What is the Rural Hearing Gap – and why does it matter? 

Hearing loss is a pervasive yet often hidden health challenge affecting millions of people across the UK. While 5.8% of GP patients reported deafness or hearing loss in 2024, research indicates that the true figure is significantly higher – affecting up to 18 million adults, or one-in-three, when mild and unilateral loss are included. Prevalence increases sharply with age, meaning rural communities – where 27% of residents are aged 65+ years – are disproportionately affected. Rural workers also face elevated occupational risks, particularly in agriculture, mining, and quarrying, where prolonged exposure to noise increases the likelihood of hearing damage.  What is being done, and what more can be done, to support people with deafness and hearing loss, especially in rural communities? Jessica Sellick investigates.  

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Hearing loss remains one of the country’s most overlooked health challenges, despite rising demand, a shrinking specialist workforce, fragmented commissioning arrangements, and growing evidence of unmet need. But what exactly do we mean by hearing loss, what prevents people from seeking help, and where do the gaps and opportunities lie in delivering community-based audiology services? Most importantly, what needs to change to ensure timely, consistent, and genuinely accessible hearing care for everyone, including those living in rural communities?  

What is hearing loss, and how common is it? According to NHS England, common signs you are losing your hearing include: difficulty hearing other people clearly and misunderstanding what they say (especially in noisy places), needing to ask people to repeat themselves, listening to music or watching TV with the volume higher than other people need, difficulty hearing on the phone, finding it hard to keep up with a conversation, and feeling tired or stressed from having to concentrate while listening. It is recommended that you seek urgent medical help if you have sudden hearing loss in one or both ears, your hearing has been getting worse over the last few days or weeks, or you have hearing loss along with other symptoms. 

Clinically, there are three types of hearing loss:  

  1. Sensori-neural: this type of hearing loss can be caused by damage or a defect of the inner part of the ear. This may be due to natural wear and tear, noise exposure, congenital, genetic or viral conditions.  
  1. Conductive: this type of hearing loss can be caused by damage or a defect of the outer or middle part of the ear. This may be due to a number of causes including malformation of the ear, wax, infection or middle ear effusion. This type of hearing loss affects the transmission of the sound from the outer ear through the middle ear and into the inner ear.  
  1. Mixed: this type of hearing loss is a mixture of a sensori-neural hearing loss with an element of conductive hearing loss.  

While some people are born with hearing loss, in most cases it develops over time. Some of the common causes of hearing loss and related symptoms include ageing (presbycusis), damage from loud noise over many years, ear infections, earwax build-up, perforated eardrum, and Labyrinthitis or Ménière’s disease. The biggest cause of hearing loss is ageing, followed by exposure to loud noise.  

In 2024, the proportion of GP patients surveyed reporting deafness or hearing loss was 5.8%. While this is lower than that reported in 2023 at 6.0%, it is much higher than 10 years ago when the figure was 4.0%. While official statistics rely heavily on self-reporting, research shows that millions of people with measurable hearing loss do not report it, meaning they disappear from official counts. For example, researchers at the University of Manchester and University of Nottingham used population estimates from the 2021 Scottish census and the 2022 England and Wales Census [resulting in a population increase of 4.6 million] to calculate the number of people with a milder degree of hearing loss. The data analysis shows that if people with a milder degree of hearing loss in both ears are included, the estimate is 12.3 million, or 1 in 4 of the population aged 18-80 years; and the number is greater still — 18 million or 1 in 3 —  if those with a hearing loss in only one ear are also included. Co-author of the study, Professor Kevin Munro, notes: “These data more accurately reflect the number of adults in the UK who have impaired hearing that will cause listening difficulty, especially in background noise. Maintaining the hearing health of adults is a strong social responsibility. So it is important to acknowledge that millions of people’s experiences have effectively been dismissed by existing data which means they are effectively left out of the national conversation.”  

