Patients relying on NHS Scotland's audiology services have been let down by an "absence of national leadership", workforce shortages, and a lack of any quality assurance.

That was the conclusion of a damning 87-page review, published on Friday, which has set out more than 50 recommendations.

It also marks the culmination of a scandal which first surfaced following criticism over the poor care provided over several years to a disabled patient in Lothian – Child A – who was eventually diagnosed with "severe and profound" hearing loss aged eight.

The watchdog

It is possible that were it not for the dogged efforts of Child A's parents, the failings in audiology services nationally would never have come under scrutiny.

In May 2021, details of the case emerged when the Scottish Public Services Ombudsman (SPSO) published an investigation report into their complaint.

NHS Lothian was forced to apologise for what the watchdog described as "unreasonable, sustained and significant failures" in its diagnostic and testing process.

Child A was non-verbal and had complex needs, including cerebral palsy and learning difficulties. Their parents suspected significant hearing impairment from the age of around two and a half to three, but repeated investigations between June 2012 and January 2018 failed to reach a diagnosis.

Audiologists told the child's parents that they found it "difficult to obtain reliable test results" due to the youngster's communication difficulties, and Child A was discharged twice from NHS Lothian's audiology service after staff said they were satisfied that they "did not have any significant hearing loss".

Fobbed off and unhappy, the parents sought a referral to another health board for a second opinion.

Only then, by which time Child A was eight years old, was "severe to profound hearing loss" identified in both ears, caused by CMV – a congenital viral infection which, had it been detected earlier, should have triggered six-monthly screenings for signs of deafness.

In the end, Child A was fitted with hearing aids, but the prolonged delay in diagnosis meant they were unlikely to be a suitable candidate for cochlear implants – surgical devices which can provide a sensation of hearing.

In its report on the case, the watchdog said Child A had suffered a "significant injustice" as a result of missed "red flags". They had been unfairly branded "difficult to test" by audiologists at Lothian who seemed "focused on trying to prove Child A could hear rather than considering that they had a hearing impairment".

Case review

As a direct result of the blunders described in Child A's care, NHS Lothian commissioned the British Academy of Audiology (BAA) to carry out an independent review into its paediatric audiology services.

This was one of the requirements set out by the SPSO, to determine whether other youngsters had suffered substandard care.

The answer, set out in the BAA report in December 2021, was that many had. After auditing 1,113 patient records, the BAA said that 155 children had experienced "significant failures". This included five who were unsuitable for cochlear implants as a result of delays in the diagnosis of their hearing loss.

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Deaf children were betrayed by repeated failings at NHS Lothian

Three areas of Lothian's paediatric audiology service had a "very high risk of significant failure", said the BAA, which criticised everything from poor practice in testing protocols to a lack of routine screening to identify infants born with hearing loss. 

These failings, it said, "have adversely impacted the early years spoken language acquisition of numerous children, affecting a number of these children for life".

National picture

It is now clear that these issues were not confined to NHS Lothian.

An independent review, commissioned by the Scottish Government in January 2022 and carried out by Professor Jackie Taylor – a former president of the Royal College of Physicians and Surgeons Glasgow (RCPSG) – has identified "many areas ripe for improvement".

Her report describes a service which has fallen victim to an "absence of national leadership, strategic planning and workforce planning", "limited access" to graduate and postgraduate training, and "few opportunities for continuing professional development and skills maintenance" for those once in post.

In recent years, there has also been "no quality assurance" of paediatric and adult audiology services.

The report echoes claims outlined in a letter to The Herald by whistleblowers back in 2019, who voiced concerns over "extremely poor standards of clinical practice" at Borders General hospital in Melrose.

Three senior audiologists said they had tried in vain to flag over 100 harms or near-misses – including in paediatrics – which had resulted in patients being given unnecessary steroids, medical devices, and CT and MRI scans. As a result, they said they had found themselves "subject to bullying and intimidation by senior management".

NHS Borders said that external advisors had found their audiology staff to be "competent clinicians".

Four years on, Prof Taylor depicts NHS audiology Scotland-wide as a service burdened by "multiple, systemic problems". An overhaul appears long overdue.

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