Community Affairs 24 February 2011
CHAIR—I now ask witnesses from Australian Hearing to come forward.
Senator SIEWERT—I have had reported to me that some of the very early Cochlear implants are no longer available. So, when the old ones run out, there will no longer be processes to fit that, yet I can clearly remember when we went to visit, as part of our hearing inquiry, that it is technology for life, and these can be retrofitted.
Ms Clapin—The main implants fitted in Australia are made by Cochlear Limited, and they can be retrofitted. The oldest ones of the implanted part of the implant are now over 20 years old and still working. As they introduce new speech processes we upgrade them. I do not think there are any issues that I am aware of.
Senator SIEWERT—I am not mistaken in what was communicated to me, but perhaps there might be some misunderstanding on the part of the people who were talking to me about it. They were concerned that there is a group of people who will no longer be able to use these. There is an issue of cost, and I will refer to that shortly. They were saying that they no longer will be available and be able to fit to the old technology.
Ms Mavrias—It may have related to the actual external part, the speech processor. Some of those have been made obsolete in terms of technology, but Cochlear is still able to maintain the implanted part.
Senator SIEWERT—My understanding was that the implant itself will always be able to be linked to some form of speech processor.
Ms Clapin—Possibly what could have happened is that for some people who had an older speech processor perhaps it could no longer be repaired, and it was their concern that they could not get that model or the parts for that.
Senator SIEWERT—I do not mean to harp on this but, no, that is not what they meant. They meant it was no longer compatible with their implant. I think it is very well known that your speech processors only last for a specific period. In fact, that is one of the issues that came up at the inquiry. The cost of replacing those can be prohibitive for some people. But that is a separate issue to whether the technology is actually compatible fully with the implant.
Ms Clapin—As far as I know it is, and we will take that on notice and confirm that for you.
Senator SIEWERT—If you could, that would be appreciated, because I must admit I was quite surprised. The way it was explained to us, it looked like a really good system in terms of the implant always being compatible with the processor. I do understand the point about processors. In fact, that is the point about this technology; it is getting better and better all the time. If you could take that on notice, that would be great. I want to go to another issue that exercised us quite a bit during the inquiry and continues to be raised with me, and I refer to the issue of hearing devices that do not suit the needs of many people. Therefore, they do not get used and people think that their hearing aids do not work. Various suggestions have been put forward about how to improve that. Have you been asked to provide any advice to the department or to government about a quality improvement process in terms of not the aids themselves but fitting aids that meet peoples’ needs? I must admit I have now had a number of people say to me that they have been fitted by your people but with aids that do not meet their needs, for various reasons. You will know all of those.
Ms Clapin—Yes. Over the years the Office of Hearing Services, which administers the program, has worked to improve the qualifications and standards of the practitioners in the industry, which has assisted in improving all the fitting skills and making sure that the hearing aids are most appropriate for the clients’ needs. We have not been provided with any more recent advice as to specific qualitative improvements that they could make to the program.
Senator SIEWERT—You say ‘not recent’? How long ago in terms of years?
Ms Mavrias—Certainly in the last 18 months we have been in discussions with the Office of Hearing Services. They made a change this year, on 1 July, to introduce a minimal threshold with regards to fitting, and that was an attempt to ensure that hearing aids were being fitted to the clients who will use them and who need a hearing aid. There was industry consultation on that initiative.
Senator SIEWERT—We did have quite a bit of discussion about that initiative. I understand the rationale behind that. It has not solved the fact that people are still talking to me about the fact that there are still issues with regard to service and appropriateness of the devices, whether they are meeting their needs, et cetera. The point that has been put to me—and this came up very significantly during the inquiry—is that this is a significant barrier to people actually using their aids. I will not go through again the details of people putting them in their drawers. You have not been engaged with government since the issues around the minimum threshold were raised in how you can further improve service?
Ms Mavrias—In terms of enhancements, we are certainly open to having those discussions. Australian Hearing takes the approach of looking at outcomes, and that is after our focus around rehabilitation techniques. It is very much focused on looking at the clients’ needs and ensuring that whatever rehabilitation we provide we look at the outcomes and positive things. In terms of the program, we encourage a more outcomes based focus.
Senator SIEWERT—Thank you. I know that I need to pursue that with the department as well, and unfortunately we ran out of time yesterday so I will put some questions on notice for the department. I would like to move on to Aboriginal and Torres Strait Islander hearing and issues around sound fields. A point has been made that you can provide support to Aboriginal clients for hearing aids but still not sound fields. Have you since spoken to government about progress in that particular area?
Ms Clapin—As you know, the recommendations have not been tabled by the Department of Health and Ageing, and we are waiting for those to come out before we can finally plan to progress any of those implementations.
Senator SIEWERT—I will wait for the government’s response to our committee report. Minister, do you know how far away that is?
Senator Arbib—Sorry, I do not have any information about that. I can seek it for you.
Senator SIEWERT—If you could, that would be very much appreciated. How are you going with your funding? Does it meet all of your research needs?
Ms Clapin—Yes. At the moment we are on track with our funding. We are not overspent, and it is meeting our needs.
Senator SIEWERT—When we went out to visit the lab, we saw some very innovative projects. Are you still able to maintain that level of activity? From my limited exposure and knowledge, it is leading edge research?
Ms Clapin—Yes, and they are still maintaining those activities and have some very interesting projects going at the moment.