National charity RNID also describes how deafness and hearing loss are prevalent. Using the same population base as researchers at Manchester and Nottingham universities, but a standard prevalence threshold (of ≥25 dB HL in one or both ears), they estimate that one in three adults in the UK are deaf, have hearing loss, or tinnitus; over half the population aged 55 years or more have hearing loss; almost 80% of people over the age of 70 years have hearing loss; and an estimated 2.4 million adults in the UK have a level of hearing loss that means they would struggle to hear most conversational speech. While the RNID has adopted the 18 million figure from the universities in its public communications, NHS clinical services and many researchers continue to use the ≥25 dB HL threshold because it meets the standard threshold used in epidemiological studies. More broadly, the World Health Organization (WHO) classifies hearing loss into grades – from mild (20–34 dB HL) through to moderate (35–49 dB HL), moderately severe (50–64 dB HL), severe (65–79 dB HL), profound (80–94 dB HL), and complete (≥95 dB HL). The WHO defines hearing loss greater than 35 dB HL as ‘disabling’. These thresholds are widely used in global epidemiology studies.  

There is clear evidence that hearing-health stigma persists in the UK. A survey of over 1,000 representative adults aged 18-65+ years by TympaHealth in 2025 found more than one in three people (35%) have experience of hearing loss, with over half (56%) stating it has a negative impact on their mental health, while more than one in three (35%) have never had their hearing checked. The survey results reveal:  

  • Embarrassment is the primary deterrent, with 31% expressing concerns about potentially having to wear hearing aids.  
  • Levels of embarrassment were even higher for younger respondents, with 38% of 18-24 and 25–34 year olds stating they would be worried about having to wear hearing aids, compared to 23% of 45–54 year olds and 19% of 55–64 year olds.  
  • More than one in five respondents (23%) cited social stigma around hearing loss, rising to 30% for those aged 25-34 years.  
  • The data also showed a lack of awareness among UK adults of the negative impact hearing loss can have on brain health, with over half (53%) of people reporting they were unaware of the long-term health implications.  

How do you measure hearing loss, and what can you do about it? A hearing test is used to check hearing. There are several ways you can get your hearing tested, with it usually taking from 3 minutes to one hour depending on the different tests you have. Children may have a hearing test as part of their health and development reviews, while GPs can refer adults and children to an audiologist for a test. Some pharmacies and opticians also have hearing specialists who can do tests, and online hearing tests are also available for adults aged 18 years and over.  

Hearing tests for adults may include pure tone audiometry (raising your hand every time you hear sounds), speech audiometry (raising your hand every time you hear speech), and tympanometry (where a small device is placed in your ear to check how well your eardrum is moving). Hearing tests for children, depending on their age and development, may include visual reinforcement audiometry (where a child links the sound to a visual reward such as a toy), play audiometry (where a child is asked to listen to sounds and do a simple task such as putting a ball into a bucket), pure tone audiometry (the child listens to different sounds through headphones and presses a button every time they hear something), tympanometry (a small device is placed into the child’s ear to check how well the eardrum is moving), and bone conduction test (where a small vibrating device is placed behind the ear to check bones in the head are working properly).   

While hearing tests are normally free, adults may have to pay for any treatment they might need. Treatments for hearing loss and deafness depend on the causes of it and its severity. For example, sometimes a clinician may be able to treat the cause such as managing an ear infection with antibiotics, or using ear drops to treat earwax build-up; while for permanent hearing loss, hearing aids and implants are used to make sounds louder and clearer. While most patients get their hearing aids free through the NHS, approximately one-fifth of patients pay an average of £2,850 for a pair of hearing aids, with some facing further costs for follow-up appointments, disposable batteries for non-rechargeable models, replacement parts, and repairs.  

