To:

• Integrated care board chief executives
• Integrated care board medical directors
• Integrated care board finance directors

cc.

• NHS England regional directors
• NHS England regional medical directors
• NHS England regional finance directors
• NHS England regional healthcare scientists

Dear colleagues,

National Paediatric Hearing Services Improvement programme – national position, waiting times, mutual aid and next steps

We are writing to update you on the current national position of the Paediatric Hearing Services Improvement (PHSI) programme, which was established in response to the identification of systemic issues within NHS paediatric audiology services in England, including the misdiagnosis of childhood hearing impairment.

As outlined in our previous communication, we set a national ambition to recall and reassess those patients identified as requiring a follow up assessment by 31 March 2025, with patients either discharged or placed on an appropriate treatment pathway by 30 September 2025.

While many integrated care boards (ICBs) have made strong progress, some systems remain behind schedule. To accelerate the review and recall process, we ask ICBs to provide updated trajectories using the template accompanying this letter by Friday 20 June 2025 to england.csohearingprogramme@nhs.net. This should include detailed plans for the completion of any remaining onsite service assurance reviews, historic diagnostic trace reviews, the recall process, the reassessment of patients and the process you will put in place to ensure any child identified as requiring intervention will receive this as a matter of clinical urgency by September 2025. This information will help us assess the expected progress and determine the level of targeted support required.

Managing waiting times performance alongside delivery of recall and reassessment

Ensuring timely access to paediatric audiology assessments is important. However, there is also a need, in the short term, for providers to prioritise the process of review, recall and re-assessment of children in services identified for a lookback of historic diagnostic traces. This is likely to require mutual aid to providers in a system or network. Please note:

• The risk of decline in an individual provider’s diagnostic 6 week-wait performance should not be a reason to decline support to this process. It has been agreed nationally that the review, recall and re-assessment process should be prioritised in the short term.
• All services should be ensuring robust clinical triage arrangements are in place so that children on the waiting list are being clinically triaged (and therefore access continues to be prioritised for more clinically urgent cases). Waiting list triage guidance and a prioritisation matrix tool is available in the PHSI programme technical guidance on NHS Futures (The Office of the Chief Scientific Officer – FutureNHS Collaboration Platform). Ideally these processes should be co-ordinated across networks of providers such as provider collaboratives or networks. These networks can be within or across ICB footprints or at regional level.
• All ICBs must have an ICB co-ordinated approach to the provision of mutual aid. This can be delivered through provider collaboratives or networks.
• Individual provider organisations must be clear on the short term impact on waiting times of the additional review, recall and reassessment workload and this impact assessment must also be communicated clearly to ICBs.
• Paediatric audiology services are reminded of their responsibility to report waiting times through the diagnostics waiting times and activity (DM01) and the Community Health Services Waiting Lists which are nationally mandated data collections.
• For sites providing mutual aid that hold accreditation through the United Kingdom Accreditation Service (UKAS) under the Improving Quality in Physiological Services (IQIPS) scheme for paediatric audiology, UKAS should be informed of the additional workload and any anticipated impact on waiting times. UKAS has confirmed to NHS England that they take a pragmatic approach to waiting times within an accredited organisation, based on management of the risk to patients. For services providing mutual aid the impact on service accreditation status will be considered if temporarily waiting times are impacted. UKAS do not regulate services for waiting times, however, to meet the standard requirements UKAS will expect services to be monitoring their waiting times to meet the categories detailed in the national waiting time collections.

Thank you for your continued commitment to this vital programme. If you have any questions or require assistance, please contact the PHSI programme inbox at england.csohearingprogramme@nhs.net.

Yours sincerely,

Professor Meghana Pandit, Co-National Medical Director (Secondary Care)
Professor Dame Sue Hill, Chief Scientific Officer for England and SRO, PHSI programme
Dr Rhydian Phillips, Director of Diagnostics and Transport

Publication reference: PRN01994_i