Interview with John Bamford Ph.D., Ellis Llwyd Jones Professor of Audiology and Deaf Education, University of Manchester
Share:
Topic: Audiology in England, 2005
Beck: Hi John. It is a delight to meet you. I have been very impressed with your accomplishments in the United Kingdom and it's an honor to meet with you here at the Phonak Pediatric Conference.
Bamford: Thanks Doug. It's nice to meet with you too.
Beck: John...I know you've been instrumental in the development of England's Universal Newborn Hearing Screening program, and you've been involved is the design and implementation of graduate education for audiology in England, too. I wonder if you'd please review a little bit of your professional education and history?
Bamford: I graduated in psychology from the University of Reading in 1967, and then stayed on to do a PhD, graduating in 1971. The PhD was concerned with dividing attention between competing cognitive tasks, mainly in the domain of vision but with some auditory studies. After graduating, and traveling the world for a while, I took a research post investigating reading ability in deaf children. This brought me into the field of deafness, and led to research grants in which we developed the BKB Sentence Lists, and began to investigate hearing aid selection procedures. In 1979 I made the switch to clinical audiology, and by 1985 I was heading up the audiology services at the Royal Berkshire Hospital in Reading, one of the UK's leading services at the time. In 1989 I moved back into academia and took up the Chair at Manchester.
Beck: John, I'd like to ask some demographic issues. I know England has a population of some 55 or 60 million people. Based on that, how many graduate programs are there in England, or perhaps in the UK for audiologists? And additionally, how many audiologists are in England, or the UK?
Bamford: There are about 2300 audiologists in the UK. Until recently most of these entered the profession by non-graduate training, so we currently have about 1900 technicians, 100 hearing therapists, and about 300 graduate (master's level) audiologists. The three professional groups have now merged to form the British Academy of Audiology, and a common career structure is being implemented with all-graduate entry (BSc, postgraduate Diploma, or MSc). So in a few years, all audiologists in the UK will be graduate trained. Six or seven universities will be running the degree or MSc/Dip programs, graduating 200-250 professionals per year.
Beck: Regarding Newborn Hearing Screening programs, can you please tell me, how many babies are tested per day in England, and what percentage fail, or are referred, based on their OAE and/or ABR results?
Bamford: The National Screening Committee recently funded a study to evaluate these issues based on 23 sites across England, based on 110 thousand births per year. The results indicate that referral rates run about 2 percent or so. The protocol includes failures of even one ear. So we're picking up children with unilateral hearing issues too. Of the referrals, some 0.9 percent are bilateral, and about 1.1 percent are unilateral referral rates. The rate of true, bilateral, permanent hearing loss has turned out to be about 1 child per 1000 screened, which is about the same as in the States.
Interestingly, we have also found that the yield of true, unilateral, permanent hearing losses is about 0.7 per thousand. In any given area of England, some 99 percent of the babies are offered a screen, 95 percent complete the screen, only a small percentage of the parents refuse it. The whole of England will be covered by the screen by 2005/6, with some 600,000 screenings per year. This implementation is led by my colleague at Manchester, Prof Adrian Davis (see www.nhsp.info).
Beck: And can you tell me a little about follow-up? What percentage of children in England are essentially "lost" or fail to follow-up?
Bamford: In England, it's about ten percent who do not turn up for their follow-up. Now interestingly, recall that I said our stats were derived from 23 sites? Well, if you take out the two sites that were very different from the other 21, the "lost to follow-up" rate goes down to about 4 percent. So I expect that as we gather more information and data, our rate will probably come down, and may settle down at about 5 or 6 percent.
Beck: And in the UK, the majority of screenings are done by a trained screeners, and the screenings are essentially "free," is that correct?
Bamford: Yes, that's right. We have a trained cadre of screeners. They start with an OAE, and if the baby doesn't pass the OAE, they go ahead and do the Automated - ABR (AABR). So the screening itself is made up of those two tests, and if the child does not pass the screening, they are referred to the audiologist. As far as free....yes it is 'free at the point of delivery', paid for out of tax revenue as part of the National Health Service. People really like the NHS, it provides excellent services, care and we're all very proud of it.
Beck: John, I'd like to switch to another topic I know you're involved with, which is the modernization of hearing aid services in the United Kingdom. What can you tell me about that please?
Bamford: This is a big project that is dear to my heart and has been for the last three years or so. The National Health Service historically had basic, low cost hearing aids made for them and that was OK for a while, but those instruments were so far behind the available and improved technologies. The technology gap was abundantly evident, and when the digital revolution occurred in hearing aids, the differences between the private sector products and the NHS provided products became absolutely untenable. So, we knew we had to do something to really catch up to available "quality of life" gains and benefits that were available via digital hearing aids. By the way, it's important to note that the NHS is the largest purchaser of hearing aids in the world, so these issues are not trivial. So, making a long story short... The NHS does indeed, now provide digital, branded hearing aids, supplied "free of charge" to adults.