There is currently no England or UK specific evidence quantifying how many people avoid or delay having hearing tests because they are worried about being asked to pay for the test or subsequent treatment. One study looked at the clinical and cost effectiveness of early versus delayed management of hearing loss on patient outcomes, finding that early provision of hearing aids was cost effective compared with delayed provision of hearing aids for managing hearing loss (Incremental Cost Effectiveness Ratio, ICER: £3,976 per Quality Adjusted Life Years, QALY gained). They also found hearing aids were cost effective compared with no hearing aids for managing hearing loss (ICER: £4,167 per QALY gained). 

While it isn’t always possible to prevent hearing loss if you have an underlying condition that causes you to lose your hearing, there are several things you can do to reduce the risk of hearing loss from long-term exposure to loud noises [the second most common cause of hearing loss after age-related changes]. For example, using headphones to block out noise, using ear protection equipment, being aware of the symptoms of common causes of hearing loss, and speaking to your GP if you or a family member are experiencing hearing problems.  

While current treatments improve hearing for many people, they only manage the symptoms of hearing loss rather than addressing the root causes. Regenerative medicine, including stem cell technologies, has the potential to provide revolutionary treatment options for some patients in the future. For example, Rinri Therapeutics is initiating clinical trials of Rincill-1 for sensori-neural hearing loss; while the REGAIN trial (Regeneration of inner ear hair cells with gamma secretase inhibitors) at University College London Hospitals NHS Foundation Trust and University College London has found the drug gamma secretase inhibitor LY3056480, while not restoring hearing loss, led to improved changes for some patients. The availability of big data, and advances in informatics and artificial intelligence may accelerate the discovery and development of  new clinical treatments.   

What is access to assessment and treatment for hearing loss like? Most NHS audiology services are commissioned by Integrated Care Boards (ICBs) with the exception of some specialised services which are currently commissioned by NHS England. Some ICBs enable patients to self-refer to community audiology, and the 10 Year Health Plan for England sets out a commitment that in the future all patients will be able to self-refer (where clinically appropriate) using the NHS App.  

Historically, NHS England published statistics on ‘direct access audiology’, including data on the number of referral to treatment (RTT) completed pathways, and incomplete pathways for Direct Access Audiology. Rules to publish RTT data collection became mandatory from April 2008 and applied to all NHS-funded direct access (non-consultant led) audiology pathways. It also included monthly data collection on waiting times, where any NHS organisation [provider or commissioner based] providing services falling within the scope of Direct Access Audiology was required to complete a provider return. This data collection was paused in March 2020 due to the COVID-19 pandemic. A consultation on health and social care statistical outputs between 2023 and 2024 led to a decision to discontinue some elective datasets including Direct Access Audiology permanently in November 2024. Since then, information on audiology waiting times has been made available from three key sources: (1) information on patients waiting for community audiology services is collected as part of the community health services waiting lists; (2) information on waiting times for audiology diagnostics is collected as part of the diagnostic waiting times and activity for 15 key diagnostic tests and procedures collection; and (3) information on hospital referrals and first outpatient attendance date is available in hospital episode statistics.  

In July 2025, Michelle Walsh (MP, Sherwood Forest) tabled a question asking the Secretary of State for Health and Social Care, what steps the Department was taking to reduce waiting times for appointments and assessments for hearing services. In response, Karin Smyth highlighted NHS England’s reforming elective care services plan in expanding diagnostic tests and speeding up waiting times for tests:  

“NHS England is supporting provider organisations and integrated care boards (ICBs) who are the commissioners of audiology services to improve performance and reduce waiting lists for appointments and assessments for hearing services. This includes capital investment to upgrade audiology facilities in NHS Trusts, expanding audiology testing capacity via Community Diagnostic Centres, and direct support through a national audiology improvement collaborative”.  

In September 2025 a question about children and young people with hearing impairment was raised in the Commons. Jim Shannon (MP, Strangford) asked the Secretary of State about the information it holds on the number of people aged under 21 years diagnosed as legally deaf in the last 12 months. The answer, from Dr Zubir Ahmed, revealed that:   

“The information requested is not held centrally. The Office for National Statistics collates data on deaf adults, but not deaf children…However, other organisations have data or estimates of the number of deaf children and young people. For example, the Consortium for Research into Deaf Education… NHS audiology services are locally commissioned, and the responsibility for meeting the needs of non-hearing people lies with local NHS commissioners”.  

