Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, if she will have discussions with NHS England on the potential (a) impact of not including ear wax removal services in the standard general medical services contract on health inequalities and (b) merits of appointing a (i) national clinical director and (ii) specialty advisor on audiology to advise on this matter.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

In June 2018, there was an update to the National Institute for Health and Care Excellence’s (NICE) guidance, which states that ear wax syringing is no longer recommended due to safety concerns. Instead, self-care methods including olive-oil drops and, if required, ear irrigation or micro-suctioning, are recommended.

The Government has no plans to include ear wax removal services in the national Standard General Medical Services Contract. Irrigation and micro-suctioning require a higher level of expertise and specialist equipment than syringing, which most general practices (GPs) do not have. This means that patients who were previously treated with syringing by their GPs may now require a referral to other National Health Service providers, to access irrigation or micro-suctioning services.

Local commissioners, including integrated care boards, are responsible for arranging services which will meet the recommendations on ear wax removal, as set out in the NICE guidance. This may involve commissioning GPs who agree to develop the required expertise to deliver these treatments or other providers, to whom GPs may refer patients, to provide ear wax removal services.

NHS England issued a communication to all commissioners in June 2022 which asked them to ensure that GPs, with whom they have agreed will not deliver ear irrigation or have not been commissioned to provide micro-suction services, are able to refer patients to appropriate local NHS services for ear wax removal, where symptoms persist following self-care methods. This includes arranging services in line with guidance on ear wax removal services, published by NICE. This guidance is available at the following link:

https://www.nice.org.uk/guidance/ng98/chapter/Recommendations#removing-earwax

The Department is not aware of any plans by NHS England to appoint a national clinical director or speciality advisor for ear wax removal services. Finally, the Department has noted the publication of the Royal National Institute for Deaf People’s (RNID) report Blocked Ears, Blocked Access with interest, and will meet with members of the RNID to discuss this report in due course.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, if she will make an assessment of the potential implications for her policies of the RNID's findings in its report entitled Blocked Ears, Blocked Access: The crisis of NHS ear wax removal in England, published in January 2024.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

In June 2018, there was an update to the National Institute for Health and Care Excellence’s (NICE) guidance, which states that ear wax syringing is no longer recommended due to safety concerns. Instead, self-care methods including olive-oil drops and, if required, ear irrigation or micro-suctioning, are recommended.

The Government has no plans to include ear wax removal services in the national Standard General Medical Services Contract. Irrigation and micro-suctioning require a higher level of expertise and specialist equipment than syringing, which most general practices (GPs) do not have. This means that patients who were previously treated with syringing by their GPs may now require a referral to other National Health Service providers, to access irrigation or micro-suctioning services.

Local commissioners, including integrated care boards, are responsible for arranging services which will meet the recommendations on ear wax removal, as set out in the NICE guidance. This may involve commissioning GPs who agree to develop the required expertise to deliver these treatments or other providers, to whom GPs may refer patients, to provide ear wax removal services.

NHS England issued a communication to all commissioners in June 2022 which asked them to ensure that GPs, with whom they have agreed will not deliver ear irrigation or have not been commissioned to provide micro-suction services, are able to refer patients to appropriate local NHS services for ear wax removal, where symptoms persist following self-care methods. This includes arranging services in line with guidance on ear wax removal services, published by NICE. This guidance is available at the following link:

https://www.nice.org.uk/guidance/ng98/chapter/Recommendations#removing-earwax

The Department is not aware of any plans by NHS England to appoint a national clinical director or speciality advisor for ear wax removal services. Finally, the Department has noted the publication of the Royal National Institute for Deaf People’s (RNID) report Blocked Ears, Blocked Access with interest, and will meet with members of the RNID to discuss this report in due course.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether her Department has had recent discussions with NHS England about the potential inclusion of ear wax removal services in the standard general medical services contract for 2024-25.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

In June 2018, there was an update to the National Institute for Health and Care Excellence’s (NICE) guidance, which states that ear wax syringing is no longer recommended due to safety concerns. Instead, self-care methods including olive-oil drops and, if required, ear irrigation or micro-suctioning, are recommended.

The Government has no plans to include ear wax removal services in the national Standard General Medical Services Contract. Irrigation and micro-suctioning require a higher level of expertise and specialist equipment than syringing, which most general practices (GPs) do not have. This means that patients who were previously treated with syringing by their GPs may now require a referral to other National Health Service providers, to access irrigation or micro-suctioning services.

Local commissioners, including integrated care boards, are responsible for arranging services which will meet the recommendations on ear wax removal, as set out in the NICE guidance. This may involve commissioning GPs who agree to develop the required expertise to deliver these treatments or other providers, to whom GPs may refer patients, to provide ear wax removal services.