Beck: That is an enormous accomplishment, John. I cannot imagine how difficult and intricate the issues must've been, but you're clearly a very patient man! And, so how does that "trickle down" to the fitting of children?
Bamford: Right -- that was the issue. So we thought, if we're providing digital instruments to the adults, certainly we needed to provide them to children too, and that raised a great many questions. Therefore, we undertook a study to examine issues like how to best couple FM systems and digital hearing aids? What training and features would be needed? How would loaner systems work? What training would be required and on and on. So we ran our feasibility studies to better understand how to go to digital non-linear fittings. That earned us funding to train the audiology teams in England to provide digital products for the children, and that's where we are now.
Beck: I know that when you're in the middle of these things, they seem to take forever and ever, but from the outside, you've really progressed rapidly with your Newborn Hearing Screening program and the provision of digital hearing aids through the NHS.
Bamford: Yes, a lot of what we've done has been very quick...newborn screenings are the standard in England now, and we've got digital hearing aids available through the NHS, and so the last issue is education for professionals. We would like to have audiology established as an all graduate level profession in England, as it is in the States. We've now got the B.Sc. available in audiology and three of the programs offer post-graduate conversion course, either a diploma or master's. We also have the British Academy of Audiology (BAA) which is fairly new, and very helpful as the unified professional body, and we have a unified career ladder too, so we're pushing ahead and making tremendous progress. This progress has been driven by lots of different groups and individuals, including professional bodies, government, and the voluntary sector all working together. Of course, the next steps may include graduate continuing education, and also e-learning opportunities. So all of that's still ahead of us.
Beck: Yes, the progress is apparent, and you should be very proud of your accomplishments. John, it's been a pleasure speaking with you. Your enthusiasm and knowledge are refreshing and I am thrilled to work with you!
Bamford: Thanks Doug. The pleasure has been mine.
--------------------
Special Thanks to Phonak for providing the opportunity for Dr. Douglas L. Beck to interview Prof. John Bamford at the Phonak Pediatric Conference, held in Chicago, November, 2004.
Please visit www.hcd.man.ac.uk
Please visit www.mchas.man.ac.uk
For more information about Phonak, CLICK HERE.
Bamford: Thanks Doug. It's nice to meet with you too.
Beck: John...I know you've been instrumental in the development of England's Universal Newborn Hearing Screening program, and you've been involved is the design and implementation of graduate education for audiology in England, too. I wonder if you'd please review a little bit of your professional education and history?
Bamford: I graduated in psychology from the University of Reading in 1967, and then stayed on to do a PhD, graduating in 1971. The PhD was concerned with dividing attention between competing cognitive tasks, mainly in the domain of vision but with some auditory studies. After graduating, and traveling the world for a while, I took a research post investigating reading ability in deaf children. This brought me into the field of deafness, and led to research grants in which we developed the BKB Sentence Lists, and began to investigate hearing aid selection procedures. In 1979 I made the switch to clinical audiology, and by 1985 I was heading up the audiology services at the Royal Berkshire Hospital in Reading, one of the UK's leading services at the time. In 1989 I moved back into academia and took up the Chair at Manchester.
Beck: John, I'd like to ask some demographic issues. I know England has a population of some 55 or 60 million people. Based on that, how many graduate programs are there in England, or perhaps in the UK for audiologists? And additionally, how many audiologists are in England, or the UK?
Bamford: There are about 2300 audiologists in the UK. Until recently most of these entered the profession by non-graduate training, so we currently have about 1900 technicians, 100 hearing therapists, and about 300 graduate (master's level) audiologists. The three professional groups have now merged to form the British Academy of Audiology, and a common career structure is being implemented with all-graduate entry (BSc, postgraduate Diploma, or MSc). So in a few years, all audiologists in the UK will be graduate trained. Six or seven universities will be running the degree or MSc/Dip programs, graduating 200-250 professionals per year.
Beck: Regarding Newborn Hearing Screening programs, can you please tell me, how many babies are tested per day in England, and what percentage fail, or are referred, based on their OAE and/or ABR results?
Bamford: The National Screening Committee recently funded a study to evaluate these issues based on 23 sites across England, based on 110 thousand births per year. The results indicate that referral rates run about 2 percent or so. The protocol includes failures of even one ear. So we're picking up children with unilateral hearing issues too. Of the referrals, some 0.9 percent are bilateral, and about 1.1 percent are unilateral referral rates. The rate of true, bilateral, permanent hearing loss has turned out to be about 1 child per 1000 screened, which is about the same as in the States.