In December 2025, a Westminster Hall debate on community audiology was held. Danny Beales (MP, Uxbridge and South Ruislip) highlighted inconsistencies around data collection and oversight, describing how:  

“NHS England recently decided to stop referral-to-treatment waiting time reporting for audiology services, which has removed visibility of the full patient pathway. Diagnostic data suggests that audiology is now a poorly performing diagnostic service, with over 70,000 people waiting and some regions experiencing delays of more than 40 weeks. Without consistent data, commissioners and providers, and policymakers such as us, simply cannot understand where pressures are greatest and where intervention is needed most”.   

In practice, there is no single, integrated national database for all hearing healthcare information, with data often stored across multiple, non-integrated systems. This makes having a real-time understanding (nationally and locally) of how many patients are waiting for a referral, treatment, or follow-up care difficult.   

Back in 2016, NHS England produced a Commissioning Framework for adult hearing services. It was created as part of the recommendations contained in the Action Plan on Hearing Loss published in 2015. The Framework was intended to ensure that then Clinical Commissioning Groups (CCGs) could make informed decisions in providing consistent, high quality and integrated care to meet the needs of local people with hearing loss across England. This set the template for placing commissioning decisions firmly at a local level in the NHS structure. Then, in 2018, the National Institute for Health and Care Excellence (NICE) published guidance on ‘hearing loss in adults: assessment and management’ (NG98).  

Today, community audiology services are commissioned by Integrated Care Boards (ICBs). The 2016 Framework is still used to support ICBs to make decisions about what is good value for the populations they serve, including providing care for people with hearing loss. In November 2025, Lord Kamall asked the Government what discussions they were having with ICBs about commissioning community audiology services in all areas in England. In response, Baroness Merron stated that “systems are expected to put in place self-referral routes to community audiology services…NHS England is adding information on the relevant condition specific pages on the NHS.UK website. ICBs are responsible for ensuring that patients have the information they need to make decisions about their care, including if they have the option to self-refer to locally commissioned services”.  

The Department for Health and Social Care (DHSC) ‘expects local commissioning to be informed by the best available evidence, relevant National Institute for Health and Care Excellence (NICE) guidelines, and guidance issued by NHS England’. At the Westminster Hall debate on community audiology in December 2025, Sir Edward Leigh (MP, Gainsborough) noted that “The current model relies heavily on local commissioning decisions. There is wide variation in access, as well as in the scope and quality of provision across England. Patients in some areas benefit from straightforward self-referral and timely community services, while others face longer waits or unnecessary hospital referrals. I suspect that the service in London and other big cities is better than that in our home county of Lincolnshire”.  

In 2025 and 2026 NICE’s prioritisation board has been considering if it should develop a guideline on paediatric audiology following a topic suggestion, and whether to update its technology appraisal guidance on cochlear implants for children and adults. 

Elsewhere, in June 2024, the Department of Health in Northern Ireland launched a new guide to support those who are deaf, have hearing loss or tinnitus. This sets out a pathway from referral, through diagnosis, assessment, treatment, community support and specialist services. Jackie White from the RNID welcomed the publication in highlighting how: “We support people every day who have questions about their own care pathway and what will happen next. It is therefore really helpful to have this information in one place and in a user friendly format too. Hopefully people will feel more informed and empowered about the support available to them as a result of this pathway”. It is estimated that 350,000 people in Northern Ireland, or about one in five of the population, are deaf or hard of hearing. 

In practice, there is currently no mandatory, system-wide quality assurance standard or requirement for all NHS-funded audiology provision in England. What will it take to ensure people in all areas are able to self-refer to clinical audiology, and – following practice in Northern Ireland – understand their care pathway?  

