The NHS hearing aid service
About this factsheet
This factsheet is part of RNID’s hearing aids range. It is written for deaf
and hard of hearing people. We use the term deaf people to refer to
deaf, deafened and hard of hearing people throughout this factsheet.
If you think you have a hearing loss or you are sure that you have, you
have probably thought about getting a hearing aid. However, you may
not know what to do next. This factsheet tells you what you need to do
to get a hearing aid.
In the UK, you can get a hearing aid free from the National Health
Service (NHS) or you can buy one privately. This factsheet tells you
more about getting an NHS hearing aid. If you already have an NHS
hearing aid, you will also find this factsheet useful since it tells you what
the NHS hearing aid service can offer you. For information about buying
a hearing aid privately, see RNID’s factsheet, Buying a hearing aid?
At the end of this factsheet we give you details of organisations you can
contact for further information.
If you would like this factsheet on audio tape, in braille or in large print,
fill in the Want to know more? form at the end of this factsheet and send
it to RNID.
How to get an NHS hearing aid
If you think you are hard of hearing and may need a hearing aid, the first
thing you need to do is visit your GP (family doctor). You may have wax
The NHS hearing aid service, RNID Information, February 2003 2
or an infection which can temporarily affect your hearing and which can
be treated by your GP. Alternatively, he or she may refer you to a
hospital ear, nose and throat (ENT) clinic. Here, you will be seen by an
ENT surgeon and an audiologist.
Your GP may send you straight to the audiology department at the local
hospital to have your hearing tested. This is called ‘direct referral’ and it
means you will not have to join a waiting list to see the ENT surgeon
first. You will still have to wait for an audiology appointment, though. In
most areas, direct referral to the audiology department is only possible
for people over 60 and depends on local arrangements.
Some GPs arrange for audiology staff to visit their surgery or health
centre to run a clinic, so you may be able to have an assessment of your
hearing there instead of at the hospital.
Your GP may need convincing about the problems your hearing loss
causes. You may have to insist on being referred to a hospital for
assessment. Remember that you have the right to have your hearing
assessed, particularly if you feel your hearing loss is becoming a
problem.
The hospital appointment
If you have been referred to an ENT surgeon, you will usually see them
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 performed with a tuning fork. These tests
can tell which ear has the greater hearing loss and the type of hearing
loss. Audiology staff will then carry out further tests using a machine
The NHS hearing aid service, RNID Information, February 2003 3
called an audiometer. The audiometer produces sounds of differing
frequencies (pitch) and levels of loudness. You will be asked to listen to
these through a set of headphones and you have to say when you hear
the particular sound, usually by pressing a button. The audiology staff
will record the softest sound that you can hear at each frequency. This
is known as the ‘threshold’. If the tests suggest you would find a hearing
aid useful, the audiology staff will discuss options with you and will take
impressions of your ears to make earmoulds that fit perfectly.
You should be offered two hearing aids if you will benefit more from two
aids than from one, though policy about this varies from one clinic to
another. Opinion varies as to how two aids should be provided. You
may be given both aids at the same time, so that you start to get used
to using an aid in each ear immediately, or you may be given one aid
and have time to get used to it before the second aid is fitted.
You will have an appointment a few weeks after the assessment when
the earmould is ready, so that you can have your hearing aid fitted. The
hearing aid will be chosen to suit your hearing loss. The audiology staff
who fit it will also adjust it for you, show you how to put it in, how to use
the volume control and the on/off/telecoil switch, and how to change the
batteries.
The audiology staff will also explain what your hearing aid can and
cannot do. They may suggest ways you can get used to it, such as
gradually increasing how long you wear the aid, and practising listening
to different sounds around the house before trying it when you are out.
You should have an appointment about six weeks after this, so that you
can ask questions and sort out any problems you may be having. The
audiology staff can make necessary adjustments to the earmould or
hearing aid.
The NHS hearing aid service, RNID Information, February 2003 4
How the NHS hearing aid service works
The NHS buys a range of hearing aids and uses it’s bulk buying power
to get cheaper hearing aids from hearing aid manufacturers. The
audiology departments then buy these aids and loan them to NHS
patients, though they may not have every aid in the range. It is the job of
audiology staff to choose the best NHS hearing aid for you.
The companies that make NHS hearing aids also supply the private
sector, but NHS provision is separate from private purchase. You are
still entitled to an NHS hearing aid if you buy a hearing aid privately, but
you cannot get financial help from the NHS to buy an aid.
It is unlawful to sell an NHS hearing aid and they remain NHS property,
so if you have one that you no longer use, you should take it back to an
audiology department. If you lose or damage your hearing aid, the NHS
may charge you for ‘loss of property’. However, each case of such loss
or damage should be assessed individually.
National Health Service hearing aids
NHS hearing aids are usually available in the following categories:
In-the-ear (ITE types)
These hearing aids are modular aids – this means they are a standard
shape – connected to individually-made earmoulds. The aid and mould
fit into your ear as a single unit. They are suitable for people with mild to
moderate hearing loss.
The NHS hearing aid service, RNID Information, February 2003 5
Behind-the-ear aids (BTE types)
These are worn behind the ear, with sound relayed to the ear through
the earmould. Three series of these aids are available on the NHS:

Those that are medium power for mild to moderate hearing loss.

Those that are high power for moderate to severe hearing loss.

Those that are very high power for severe to profound hearing loss.
Some are mini aids and others are compact or of a standard size.
Body worn hearing aids (BW types)
BW hearing aids consist of a box, a little larger than a matchbox, which
you clip to your clothes, or put in a pocket or pouch. A lead connects
the aid to an earphone, which is attached to the earmould in the ear.
Earphones are of varying strengths to suit different degrees of hearing
loss. The following types of BW hearing aids are available on the NHS:

High-powered aids, suitable for moderate to profound hearing loss.

Very high-powered aids, suitable for profound hearing loss.
Bone conduction hearing aids
These are suitable for people who cannot use a conventional hearing aid
because of frequent ear infections or the shape of their outer ear. The
bone conductor is held on to the mastoid – the bone behind the ear – by
a small headband. It vibrates in response to sounds, transmitting them
through the skull to the inner ear. These aids are available as behindthe-
ear and body worn models.
An alternative type of bone conduction hearing aid is the bone anchored
hearing aid (BAHA). The BAHA is attached to a titanium fixture, which is
surgically implanted in the region behind the ear.
The NHS hearing aid service, RNID Information, February 2003 6
The different features of hearing aids
Automatic Gain Control (AGC): hearing aids with AGC can
automatically adjust their level of amplification according to the level of
sound they pick up. As the sounds coming into the aid get louder, they
are amplified less. This means that sounds never become
uncomfortably loud.
Frequency range: the range of frequencies (pitches) of sound amplified
by the hearing aid. People’s hearing loss varies and hearing aids are
therefore chosen and adjusted to amplify the range of tones that each
person needs to hear more clearly.
Full on gain and maximum output: full on gain is the highest amount
that the aid can amplify sound by, and maximum output is the highest
volume of sound that an aid can produce. More powerful aids have
higher gain and output and are therefore suitable for people with a more
severe hearing loss.
Peak clipping: this is another system for limiting the loudness of
sounds so that they do not get to an uncomfortable level. Sounds above
a certain loudness level are ‘clipped’ but this sometimes results in
distorted sound. Aids with AGC (see above) provide better sound quality
and you may prefer these.
Telecoil: a tiny device in the hearing aid that enables it to pick up an
electromagnetic signal from an induction loop. For practical purposes,
this means that to use an induction loop or telephone with an inductive
coupler, you need to switch to the ‘T’ setting on your hearing aid. You
should then hear the sound source much more clearly, without
interference from room acoustics or background noise.
The NHS hearing aid service, RNID Information, February 2003 7
Spare hearing aids
It will not usually be possible for you to have a spare hearing aid, but
policy differs from centre to centre. Whether you can have a spare may
depend on various factors. For example, you are more likely to get a
spare if you have a visual impairment and a very severe hearing loss, or
you have a hearing loss in one ear and no useful hearing in the other.
Digital hearing aids and the NHS
RNID has campaigned long and hard for modernisation of the NHS
hearing aid service. In January 2000 the Government announced that it
would fund a project to upgrade the service and introduce high quality
digital hearing aid technology. Have a look at our factsheet on Digital
hearing aids for more information.
England
In September 2000 the first of 20 selected NHS trusts in England began
to provide digital aids as part of the ‘First wave’ project.
50,000 RNID supporters campaigned with us for the modernisation to
be extended throughout the NHS. On 24 December, 2001, the Health
Minister announced an additional £20 million to modernise hearing aid
services in 46 more NHS Trusts during 2002. They will all have started
fitting digital hearing aids by April 2003.
In February 2003, the Health Minister announced a further £94 million to
complete the modernisation programme, bringing the new digital
hearing aid service to all remaining audiology departments in England
by April 2005.
The NHS hearing aid service, RNID Information, February 2003 8
Northern Ireland
The Northern Ireland Minister has pledged £2.5 million to modernise
audiology services by March 2004. This will be used to equip and train