Interestingly, we have also found that the yield of true, unilateral, permanent hearing losses is about 0.7 per thousand. In any given area of England, some 99 percent of the babies are offered a screen, 95 percent complete the screen, only a small percentage of the parents refuse it. The whole of England will be covered by the screen by 2005/6, with some 600,000 screenings per year. This implementation is led by my colleague at Manchester, Prof Adrian Davis (see www.nhsp.info).
Beck: And can you tell me a little about follow-up? What percentage of children in England are essentially "lost" or fail to follow-up?
Bamford: In England, it's about ten percent who do not turn up for their follow-up. Now interestingly, recall that I said our stats were derived from 23 sites? Well, if you take out the two sites that were very different from the other 21, the "lost to follow-up" rate goes down to about 4 percent. So I expect that as we gather more information and data, our rate will probably come down, and may settle down at about 5 or 6 percent.
Beck: And in the UK, the majority of screenings are done by a trained screeners, and the screenings are essentially "free," is that correct?
Bamford: Yes, that's right. We have a trained cadre of screeners. They start with an OAE, and if the baby doesn't pass the OAE, they go ahead and do the Automated - ABR (AABR). So the screening itself is made up of those two tests, and if the child does not pass the screening, they are referred to the audiologist. As far as free....yes it is 'free at the point of delivery', paid for out of tax revenue as part of the National Health Service. People really like the NHS, it provides excellent services, care and we're all very proud of it.
Beck: John, I'd like to switch to another topic I know you're involved with, which is the modernization of hearing aid services in the United Kingdom. What can you tell me about that please?
Bamford: This is a big project that is dear to my heart and has been for the last three years or so. The National Health Service historically had basic, low cost hearing aids made for them and that was OK for a while, but those instruments were so far behind the available and improved technologies. The technology gap was abundantly evident, and when the digital revolution occurred in hearing aids, the differences between the private sector products and the NHS provided products became absolutely untenable. So, we knew we had to do something to really catch up to available "quality of life" gains and benefits that were available via digital hearing aids. By the way, it's important to note that the NHS is the largest purchaser of hearing aids in the world, so these issues are not trivial. So, making a long story short... The NHS does indeed, now provide digital, branded hearing aids, supplied "free of charge" to adults.
Beck: That is an enormous accomplishment, John. I cannot imagine how difficult and intricate the issues must've been, but you're clearly a very patient man! And, so how does that "trickle down" to the fitting of children?
Bamford: Right -- that was the issue. So we thought, if we're providing digital instruments to the adults, certainly we needed to provide them to children too, and that raised a great many questions. Therefore, we undertook a study to examine issues like how to best couple FM systems and digital hearing aids? What training and features would be needed? How would loaner systems work? What training would be required and on and on. So we ran our feasibility studies to better understand how to go to digital non-linear fittings. That earned us funding to train the audiology teams in England to provide digital products for the children, and that's where we are now.
Beck: I know that when you're in the middle of these things, they seem to take forever and ever, but from the outside, you've really progressed rapidly with your Newborn Hearing Screening program and the provision of digital hearing aids through the NHS.
Bamford: Yes, a lot of what we've done has been very quick...newborn screenings are the standard in England now, and we've got digital hearing aids available through the NHS, and so the last issue is education for professionals. We would like to have audiology established as an all graduate level profession in England, as it is in the States. We've now got the B.Sc. available in audiology and three of the programs offer post-graduate conversion course, either a diploma or master's. We also have the British Academy of Audiology (BAA) which is fairly new, and very helpful as the unified professional body, and we have a unified career ladder too, so we're pushing ahead and making tremendous progress. This progress has been driven by lots of different groups and individuals, including professional bodies, government, and the voluntary sector all working together. Of course, the next steps may include graduate continuing education, and also e-learning opportunities. So all of that's still ahead of us.
Beck: Yes, the progress is apparent, and you should be very proud of your accomplishments. John, it's been a pleasure speaking with you. Your enthusiasm and knowledge are refreshing and I am thrilled to work with you!
Bamford: Thanks Doug. The pleasure has been mine.
--------------------
Special Thanks to Phonak for providing the opportunity for Dr. Douglas L. Beck to interview Prof. John Bamford at the Phonak Pediatric Conference, held in Chicago, November, 2004.
Please visit www.hcd.man.ac.uk
Please visit www.mchas.man.ac.uk
For more information about Phonak, CLICK HERE.