Back in September 2022, the British Academy of Audiology published a letter to NHS England regarding an audiology staffing crisis. Data from the National Deaf Children’s Society (NDCS) and the British Academy of Audiology (BAA) in 2021 showed that 48% of audiology services had experienced a decline in staffing since 2019, equating to an overall workforce reduction of 8%. In addition, 9% of all audiology clinical posts were vacant, and 65% of audiology services reported at least one vacancy.    

In April 2025, the Secretary of State for Health and Social Care commissioned Dr Camilla Kingdon to conduct an independent review of children’s hearing services in England. The review was published in December 2025 and focuses on the harm caused by missed and late identification of deafness, or delayed treatment, in children. The Review found over 300 children have been harmed because of repeated errors made in paediatric audiology, with the full number still to be established and likely to be more. The recommendations include proposals to require all audiologists to be registered on a single professional register, that NHS Trusts and ICBs should implement improved governance arrangements, that the NHS Workforce Plan should including modelling and recommendations specific to audiology, and that national research funding should be allocated to explore the potential of machine learning, data analysis and emerging technologies.  

The Westminster Hall debate, also in December 2025, covered workforce issues with Danny Beales (MP, Uxbridge and South Ruislip) highlighting the planning issues facing audiology services with “fewer than 10,000 audiologists and hearing therapists in the UK”, echoed by Sir Edward Leigh (MP, Gainsborough) who described how “shortages exist across multiple salary bands, from junior to senior clinicians”.  

Back in February 2024, RNID published a report on the state of UK audiology services. Between July and September 2023 they circulated an online survey to understand more about people’s experiences of the adult hearing pathway and to explore potential areas for innovation. 1,435 people responded to the survey, highlighting challenges around inaccessible communication, confusing referral processes, limited appointment availability, reduced support to adapt to hearing devices, and not being informed about assistive technology or hearing aids and cochlear implants. RNID made 4 key recommendations: (i) the need to implement accessible information standards so that basic patient communication needs are met, (ii) ear wax removal services must be available to meet population need, (iii) NHS healthcare providers need to test replicating and scaling existing solutions, and (iv) greater investment is needed for innovation. The RNID is running an ear wax removal campaign, highlighting how 2.3 million people in the UK require removal every year and that with many GP surgeries no longer offering this service, private removal, often costing up to £100, is unaffordable for many.    

More recently, research published by the University of Cambridge and the British Society of Audiology in May 2025 asked 550 people who are deaf or who have hearing loss about their experiences with the NHS. This found two-thirds of patients were missing half or more of vital information shared during appointments, and that despite being a legal requirement, patients had inadequate access to British Sign Language Interpreters and other accessibility support such as hearing loop systems. Zara Musker, co-author of the research describes how:  

“I have faced my own experiences of inadequate access, and lack of deaf awareness in NHS healthcare not just in the appointment room but the whole process of booking appointments, being in the waiting room, interacting with clinicians and receiving important healthcare information…NHS services are still not meeting the needs of patients”.  

The research includes a number of recommendations including proposals for mandatory deaf awareness and communication training for NHS staff, the provision of interpreters across NHS sites, text based appointment systems and waiting room alerts, and undertaking walk-through assessments to ensure accessibility across the full patient journey. In January 2026, the BSA published new practice guidance to improve audiology services for adults.  

Figures highlight variation in the recruitment and retention of the clinical audiology workforce. What more can be done to improve ‘workforce intelligence’ so the supply-demand gap can be addressed (e.g. regular stocktakes as per the work undertaken previously by the Centre for Workforce Intelligence)? Many patients are relying on family members and friends to help them to communicate with clinicians – what more can be done to implement practical solutions to make hearing loss services, and NHS services more widely, ‘hearing loss and deaf-aware’?  

