends that state and territory governments expand
eligibility for Patient Assisted Travel Schemes to include support for people
accessing audiological services.
The committee recommends that the Australian Government provide funding
to expand services for hearing impaired children in rural and remote areas
through e-technology based programs such as that developed by the Royal
Institute for Deaf and Blind Children.
The committee recommends that the Council of Australian Governments
extends its commitment for universal newborn hearing screening to include a
hearing screening of all children on commencement of their first year of
compulsory schooling. Given the crisis in ear health among Indigenous
Australians, the committee believes urgent priority should be given to hearing
screenings and follow up for all Indigenous children from remote communities on
commencement of school.
The committee recommends that the Audiological Society of Australia
develop and make available to its members resources and professional
development that promotes better understanding about the impact a diagnosis of
hearing loss can have on people, and which provides resources and techniques
for counselling and supporting people at the time of diagnosis.
The committee recommends that education providers develop professional
standards for interpreters working in educational environments. These standards
should be based on existing standards, such as the National Accreditation
Authority for Translators and Interpreters paraprofessional level
accreditation, or the National Auslan Interpreter Booking and Payment Service /
Australian Sign Language Interpreter's Association Deaf Relay Certification.
The committee recommends that the Office of Hearing Services engage with
representatives of the hearing aid manufacturing and distribution industry, private
providers of hearing health services, and hearing health consumers to
the relationship between the voucher program, top-ups and the
financial viability of private health services; and
whether extending the capacity to audiologists to bulk bill
Medicare directly for clinical services would have any impact on the financial
viability of private health services (i.e. would it ameliorate the need to push
'top-ups' to stay viable?); and
that the findings of these investigations be made publicly
available for the consideration of all hearing health stakeholders.
The committee recommends that the Office of Hearing Services review its
policy with regard to the replacement of damaged, lost or obsolete cochlear
implant speech processors for eligible clients over 21 years of age, and if
possible align it with the replacement policy for eligible clients less than 21
years of age.
The committee recommends that the public counters in all government
service shopfronts be accessible to people with a hearing impairment through
the provision of hearing loop technology. The committee recommends that the
Office of Hearing Services coordinate a project which sets targets toward that
end for all government agencies, at all levels of government, and that these be
publicly reported upon.
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