audiology staff and to supply departments with digital hearing aids so
that they can begin to provide these to patients by September 2003.
Scotland
In February 2003 the Scottish Executive announced an investment of £8
million over four years to modernise audiology services. This was on top
of the £2.25 million funding that they had already provided to upgrade
audiology equipment.
Wales
The Welsh Executive has provided £2.25 million to help modernise
audiology services and hearing aids throughout Wales. Local funding
has also been provided and all departments are now delivering the new
service.
What else is available?
A wide range of hearing aids is available through the NHS, so it is likely
that one of them will suit you. However, if they are not suitable, a
commercial hearing aid may be prescribed for you. Policy on this varies.
It depends on the audiology department’s financial constraints, and
often on whether or not your situation meets criteria set by the ENT
surgeon or head of department. Commercial hearing aids that are not
part of the standard NHS range may include:
BTE, ITE and ITC (in-the-canal) hearing aids with special features.
Some are self-adjusting and some have settings for different listening
conditions such as a noisy environment, using the telephone, or
The NHS hearing aid service, RNID Information, February 2003 9
meetings. You may be able to use a remote control to change the
settings or volume. ITC aids are not suitable for profoundly deaf people.
CROS or BiCROS hearing aids are a further option for people with no
hearing in one ear and normal or mild to moderate hearing loss in the
other ear. CROS hearing aids feed sound from the side where there is
no useable hearing into the good ear. A BiCROS aid amplifies sound
from both sides and feeds it into the ear that has useable hearing.
Frequency Transposition Aids. These can be helpful for people with
some hearing at low frequencies, but no hearing at high frequencies.
Noise generators can be provided for people with tinnitus. Please
contact the RNID Tinnitus Helpline for further information (contact
details at the end of this factsheet).
Patients with mild to moderate hearing loss who wear glasses can
have hearing aids attached to their spectacle frames.
Personal communicators and listening devices may be issued to
people who cannot tolerate or manage hearing aids. They may also be
used with hearing aids.
Vibrotactile aids. These may be helpful to people who have little or no
hearing in either ear.
Having your hearing aid serviced and getting new batteries
NHS hearing aids come with a booklet to keep a record of information
about them such as the type of hearing aid, and when and where they
were issued. This booklet proves you have an NHS hearing aid, so if you
The NHS hearing aid service, RNID Information, February 2003 10
need to, you can go to any audiology department to get new batteries or
check that your aid is working properly. Remember that you can go
back as often as you need to if you have a problem with your hearing
aid. If you think your hearing has changed, you can ask to have it tested
again to see if you need a different hearing aid.
If you have an NHS hearing aid, you can get free batteries from any
audiology department. Audiology staff will tell you if you can get
batteries from the hearing aid centre by post, or at a drop-in clinic. At
drop-in clinics, you do not need an appointment for batteries, simple
repairs or earmould retubing, but they may not always be open. Some
GP surgeries run battery exchange services. You can also buy batteries
from any pharmacy.
If you find your hearing aid does not help
If you find it difficult to get used to your hearing aid, do not give up. Try
wearing it for a few days and make a note of all the problems you have
with it. Then make an appointment with the audiology department to
talk to the staff there about the problems you are having. They can
check whether your hearing aid is working properly. They may be able
to adjust your hearing aid to suit you better. If it whistles, you may need
a new mould, or you may not be inserting it correctly. Whatever
happens, keep trying. It takes a while to get used to a hearing aid. If you
still find that your hearing aid is not really helping, you could ask for a
better hearing aid in the NHS range or for an aid for each ear if you have
been offered only one aid so far.
The NHS hearing aid service, RNID Information, February 2003 11
Other ways to help yourself
Just acknowledging that you have a hearing loss and may need a
hearing aid is a huge step, but it is only the beginning. You can do many
other things to help yourself:

Some audiology departments have a hearing therapist to counsel you
if you are finding it difficult to get used to your hearing loss or using a
hearing aid, and to liaise with social services if you need other
equipment. Hearing therapists may also advise you about
communicating with other people. They may run tinnitus clinics and
they will know if there are local support groups you can join. Whether
or not you have access to a hearing therapist, your audiology
department is there to help if you have problems with your hearing
aid.

Contact your local social services. Ask their sensory impairment unit
or the social worker with deaf people to visit you to assess your
needs. They may provide special equipment such as amplified
telephones or visual alerting systems for your home, or suggest other
ways they can help. RNID’s factsheet, Social services for deaf
people, gives more information about how social services can help.

Make sure your family and friends know about your hearing loss.
RNID has a leaflet, Lipreading and lipspeaking, which they will find
useful. Keep reminding them that they must make an effort to talk
clearly to you. You are not being selfish or demanding – no-one
wants to be left out of a conversation.

Go to lipreading classes. You will be able to learn tactics for
lipreading and to practise with other hard of hearing people.

Find out if there is a local hard of hearing group you can join. Sharing
experiences and listening to the suggestions of other people can be
very helpful.
The NHS hearing aid service, RNID Information, February 2003 12

Try to find out if there is a volunteer visiting service in your area.
Support from other people can give you the confidence and
encouragement you need to keep trying with your hearing aid.
If you need to make a complaint
If you are not happy with the service you have had from the audiology
department, and you would 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 complaints procedure that all
NHS Trusts have.
Further information
Visit www.mhas.info for the latest information about Modernising
Hearing Aid Services (MHAS).
Further information from the RNID Tinnitus Helpline
If you want to find out more about tinnitus you may find the other
factsheets in RNID’s tinnitus range useful. You may also wish to get
RNID’s leaflet, Questions about tinnitus.
The RNID Tinnitus Helpline offers information and advice to people with
tinnitus, their families and friends and the professionals who work with
them. You can contact the Helpline for further copies of this factsheet
and the full range of RNID information factsheets and leaflets.
Alternatively, fill in the Want to know more? order form at the end of this
factsheet and return it to RNID.
RNID Tinnitus Helpline
RNID Tinnitus Helpline, 19-23 Featherstone Street, London EC1Y 8SL.
The NHS hearing aid service, RNID Information, February 2003 13
Tel: 0808 808 6666. Textphone: 0808 808 0007. Fax: 020 7296 8199.
E-mail: tinnitushelpline@rnid.org.uk Website: www.rnid.org.uk
Further information from RNID
If you want to find out more about some of the subjects covered in this
factsheet the following RNID factsheets may be useful:

Bone conduction hearing aids.

Digital hearing aids.

Buying a hearing aid?

You may also wish to get RNID’s leaflet All about hearing aids.
The RNID Information Line offers a wide range of information on many
aspects of deafness and hearing loss. You can contact us for further
copies of this factsheet and the full range of RNID information
factsheets and leaflets.
RNID Information Line
RNID Information Line, 19-23 Featherstone Street, London EC1Y 8SL.
Tel: 0808 808 0123. Textphone: 0808 808 9000. Fax: 020 7296 8199.
E-mail: informationline@rnid.org.uk Website: www.rnid.org.uk
Alternatively, fill in the Want to know more? order form at the end of this
factsheet and return it to RNID.
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purposes only. It may not be photocopied in part. It may not be
photocopied or reproduced if your intention is to sell the factsheets.
Factsheets are updated regularly. Any out-of-date editions should be
destroyed. You can get the most recent edition from RNID. If you wish
The NHS hearing aid service, RNID Information, February 2003 14
to photocopy this factsheet, please contact the RNID Information Line
(see above for details) or go to our website at www.rnid.org.uk to check
that you have the most recent edition. If you are a commercial
organisation and you need multiple copies of this factsheet, please
contact the RNID Information Line to find out how to get the quantity
you need.
RNID Information, February 2003
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