In response to the Westminster Hall debate in December 2025, Stephen Kinnock (the Minister for Care) provided the following summary of the current situation:  

“The old chestnut that we are constantly trying to crack is around devolving to ICBs the power and agency that they should have because they are closest to the health needs of their population, while ensuring that they are clear about the outcomes, frameworks and standards that we expect. We honestly hold our hands up and say that we have not got that right in all cases, but we are committed to self-referral as a principle and as a really important part of the shift from hospital to community”.   

Audiology services can easily be provided in community-based settings and are cost-effective. In Wales, patients with hearing aids can already directly access audiology services without a GP referrals. What can we learn from what’s working (and not working) in direct access in Wales?  

What specific challenges and opportunities do rural communities face in accessing hearing support? According to the population section of the Statistical Digest of Rural England; in mid-2024, 17% of England’s population lived in rural settlements – and 27% of rural residents were aged 65 years and above. The more rural the area, the higher the average age. Back in 2016, the NHS Commissioning Framework estimated levels of people with hearing loss per Clinical Commissioning Group (CCG) in 2014 and projected figures up to 2019. The findings identified 20 larger CCGs with older populations and more rural areas as having a higher prevalence rate of hearing loss (see tables 4 and 5, pages 22-23). We know that in most cases hearing loss occurs as we age, therefore, proportionately, rural residents are more susceptible. Research similarly demonstrates that farmworkers exposed to prolonged loud noise are at an elevated risk of hearing loss, and the Health and Safety Executive (HSE) identifies mining and quarrying as sectors with a particularly high prevalence of noise induced hearing loss (NIHL). Consequently, rural workers are exposed to chronic occupational noise.  

Research indicates that people with hearing loss face significant stigma, communication barriers, and difficulties accessing NHS services – and these challenges are welldocumented drivers of underreporting. In rural areas, these barriers are intensified by concerns about stigma and confidentiality, greater physical distances, limited connectivity, and ongoing challenges in recruiting and retaining the health workforce – it is, therefore, highly likely that hearing loss is even more underreported in rural areas.  

Richard Foord (MP, Honiton and Sidmouth) provided the following reflections from his Devon constituency at the Westminster Hall debate in December 2025:   

“In my Devon constituency, I represent people who care a great deal about hearing health. Honiton and Sidmouth has the sixth oldest constituents in the country by demographics. Local health data shows that 7.3% of residents in the Devon ICB area report hearing loss or deafness. That compares with an average in England of 5.8%…In Devon, community audiology has been complicated by some major changes in provider arrangements. Until March this year, Chime Social Enterprise delivered NHS audiology services and routine community audiology. Chime had its challenges, but it had a local presence, including in a lot of towns that I represent. It had drop-in clinics for people who needed urgent repairs or had urgent issues. However, from 1 April 2025, NHS Devon integrated care board commissioned several new providers in place of Chime for routine and specialist audiology, and that changeover has caused a lot of problems. One elderly constituent, who has relied on hearing aids for more than 25 years, told me that she had to wait from June until September before she was able to see her usual audiologist. When she finally got to her appointment in Sidmouth, she discovered that the new provider had no access to her medical records, and she was told that she would have to come back in November to have new hearing aids fitted and supplied. Something that should not have taken very long at all took a total of five months. That was not just five months of inconvenience waiting for an appointment; it was five months of struggling to communicate with the rest of the world”.   

A survey carried out by Healthwatch Northumberland also indicated that for patients living in more rural areas, transport can be a barrier to accessing NHS audiology services. One quote from a rural resident related to the closure of a local clinic, requiring them to take a 108 mile round trip to get to the hospital: “I am 89 years old and have no access to a car. I am expected to travel 54 miles to The Freeman at Newcastle for my replacement batteries. This is impossible for me”. Inaccessible or unreliable transport leads to missed appointments, delayed diagnoses, and reduced engagement with clinical services, ultimately limiting patients’ access to health care.      