NHS England issued a communication to all commissioners in June 2022 which asked them to ensure that GPs, with whom they have agreed will not deliver ear irrigation or have not been commissioned to provide micro-suction services, are able to refer patients to appropriate local NHS services for ear wax removal, where symptoms persist following self-care methods. This includes arranging services in line with guidance on ear wax removal services, published by NICE. This guidance is available at the following link:

https://www.nice.org.uk/guidance/ng98/chapter/Recommendations#removing-earwax

The Department is not aware of any plans by NHS England to appoint a national clinical director or speciality advisor for ear wax removal services. Finally, the Department has noted the publication of the Royal National Institute for Deaf People’s (RNID) report Blocked Ears, Blocked Access with interest, and will meet with members of the RNID to discuss this report in due course.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, if she will require NHS England to publish commissioning guidance to integrated care boards on universal provision of ear wax removal services.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

In June 2018, there was an update to the National Institute for Health and Care Excellence’s (NICE) guidance, which states that ear wax syringing is no longer recommended due to safety concerns. Instead, self-care methods including olive-oil drops and, if required, ear irrigation or micro-suctioning, are recommended.

The Government has no plans to include ear wax removal services in the national Standard General Medical Services Contract. Irrigation and micro-suctioning require a higher level of expertise and specialist equipment than syringing, which most general practices (GPs) do not have. This means that patients who were previously treated with syringing by their GPs may now require a referral to other National Health Service providers, to access irrigation or micro-suctioning services.

Local commissioners, including integrated care boards, are responsible for arranging services which will meet the recommendations on ear wax removal, as set out in the NICE guidance. This may involve commissioning GPs who agree to develop the required expertise to deliver these treatments or other providers, to whom GPs may refer patients, to provide ear wax removal services.

NHS England issued a communication to all commissioners in June 2022 which asked them to ensure that GPs, with whom they have agreed will not deliver ear irrigation or have not been commissioned to provide micro-suction services, are able to refer patients to appropriate local NHS services for ear wax removal, where symptoms persist following self-care methods. This includes arranging services in line with guidance on ear wax removal services, published by NICE. This guidance is available at the following link:

https://www.nice.org.uk/guidance/ng98/chapter/Recommendations#removing-earwax

The Department is not aware of any plans by NHS England to appoint a national clinical director or speciality advisor for ear wax removal services. Finally, the Department has noted the publication of the Royal National Institute for Deaf People’s (RNID) report Blocked Ears, Blocked Access with interest, and will meet with members of the RNID to discuss this report in due course.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what recent assessment she has made of the impact of the withdrawal of ear syringing procedures by GPs on patient wellbeing in the West Midlands.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

Manual ear syringing is no longer advised by the National Institute for Health and Care Excellence (NICE) due to the risks associated with it, such as trauma to their ear drum or infection. NICE takes account of the potential benefits and risks of treatments to patients when developing its recommendations and sets them out in guidance, for instance the guidance on hearing loss in adults. It is available at the following link:

https://www.nice.org.uk/guidance/ng98/chapter/Recommendations#removing-earwax

To promote the wellbeing of those with an excessive build-up of ear wax, the National Health Service website recommends home remedies such as olive oil drops. If further ear wax removal treatment is required, then general practices can refer patients into recommended, safe and professional ear wax removal services such as micro-suction or ear irrigation. Integrated care boards are responsible for ensuring such services are in place as are required to meet the needs of the local population.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what assessment she has made of the adequacy of the availability of NHS ear syringing treatment in the West Midlands.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

The National Health Service will often recommend home treatment remedies to alleviate ear wax build-up. Manual ear syringing is no longer advised by the National Institute for Health and Care Excellence (NICE) due to risks associated with it, such as trauma to their ear drum or infection.

However, in line with NICE guidance, a person may require ear wax removal treatment if the build-up of earwax is linked with hearing loss. A general practice could then consider referring the patient into audiology services. Integrated Care Boards (ICBs) are responsible for commissioning healthcare services that meet the needs of their local populations – including for audiology and ear wax removal services.

ICBs should therefore arrange for the provision of ear wax removal services for when a patient has a clinical need for ear wax removal beyond home treatments.

The NICE published guidelines last year on hearing loss – and specifically on ear wax removal treatment, at the following link:

https://www.nice.org.uk/guidance/ng98/chapter/Recommendations#removing-earwax

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what recent steps she has taken to improve equality of access to NHS ear wax removal services.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

The National Health Service will often recommend home treatment remedies to alleviate ear wax build-up. Manual ear syringing is no longer advised by the National Institute for Health and Care Excellence (NICE) due to risks associated with it, such as trauma to their ear drum or infection.

However, in line with NICE guidance, a person may require ear wax removal treatment if the build-up of earwax is linked with hearing loss. A general practice could then consider referring the patient into audiology services. Integrated Care Boards (ICBs) are responsible for commissioning healthcare services that meet the needs of their local populations – including for audiology and ear wax removal services.

ICBs should therefore arrange for the provision of ear wax removal services for when a patient has a clinical need for ear wax removal beyond home treatments.

