Written Statement: Ear Wax Management Primary and Community Care Pathway

This week marks a very significant moment following two years of collaborative work between colleagues in NHS Wales, third sector and Welsh Government with the announcement of a new pathway for ear wax management.

Ear wax (cerumen) is a common and significant health complaint, specifically significant for people with pre-existing hearing loss as it compounds their communication difficulties.  Unresolved and troublesome ear wax is a relatively easy health condition to address through removal by trained professionals.

Scoping studies found as part of the development of the Advanced Practice Audiology in primary care service indicate 3% of the population present with ear wax each year. This equates to approximately 96,000 patient appointments in primary care across Wales each year.

A Task and Finish Group was established in 2018 to ensure all citizens across Wales can access the most appropriate treatment and support for ear wax problems, in line and underpinned by the principles of prudent healthcare.

The group set out to develop a national integrated pathway which would provide consistent patient outcomes across Wales and ensuring equitable access, efficient and prudent use of NHS resources. The pathway also had to provide seamless management across primary and community care and secondary care settings whilst complying with current NICE guidance and audiology quality standards.

These objectives were finally met and agreed in 2019.

The Task and Finish Group findings showed that patients need and appreciate direct and clear language in the advice they receive on management (including self-management) of medical conditions. Information leaflets and promotional material are being developed to support people to make the right choices related to earwax self -management and direct them to access the correct services is important.

Today I am endorsing the all the recommendations by the task and finish group which are explicitly laid out in a Welsh Health Circular but include:

• Ear wax management to be delivered in a primary and community care setting, in line with the nationally agreed service specification, standard operating procedures and training standards, led by Advanced Audiology Practitioners and delivered by trained healthcare professionals.
• A national wax management training programme to be commissioned; to include microsuction and/or manual removal using a probe.
• The new wax management pathway will complement roll out of ‘first point of contact’ access to audiology services in primary and community care, for patients presenting with hearing problems, tinnitus, and specific balance problems.
• Health boards will now implement, monitor and review the new pathway and service models in their respective cluster areas.

These recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness and current NICE guidance.

I would like to thank all those who have been part of the successful development of this pathway and in particular the third sector organisations and NHS colleagues who have made this all possible.

Their contribution to meeting the challenging outcomes set out in “A Healthier Wales”, the “Hearing Framework of Action” and the “Primary Care Model” have been invaluable and this pathway will make a significant difference.