Outside of the UK, an initial study in Kentucky, United States found a willingness among rural patients to seek hearing healthcare, but cited a lack of access to providers and the overwhelming cost of treatment as barriers. Researchers then undertook a larger study looking at the experiences and challenges in obtaining hearing tests among adults living in rural areas and patients at rural health clinics between 2021 and 2024. They found that rural adults had higher rates of hearing loss, and were less likely to receive treatment. Rural patients experienced significant delays in diagnosis and treatment compared to adults living in urban areas.   

Improved data collection is essential to accurately assess reported and unreported hearing loss among rural residents in England, and to understand their access to audiology services, treatment pathways, and ongoing care and support.  

Researchers in the United States have called for novel methods to support rural adults seeking affordable hearing healthcare – including better identification of adults with hearing loss in primary care settings, and the use of patient navigators to help them obtain hearing tests, treatment, and follow-up care. Examples of rural community based hearing support services in England include:  

  • Hear for Norfolk, which provides a range of support services for individuals including help with hearing aid maintenance, hearing testing, ear wax removal, and someone to talk to and get information and advice from. Clinics include adult audiology, audiology aftercare, aural care, hearing support, and cuppa care – with support provided through home visits, community-based and mobile clinics in rural areas as well as telephone and digital support. They have also recently introduced a private audiology service.  
  • Hearing Advisory Service runs regular clinics for batteries, maintenance and repairs by appointment only across Hertfordshire, Bedfordshire, Northamptonshire and Suffolk, including in village halls.   
  • Community Resource provides information, advice and support to hearing aid users in Shropshire, Telford and Wrekin through home visits, residential care home visits, hearing loss support hubs, and its ‘live well with a hearing loss’ programme.  
  • Research and sector guidance also consistently highlights the importance of installing hearing loops and other assistive listening technologies in village halls and community buildings. These systems improve accessibility for people with hearing loss, support compliance with the Equality Act, and address the often‑overlooked communication barriers faced in rural community spaces.  

Examples of initiatives from across the UK include The Sensory Impaired Support Group (SISG) in Scotland which runs three hearing hubs (in Ayr, Cumnock and Kilwinning), carries out over 2,000 visits a year, and has 27 battery pick up points across North, South and East Ayrshire. While Hear to Help (Powys) is a volunteer service run by the RNID and funded by Powys Local Health Board. Monthly drop-in sessions are held in community venues where staff and volunteers are trained to help with hearing aid maintenance, as well as to give advice and support.  

While some community based hearing support services receive partial or full NHS funding, most rely on grant funding, donations, volunteers and increasingly a paid-for offer to sustain their activities. These services are effective because they have the flexibility to operate directly within rural communities, bringing support to residents rather than expecting individuals to arrange transport and travel long distances. They also provide essential clinical and non-clinical wraparound support. Similarly, although some rural venues have secured grants to improve accessibility, many face the challenge of raising between £120 and £6,000 or more to install hearing loops and other assistive listening technologies.  What can we learn from rural initiatives that have succeeded: how might these approaches be replicated, scaled-up and adapted for use in other rural settings? What forms of support and investment would guarantee their long-term sustainability?  

Where next? Despite the prevalence of hearing loss in England, the condition continues to be treated as a lowpriority area, even as demand for audiology services increases and the clinical workforce reduces. Hearing loss is a significant and lifealtering issue. Considerable work is now needed to ensure hearing loss is addressed with the urgency it demands, particularly in rural areas.     

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Jessica is a project manager at Rose Regeneration and a senior research fellow at The National Centre for Rural Health and Care (NCRHC). She is currently collating initiatives and plans to tackle economic inactivity and support people into good work; developing a community masterplan; and evaluating a heritage skills programme. Jessica also sits on the board of a charity supporting rural communities across Cambridgeshire and Peterborough and is a member of her local Patient Participation Group.  

She can be contacted by email jessica.sellick@roseregeneration.co.uk  

Website: http://roseregeneration.co.uk/ https://www.ncrhc.org/  

LinkedIn: 🌈Jessica Sellick