NHS hearing aid service

This factsheet is part of RNID’s hearing aids range. You will find it useful if you are deaf of hard of hearing and want to know how the NHS can help you. We use the term ‘deaf’ throughout to refer to all types of hearing loss.

Read this factsheet to find out:

How can I get hearing aids?

In the UK, you can get hearing aids free from the NHS or you can buy them privately (see our factsheet Buying hearing aids).

Digital hearing aids and the NHS

RNID has campaigned successfully for the modernisation of NHS hearing aid services and the provision of high-quality digital hearing aids. From 2000 to 2005, RNID worked with the Department of Health to lead a £125m modernisation programme in England, which is now complete. Similar audiology modernisation has taken place in Wales, Scotland and Northern Ireland. As a result digital hearing aids are now fitted routinely on the NHS.

How does the NHS hearing aid service work?

The NHS buys a range of hearing aids and uses its bulk buying power to get good quality digital hearing aids at low prices from hearing aid manufacturers. The audiology departments provide these aids free of charge on long-term loan to NHS patients. Hearing aids provided by the NHS usually fit behind the ear.

Disposable and in-the-ear hearing aids are not normally available from the NHS but can be purchased privately. However, they will not be suitable if your hearing loss is severe.

The NHS and the private sector are completely separate. Although the hearing aids come from the same manufacturers, you can’t get financial help from the NHS to buy hearing aids privately. However, if you do buy them privately, you are still entitled to NHS hearing aids. 

If you lose or damage your hearing aids, the NHS will replace or repair it. But you might have to pay a charge if they think you have been careless with it or if it happens more than once. It is against the law to sell on your NHS hearing aids. They are NHS property, so if you have aids that you no longer use, you should take them back to an audiology department.

How do I get NHS hearing aids?

If you think you are having hearing difficulties, the first thing you need to do is visit your GP. Wax may have built up or you may have an infection that has temporarily affected your hearing. These can be easily treated. Your GP may refer you to a hospital ear, nose and throat (ENT) clinic, where you will see an ENT surgeon and an audiologist.

Otherwise, your GP may send you straight to the audiology department at a local hospital or centre to have your hearing tested. This is called ‘direct referral’ and it means you won’t have to join a waiting list to see the ENT surgeon first. But you’ll still have to wait up to six weeks for an audiology appointment. In most areas, you’ll only get a direct referral if you are over 60. If you are younger, the cause of your hearing loss is more likely to require attention from an ENT doctor.

Some GPs arrange for audiology staff to visit their surgery or health centre to run a clinic, so you may be able to get an assessment of your hearing there instead of a hospital.

Your GP may need convincing about the problems your hearing loss causes. You might have to insist on being referred to the audiology service for a full assessment.
Remember: you have the right to have your hearing assessed, especially if your hearing loss is affecting your everyday life.

What happens at the hospital appointment?

Your first appointment

If you’ve been referred to an ENT surgeon, you will usually see the surgeon in a hospital outpatients’ clinic. Your ears will be examined for obvious signs of damage or disease and you will be asked about your medical history.

Some hearing tests may be carried out with a tuning fork. These tests will tell which ear has greater hearing loss and what type of hearing loss it is. An audiologist will assess your hearing and how it affects you. This will happen whether you see an ENT surgeon first or not. The tests involve a machine called an audiometer. The audiometer produces sounds of differing frequencies (pitch) and levels of loudness. You’ll be asked to listen through a set of headphones and let the audiologist know each time you hear a particular sound. They will record the softest sound that you can hear at each frequency. This is known as the ‘threshold’ of hearing.

If the tests suggest that you’d find hearing aids useful, the audiology staff will discuss options with you. They may also take impressions of your ears to make earmoulds that fit your ears. However, there is also a new, alternative way of fitting hearing aids that does not involve earmoulds. This is called an ‘open ear fitting’ and uses smaller, soft earpieces at the tip of the tubing connecting to the hearing aids instead of the earmoulds. These fittings are less visible than earmoulds but are only suitable if your hearing loss is not severe. They give you a more natural sound.

Where appropriate, you should be offered two hearing aids – one for each ear. Your audiologist will discuss what is best for you. If you’re offered two aids, you might be given one aid first to give you time to get used to it before the other one is fitted.

Your hearing aid fitting

If an ‘open ear fitting’ is suitable for you, you may be able to have your hearing aids fitted on the same day as the tests. If you need earmoulds made, you will have another appointment a few weeks after the assessment, when the earmoulds are ready, so you can have your hearing aids fitted. Your hearing aids will be chosen according to your hearing loss. The audiology staff will programme them to suit you, show you how to put them in, how to use the controls, and how to change the batteries.

The audiology staff will also explain what your hearing aids can and can’t do. They might suggest ways for you to get used to them, such as gradually increasing the length of time you wear them. They may also suggest you use them to listen to different sounds around the house, before trying it outside, as this will help you adjust to the sound of the hearing aids.

Your follow-up appointment

You should have an appointment about eight weeks after your hearing aids are fitted. This is when you can ask questions and sort out any problems. The audiology staff will check how helpful you have found your hearing aids in different situations. They may then make adjustments to the earmoulds or hearing aids. Some audiology departments may arrange to do a follow-up interview with you over the phone, so that you only need to visit again if you need further help or adjustments.

Can I get spare hearing aids?

You won’t usually be able to get spare hearing aids on the NHS, but policy differs from centre to centre and depends on several things. For example, you are more likely to get spare hearing aids if you have problems with your sight and a very severe hearing loss, or if you have a hearing loss in one ear and no useful hearing in the other.

What are the different types of NHS hearing aids?