Senator SIEWERT—When you develop up this technology, can you market that technology?
Mr Grundy—National Acoustics Laboratories, NAL, receives funding to undertake that research. In relation to that research, it is either going into the program or in some cases they are engaged by the CRC trying to take research into the market.
Senator SIEWERT—Can you then invest that back into further research?
Mr Grundy—The funding that they receive from the commercial area is in the form of a grant that covers the cost of developing that research. The majority of funding which covers the cost of NAL is via their grant allocation.
Senator SIEWERT—If you can commercially develop the technology, you can then use that to reinvest in better outcomes—to just the lab?
Mr Grundy—That is correct, yes.
Senator SIEWERT—It goes back into the lab?
Senator SIEWERT—In terms of engagement with Indigenous hearing and the uptake of devices—I understand that that has been a significant issue. One of the reasons why sound fields would work well is it gets over part of that issue, and I understand the other reasons. Since you cannot do sound fields at the moment, are you able to work with communities in terms of ensuring that devices are used and working with schools, for example, to maximise their use?
Ms Clapin—Yes. When we undertake our outreach programs we work with the whole community. That involves working with the clinic as well as the schools. Generally we have a service level agreement with the community that outlines the aims of our program. We have been successful in increasing the number of Aboriginal children across the country who are wearing hearing aids.
Senator SIEWERT—Do you have that in a quantitative form?
Ms Clapin—In terms of numbers, we have gone from 686 aided Indigenous children up to 905 in the June 2010 year.
Senator SIEWERT—That is the number of children who have received aids?
Senator SIEWERT—Do you follow up in terms of the use?
Ms Clapin—Yes. With our programs we do not go just once to a community; we have a regular program of visits. Some places we go to once a month; sometimes we go three or four times a year. We will have liaisons and phone calls as well in between those visits so that we can track what is happening.
Senator SIEWERT—Have you done any work with respect to how that is assisting with overcoming some educational barriers in schools? We took a lot of evidence—and I know that you know it—in terms of Aboriginal children’s hearing and that being a barrier when they start school and the negative educational outcomes. Have you been doing any work in looking at that link?
Ms Clapin—We do not have any actual data that will show that by fitting a hearing aid the children have improved in their schooling better than other children or anything like that. We have done a lot of work on the form of the hearing aids so that they are much more acceptable and that the children are happy to wear them and go to school with them.
Senator SIEWERT—Do you think that is one of the reasons you are getting that increase in the number of children wearing their aids and continuing to wear them?
Ms Clapin—I think that is why. We also have had an increase in the number of Indigenous adults whom we have fitted and we think that is also helping. As the children see the adults wearing hearing aids, it is more acceptable.
Senator SIEWERT—When you say you have had the increase, how many adults does that involve?
Ms Clapin—It appears we have gone from 1,601 to 2,544.
Senator SIEWERT—That is good—double. Have you been assisting the government to talk to anyone about looking at how to address the overall issue of improvement in hearing in Aboriginal communities?
Ms Clapin—We have been working with OATSIH and the community controlled Aboriginal health organisations. They have been revamping all of the Aboriginal ear health workers training, and we have been involved in that. We have also worked with the state programs in developing new primary healthcare measures that then help to limit the ear disease burden.
Senator SIEWERT—Just recently in Western Australia—I think it was in December—the Telethon Speech and Hearing Centre did an assessment of the hearing of women in Bandyup Women’s Prison. They found 44 per cent of the Aboriginal women in prison had a hearing impairment compared with 10 per cent of the non-Aboriginal women. Have you been involved in any discussions anywhere in Australia about addressing hearing impairment for prisoners?
Ms Clapin—We are aware that there would be a much higher incidence of hearing loss amongst the Indigenous prisoners. Last year it was clarified that, if Indigenous persons were in prison and were under 21, they remained eligible for our services. So we have been able to provide some services.
Senator SIEWERT—How many services have you been able to provide? I am looking at need versus what needs have been met?
Ms Clapin—The numbers have been small. I do not have the actual number here. We have not actively developed any programs with any of the authorities to seek out those people and actively go out to prisons or anything like that.
Senator SIEWERT—I have a couple of questions around that issue. Could you take on notice how many and in which state? Further, could you be proactive in talking to state authorities around addressing hearing impairments in prisons? Finally, if you could, do you have the funding or do you need the funding?
Ms Clapin—Our role is more of a tertiary-level role. We do not generally take on the role of the screening of people. We provide the hearing aids. It would really be more appropriate for the state authorities to do that screening, and then if the people were eligible, to refer them to us and we could provide the hearing aids. We would be able to accommodate that within our funding, if they are eligible.
Senator SIEWERT—I understand the issue around the screening. That is an issue that I will keep pursuing, because I think the issue in Bandyup highlights the scale of the problem that people have long suspected. Whose job is it then to work with the state to ensure the screening happens? I take your point, and if you are not doing it, who is doing it?
Ms Clapin—We do undertake some educational type activities like that to raise awareness. Yes, it would be within our remit to meet with the relevant state authorities so that they became aware of the problem and could start some screening programs.
Senator SIEWERT—Thank you. That is all of my questions. I will take some of the other questions to the department.
CHAIR—As there are no other questions for Hearing Services, we will end today’s hearing. I thank the officers from Human Services and those who are still here from Hearing Services. We appreciate your patience and your professionalism. Thank you, Minister, and thank you, Hansard and Broadcasting. We now end today’s hearing.