The first, and most obvious, thing to say is that the NHS give away free digital hearing aids: nearly 1 million of them every year. That makes them the largest supplier of hearing aids in the world. They represent a staggering 10% of the world market for hearing aids. It's simply mind-blowing.

Why Do 1 in 5 Go Private for Hearing Aids?

But the question remains, if so many digital hearing aids are available for free in the UK – why do approximately 1 in 5 people still choose to pay for their hearing aids? Surely if something's free, then why go private? But clearly many people do. In fact, many people who go private for their hearing aids also have NHS digital hearing aids – but prefer to use their private ones, keeping their NHS ones as spares.

Perhaps the easiest way to answer this is by way of an analogy.

If Clothes Were Free on the NHS...

Imagine that the Government was one day to say:

"It's important that everyone wears clothes. Our research has shown that people who don't wear clothes are more likely to suffer hypothermia and social embarrassment. Therefore it is necessary for the health of the nation that the NHS fit everyone with clothes - and these clothes should be free at the point of delivery to everyone who needs them."

Far-fetched, perhaps. But please bear with it. It's an analogy after all!

So the NHS begin to fit clothes. For free. To all who need them. And very soon everyone in the UK is wearing NHS-issue clothing. What do you think might happen?

Let's look at some possible scenarios - remembering, of course, that this is only an analogy.

• Some people are going to get on very well with their new clothing. It fits just right, and at the end of the day it's there to stop them catching hypothermia. So for them, it does what they need it to.
• Some people will look around them and see everyone wearing the same clothing and think to themselves, "This doesn't really suit my needs." Perhaps it's not functional enough them. Maybe it's not warm enough. Maybe it's not the right shape for their figure. Maybe the trousers keep falling down. Maybe they just don't like the colour. Maybe they want something that is more "them".
• Some people might have difficulty looking after their clothing. Perhaps nobody has taught them how to look after their clothes. Or nobody's shown them how to properly keep them clean. Or perhaps they've simply forgotten. Or maybe they don't think keeping them clean is important: it's free after all.
• Some people perhaps realise the need to keep their clothes clean but they don't have the know-how or the facilities to do it themselves, and getting to the NHS Laundrette is difficult. OK, there might be a very good laundrette on their corner near where they live - but it's a private laundrette, so you have to pay to have your clothes washed. And besides, the NHS don't want other laundrettes washing their clothes - because only they know how to wash NHS-issue clothes to the correct standards.
• Some people's clothes may wear out more quickly than other's. But they have to wait until they're next due for new clothes.
• And some people may come across situations where their NHS clothes simply let them down - perhaps at a Wedding or other function where more is expected of their clothing.

So let's ask some important questions. See what you think, before I give you my conclusions.

1. Was there anything actually wrong with the NHS clothing?
2. Was there anything wrong with the way the NHS clothing was fitted?

The answer to these two questions is, "probably not". The NHS clothing was probably pretty decent issue. And it was probably fitted adequately – perhaps even astoundingly well in many cases. So where's the problem?

So Where's the Problem in NHS Provision?

The problem comes in the SYSTEM of providing that NHS clothing. Here's why:

1. We're all different. We're all individuals.
   Think about the embarrassment of turning up to a party wearing the same clothing as someone else! Even in a place where a uniform is expected, there are always some who try to get away with a touch of individualism... a lick of nail varnish, an open collar. We like our individuality.
2. Some clothing is better suited to different purposes.
   A motorcyclist wouldn't wear a party frock. A rock climber wouldn't wear a suit. So of course some people will need to look elsewhere for other clothing, perhaps keeping their NHS clothing as a "back up".
3. The initial supply of the clothing is only part of the process of wearing clothes - what happens afterwards is just as important.
   And some of that is very dependent on the person wearing the clothes, and that will be very specific to the individual. For example, can they do up their buttons? Will they keep their clothes clean? Do they have access to washing facilities that are convenient to them? Would it be easier for someone to come to their house and do their washing?

The point is that most of us like choice when it comes to our clothing. It's the same with food, with music, with books, with spectacles, with everything... and that applies to hearing aids too.

So Back to Hearing Aids...

So let's return to the question of NHS hearing aids and why people choose to go private.

The Need for Choice

Firstly, there is nothing necessarily wrong with NHS hearing aids nor the way they are fitted. But they are not going to suit everyone. We're all too different - whether it's our hearing, our lifestyle, or our personality. So it's no surprise, then, that many people try NHS digital hearing aids but come to the conclusion they need or want something different or better.

Yes, people could make do – but the effect their hearing has on their life is too important to them. Perhaps they want something more discreet, more comfortable, more effective, more "them". Maybe they need ongoing support that's more convenient to them - either the location, or having a home visit, or being able to see the person they're used to so they get continuity, or they feel a particular practitioner understands their needs better.

None of this says there was anything wrong with their NHS hearing aid; it is simply recognising the fact that people are individuals, and therefore need choice so they can have what's best for them.

Stop the Competing. On with the Treating.

Secondly, it is wrong for the NHS and independent providers to be in a state of perpetual competition with each other.

Did you know, for example, that some GPs actively persuade their patients not go "private" for hearing aids – even when an independent provider of hearing aids has referred the patient to the GP in the first place because they detected a referable condition that wouldn't otherwise have been picked up! Not only is this a conflict of interest and a misuse of a GP's position to keep people within the closed NHS system, but it's totally against Government policy on offering patients choice. No doubt the GP's reasons are genuine, but are totally misguided.

Instead the NHS and independent providers healthcare should be working together for the benefit of the patient, pooling our experience and expertise towards common goals. That means we need an integrated, holistic approach to hearing care in the UK, and not the current "them vs. us" attitude where each sector tries to score points against the other in order to protect their own survival.

An Up-To-Date Approach Needed

Thirdly, the underlying system of NHS hearing aid provision in the UK is out of date.

Take, for example, opticians and dentists. You – as the patient – can choose to see the same practitioner who can then offer you either NHS provision (if you're eligible and it suits) or private.

In other words, you get to choose your provider and access any NHS provision through that provider. You can even mix and match to get the best for your needs. This takes away the competition between sectors and instead concentrates on getting the best for what you need. In other words in is "patient-centric".

Hearing aids are currently out of step with the rest of the NHS in this respect, and it therefore needs to be brought up to date. You should be able to choose your hearing care provider, based on what's important to you, and still access any NHS funding for which you're eligible – through your chosen provider. This is the only way to create a fair system.

Closing remarks

At the end of the day, it's all about choice: being able to choose the hearing solution that's right for you – based, of course, on the correct advice from experts.

And as an independent provider of hearing care, it our duty to ensure that you have access to that choice and expertise – so that you get the best for your individual hearing needs – rather than some "one size fits all approach".

That's why our independence is so important: it means that nothing comes in the way of doing what's best for you. And of course, it's important we do that well – because if you're not satisfied, we lose you as a client. And that's something we obviously don't want to do.

So when someone chooses to go private, they are not rejecting the NHS.

They are simply choosing something – whatever that "something" might be for them personally - that the NHS cannot provide them with.

After all, it's their hearing. And they have a duty to themselves, their family, their friends - perhaps even their colleagues and clients or students - to get the very best they can out of their hearing. And for many, that's easily a price worth paying.