It isn’t a secret that hearing aids and other audiology services are free at the point of access under the UK’s National Health Service. In addition to my work as an audiologist in private practice, I continue to work as an audiologist in the NHS. A very common question I hear from both my NHS patients, and my private patients, is something like this: “Are private hearing aids better than the ones available on the NHS? Are they worth the price?”
NHS vs. Private Hearing Aids
There are a few considerations one would need to keep in mind when deciding between the NHS or a private clinic for their hearing care. This goes beyond the physical hearing aids themselves, which I will discuss later in this article. But strictly speaking, when just looking at the actual hearing aids that are available on the NHS, versus what can be purchased in the private sector, there are indeed several major differences that are worth elaborating on.
Firstly, hearing aids that are prescribed in the NHS are private labelled for NHS use only. The hearing aids used in the NHS will come from the same major hearing aid manufacturers that are available privately. However, these manufacturers will issue a specific model or set of models of hearing aid that are provided exclusively to the NHS. In other words, it would generally be impossible to be fitted at a private clinic with a hearing aid meant for the NHS market, and likewise it would not be possible to be fitted in the NHS with a hearing aid meant for the private market. There are a few occasional exceptions, usually for people with very specific types of hearing loss, where there may be some overlap between the two hearing aid sectors.
The specific hearing aids used in the NHS will also vary between different audiology departments. Some departments may offer a wider range of hearing aids than others, although you usually will not be able to choose which department you get referred to. However, most NHS hearing aids will be the behind-the-ear (BTE) style. This is where the electronic components of the hearing aid sit behind the ear, which is attached to a hollow tube that feeds the sound to either a custom-fitted ear mould, or a small rubbery piece of plastic called a “dome”, which sits inside the ear canal. This is different from the receiver-in-canal (RIC) hearing aids that are more typically used by private clinics, where the actual speaker of the hearing aid sits inside the ear canal. This can have its own pros and cons, but it tends to be preferable in terms of how the hearing aid physically fits in the ear, along with sometimes allowing for a noticeable improvement in sound quality over what can be achieved with a BTE hearing aid. In most cases, you also would not be able to be fitted with an in-the-ear (ITE) hearing aid on the NHS. These are the hearing aids that have a custom mould that goes inside the ear, which houses all the electronic components of the hearing aid, without the need for any unit to sit behind the ear. The ITEs are usually the style of hearing aid that can potentially be made to be the smallest. The larger models of ITE can also be a great option for patients who struggle with their manual dexterity, as these devices can often be easier to maintain and put into the ears than RIC or BTE hearing aids.
The technology built inside private sector hearing aids also tends to be more advanced than what is available on the NHS. Hearing aids provided on the NHS usually correspond to a “mid-range” level of hearing aid technology. NHS hearing aids are also typically a couple of generations behind in terms of the overall “platform” of technology that is available in private clinics. Roughly speaking, more advanced hearing aid technologies are better suited to more challenging environments, such as restaurants, large gatherings, meetings, etc. I have an article that looks at what this all means in a bit more detail, here. I would note though, that while the technology is “objectively” better in the private sector, the amount of noticeable, subjective benefit that you may get as the hearing aid user, can be difficult to determine. Many people will find that practically speaking, NHS hearing aids work just as well as private hearing aids, while others will notice considerably more improvement in their hearing abilities with privately issued hearing aids.
NHS vs. Private Audiology Services: Other Considerations
Beyond the physical hearing aids though, I would say that there are perhaps a few more important considerations to keep in mind when deciding between the NHS or a private clinic for your hearing care. The NHS offers an excellent, comprehensive audiology service. However due to the significant pressures and demands that NHS audiology departments face, there will realistically be some limitations in what the NHS can provide. For example, waiting lists for appointments and services are usually quite long. This can often mean that the time from when you are first referred for a hearing assessment, to the time you are fitted with hearing aids, can be quite a lengthy process, and this may well take over a year, perhaps longer, for many NHS departments. If after being fitted, you find that you are having a problem with your hearing aids, there also may be a considerable wait until this can be addressed. Most private clinics have the luxury of time being on their side. The process of having your hearing assessed and then being fitted with hearing aids can usually be completed within a matter of weeks, and any subsequent issues or concerns regarding your hearing aids can often be dealt with in a few days.
Furthermore, ample time can be spent with you during your appointments in a private clinic, allowing the audiologist to give you as much support as you require. This also allows the audiologist to better get to know you and your unique concerns and goals. The audiologist can then provide the most appropriate solution to address those needs.
Lastly, in the NHS you usually will not be able to choose which audiologist you see. I have seen some excellent audiologists both in the NHS, and in the private sector. I have also seen some less than excellent audiologists in the NHS, and in the private sector. However, when seeking a private audiology clinic, you at least have the freedom to choose which clinic you wish to give your business to and can usually easily request to be seen by a specific audiologist, to ensure a consistent level of care.
In the NHS, you will typically be referred by your GP to your local NHS audiology department (either based at a hospital or a satellite clinic), where you may be seen by one of any number of audiologists. If you were fortunate to see an audiologist that you particularly liked and established rapport with, you may be able to request to see that audiologist again—but it won’t always be feasible in the NHS to book your appointment with the same clinician each time. This could also potentially lead to even longer waiting times for your appointment to be scheduled.
While this article may sound a little biased towards using a private audiology clinic, I would like to stress that many patients do very well with their NHS issued hearing aids and are very pleased with the service that is provided. As an audiologist who continues to see patients under the NHS, I certainly would like to think that my NHS patients are getting an excellent standard of care! The key difference though, is that ultimately you will have greater flexibility and choice in a private clinic, and consequently the recommendations and care that you receive can be more personalised to your unique, individual needs. I would also like to end by saying that it is critical to remember that while a private clinic may be able to dispense some very impressive, technologically advanced hearing aids, that technology all becomes largely meaningless if the audiologist prescribing and fitting the hearing aids is not a professional clinician, using best practices.
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