Kingdon review of children’s hearing services (10 November 2025)

Summary

This report sets out the findings of the independent review which looked at the response of NHS England to the service failures in children’s hearing services. It found that the failed or late identification of deafness has had a profound impact on many affected babies and children, and their families, and that initial estimates that nearly 300 children (as of May 2025) have come to harm is an underestimation.

The review makes 12 key recommendations grouped into 3 themes:

• addressing the immediate areas for improvement with the NHS England’s Paediatric Hearing Services Improvement Programme
• placing services on a secure footing looking at commissioning, staffing, data, research and deaf awareness
• lessons for similar at-risk services to mitigate future crises, including workforce and culture changes

Content

Key findings of this review

• The failed or late identification of deafness has had a profound impact on many affected babies and children, and their families.
• The NHS England Paediatric Hearing Services Improvement Programme that was established in 2023 has not met the target it set for recalling affected babies and children and has lost the confidence of external stakeholders.
• Communication between NHS England and the Department of Health and Social Care (DHSC) about the service issues in children’s hearing services did not follow expected practice and there was no dedicated DHSC lead.
• There has been no assurance of quality, as measured by safety, effectiveness and patient experience, in children’s hearing services in England, for some time. Service delivery is highly varied and so it follows that outcomes are unacceptably variable.
• Children’s hearing services are rarely on anyone’s radar - regionally, at ICB and at provider level - nor among regulators, for example the Care Quality Commission.
• The audiology workforce has been neglected for years, their status and profile is low. There is little professional governance and fragmented professional representation. There is a lack of coherent workforce planning and little investment in research.
• The findings of this review are highly relevant to any service which attracts little attention, investment or scrutiny, but has the potential to cause lifelong harm when quality standards are not upheld.

Summary of recommendations

Theme 1 – Understanding the scale of the problem

• The role and remit of the current Paediatric Hearing Services Improvement Programme needs urgent review to focus on completing review and recall.

Theme 2 – Placing these services on a secure footing for the future

• Children’s hearing services should be commissioned using a modern service framework and model commissioning contract.
• Professional registration of audiologists must be a requirement in the NHS and relationships between national organisations and organisations representing audiologists should be reset and formalised.
• Children’s hearing services should be delivered by a network model, rather than a ‘hub and spoke’ model.
• NHS trusts and Integrated Care Boards (ICBs) should implement improved governance arrangements for audiology and apply these to other healthcare sciences.
• Improved data on individual children’s hearing services should be used by NHS trusts and ICBs to monitor service quality and outcomes.
• Undergraduate and postgraduate training pathways for audiologists working in children’s hearing services need wholescale review and redesign, as does the approach to CPD.
• National research funding bodies should invest in research activity and capacity in audiology.
• Children’s hearing services should be setting the standard for deaf awareness and improve processes for seeking feedback from patients and their families.

Theme 3 – Applying the lessons learning to similar services

• The next NHS Workforce Plan should include workforce modelling and recommendations specific to the healthcare science workforce, including audiology, and action should be taken to improve workforce culture and morale in children’s hearing services.
• A regional incident response process should be formalised to enable a more structured response to service issues which do not meet NHS emergency preparedness, resilience and response (EPRR) criteria, including clear guidance around public communications and action should be taken to improve early identification of emerging issues.
• Written guidance should be provided for all officials regarding how and when to raise service issues with ministers and horizon-scanning processes should be subject to review.