Hearing aids are described as analogue or digital, depending on the technology they use to process sound. Digital aids are the latest, most advanced kind and are fitted routinely now. In fact, analogue technology is gradually being phased out. However at present, body-worn aids and some bone conduction types are only made using analogue technology. Your audiologist will advise you on the most suitable type for you.

Behind-the-ear aids (BTE types)

These have an earmould or a soft tip that sits inside your ear. The hearing aids rest behind your ears and a soft plastic tube connects each aid to the earmoulds or soft tips and channels sound from the aids into your ears. Most people with NHS hearing aids have these. The aids provided by the NHS are sophisticated digital models that can be programmed in a precise way to suit your hearing loss and everyday needs.

In-the-ear (ITE types)

These are not usually available on the NHS. They tend to need repairing more often than BTE types and as the aid is so much smaller the controls can be more difficult to use.

Body-worn hearing aids

These have a small box containing the microphone and working parts. You clip the box to your clothes or put it in your pocket. The box is connected by a lead to an earphone clipped into your earmould. Body-worn hearing aids may be more suitable for you if you have sight problems or find it hard to use very small switches or buttons. Some models are very powerful.

Bone conduction hearing aids

These are for people with conductive hearing loss, or people who can’t wear conventional hearing aids. They deliver sound through the skull by vibrations and have a special headband for this. Another type, called the bone anchored hearing aid (BAHA), involves having an operation behind the ear to implant a permanent fixture in the bone, which removes the need for wearing a headband. A small sound processor clips onto this fixture.
See our factsheet Bone conduction hearing aids for more information.

CROS (‘contralateral routing of signals’) and BiCROS hearing aids

These are for people with hearing in one ear only. CROS hearing aids pick up the sound from the side with no hearing and feed it to your hearing ear through a wire, which connects the receiver to the microphone. This ensures that you do not miss sounds on your deaf side. BiCROS aids are suitable if you have some hearing loss in your better ear. They amplify sound from both sides and feed it into the ear that has some hearing.

Useful features of modern hearing aids
Telecoil

This is a tiny device in hearing aids that works with an induction loop and allows you to hear sounds more clearly, without interference from room acoustics or background noise. It works by picking up a magnetic signal from the induction loop. To use an induction loop or telephone with an inductive coupler, you need to change to the loop (T) setting on your hearing aids. See our factsheet Loop and infrared systems – for people who are deaf.

Twin or multi-microphones

This describes a directional microphone system found in many hearing aids. It can be switched to pick up sounds in front of you, so you can hear them better than sounds to the side or behind you. This makes it easier for you to focus on what you want to listen to in a noisy place. Some of the latest models will sense automatically where the noise is coming from and adjust the microphone to reduce it. However, hearing aids cannot know what you want to listen to and so the reduction of unwanted sound can never be perfect.

Feedback suppression

This automatically reduces the whistling that bothers many people who use hearing aids.

Automatic noise reduction

This reduces some kinds of steady background noise, like the rumble of traffic or the whirr of a fan.

A choice of listening programmes

Many digital hearing aids allow you to switch between different settings for different listening conditions. Some adjust themselves automatically in response to different sound environments.

How do I service my hearing aids and get new batteries?

With your hearing aids you will be given a booklet that shows the type of hearing aids you have, and when and where it was issued. It proves you have NHS hearing aids, so if you need to, you can go to the audiology department to get new batteries free of charge or to check that your aids are working properly.

How to get new batteries

When your aid is fitted, audiology staff will tell you if you can get batteries from the hearing aid centre by post, or at a drop-in clinic or more local centre.

Remember that you can go back to your clinic (or another one if necessary) if you have a problem with your hearing aids or earmoulds. If you think your hearing has changed, you can ask to have it tested again to see if you need to have your hearing aids reprogrammed or to change to different hearing aids.

What do I do if my hearing aids are not working properly?

If you are having problems with your hearing aids, your audiologist will be able to help you. But, there are some common problems that you may be able to sort out yourself. Try the suggestions below. If they don’t help, then ask your audiologist.

Tips for sorting out common problems

If your hearing aids do not seem to be working:

Whistling and squeaking

This may be caused by ‘feedback’. This happens when sound amplified by your hearing aids leaks out and is picked up by the hearing aid microphone. It may happen if:

Buzzing noises

If you hear a buzzing sound, it might mean that you’ve switched your hearing aids to the loop (T) setting by accident. But if this is not the problem, buzzing generally means your hearing aids have developed a fault and need to be repaired.

What do I do if my hearing aids are not helping?

If you need to make a complaint

If you are not happy with the service you’ve had from an audiology department, and you’d like to complain, your first step is to speak to the hearing aid service manager. It may be possible to sort the problem out quickly. If you are still not happy that your complaint has been dealt with properly, ask about the NHS Trust complaints procedure.

Where can I get further support?

Just acknowledging that you have a hearing loss and may need hearing aids is a huge step, but there is plenty of support available.

Where can I get further information?

Further information from RNID

Our Information Line offers a wide range of information on many aspects of deafness and hearing loss. Contact us for further copies of this factsheet and our full range of information factsheets and leaflets. You can also contact us if you would like information in Braille, on audiotape or large print.

RNID Information Line
19-23 Featherstone Street, London EC1Y 8SL
Telephone 0808 808 0123   Textphone 0808 808 9000   Fax 020 7296 8199
informationline@rnid.org.uk   www.rnid.org.uk (external link)

RNID Tinnitus Helpline
19-23 Featherstone Street, London EC1Y 8SL
Telephone 0808 808 6666   Textphone 0808 808 0007   Fax 020 7296 8199
mailto:tinnitushelpline@rnid.org.uk

Buying equipment from RNID

Visit www.rnid.org.uk/shop (external link) or contact the RNID Information Line for a copy of our Solutions catalogue, full of products for deaf and hard of hearing people.

RNID Information, September 2009