The NICE published guidelines last year on hearing loss – and specifically on ear wax removal treatment, at the following link:

https://www.nice.org.uk/guidance/ng98/chapter/Recommendations#removing-earwax

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what data her Department holds on the (a) maximum and (b) minimum cost of an ear wax removal treatment by a private sector provider.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

Details of the National Health Service provider costs are included in the National Cost Collection which can be found at the following link:

https://www.england.nhs.uk/costing-in-the-nhs/national-cost-collection/

There are also unit prices for the “Clearance of External Auditory Canal (19 years and over)” and the “Clearance of External Auditory Canal (18 years and under)” published in Annex A of the NHS Payment Scheme which can be found at the following link:

https://www.england.nhs.uk/publication/2023-25-nhs-payment-scheme/

Where NHS England or Integrated Care Boards commission these services from private sector providers, the unit prices must be used.

However, the Department does not hold any information on the cost of these services delivered by private providers outside of the NHS, or what they may charge individuals for the service.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what data her Department holds on the number and proportion of ear wax removal treatments commissioned by integrated care boards that were carried out by private sector providers in (a) Cheshire and Merseyside and (b) England (i) between July 2022 and March 2023 and (ii) since April 2023.

Answered by Andrea Leadsom - Parliamentary Under-Secretary (Department of Health and Social Care)

There are very few private providers of (Ear, Nose Throat) ENT that deliver ear wax removal (ear irrigation) as a specifically commissioned service in Cheshire and Merseyside.

NHS Cheshire and Merseyside Integrated Care Board has confirmed that there is one private ENT provider in Wirral and two private ENT providers in Knowsley – both of which deliver a much wider outpatient ENT service that may involve ear irrigation.

However, there is no activity data specifically for ear irrigation (or the removal of earwax generally) as it is carried out as part of an ENT treatment pathway, not a standalone procedure.

This information is not collected at the national level. However, the overall proportion of NHS England’s spend on independent sector providers (ISPs) across services has remained relatively consistent in recent years. In 2013-14, 6.1% of total health spending was spent on purchase of healthcare from independent sector providers (£6.9bn). In 2021-22, this was 5.9% (£10.9bn).

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what assessment he has made of the adequacy of the availability of ear syringing treatment through the NHS in West London; and if he will make a statement.

Answered by Neil O'Brien

The Department has not assessed the availability of ear syringing treatment on the NHS in West London. In June 2018 the National Institute for Health Care Excellence (NICE) updated its guidance ‘Hearing loss in adults: assessment and management’ so that it no longer recommends manual ear wax syringing. This is due to risks associated with the treatment such as trauma to their ear drum or infection. Instead, NICE guidance suggests alternative arrangements, such as ear irrigation using an electronic irrigator, micro suction, or another method of earwax removal, such as manual removal using a probe.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether his Department is taking steps to ensure the provision by the NHS of safe and free earwax removal services.

Answered by Neil O'Brien

In line with recommendations provided by the National Institute for Health and Care Excellence (NICE), ear wax removal services are provided on the National Health Service for patients with a clinical need for ear wax removal. Integrated care boards are responsible for the arrangement of ear wax removal services for their respective populations.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what impact assessment the Government's has conducted on its decision in September 2020 to categorise NHS Ear Wax Removal Services as non-core for the purpose of services that must be provided by GP surgeries.

Answered by Neil O'Brien

The National Institute for Health and Care Excellence (NICE) has issued guidance no longer advising manual ear syringing due to the risks associated, such as trauma to the ear drum or infection. NICE guidance suggests alternative arrangements for treatment of excessive ear wax, such as considering ear irrigation using an electronic irrigator, micro suction, or another method of earwax removal, which could include manual removal using a probe.

General practitioner services follow this guidance and are increasingly recommending self-care methods as the primary means to support the safe removal of ear wax, such as in cases of deafness. Commissioners should ensure that there is appropriate access to ear wax removal services which are free at the point of use, where these are necessary and clinically appropriate for a patient.

Question to the Department of Health and Social Care:

To ask His Majesty's Government why ear syringing is now only provided by a private sector provider in some areas, and not by the NHS.

Answered by Lord Markham - Parliamentary Under-Secretary (Department of Health and Social Care)

Integrated care boards are responsible for commissioning services on the National Health Service in line with National Institute for Health and Care Excellence (NICE) guidance. This includes provision of recommended ear wax removal services for patients with a clinical need for ear wax removal.

In June 2018, NICE updated its guidance Hearing loss in adults: assessment and management so that it no longer recommends manual ear wax syringing. This update of the guidance was due to risks associated with the treatment such as trauma to the ear drum or infection. Instead, the guidance suggests alternative arrangements, such as ear irrigation using an electronic irrigator, micro suction, or another method of earwax removal such as manual removal using a probe.

A copy of the guidance is attached.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what steps his Department is taking to support primary and community care settings in offering ear wax removal services.

Answered by Neil O'Brien

The Department does not have plans to intervene in locally-led arrangements for the provision of ear wax removal services. Integrated care boards are responsible for commissioning ear wax removal services in local areas in line with the recommendations for ear wax removal as set out in guidance produced by the National Institute for Health and Care Excellence available at the following link:

https://www.nice.org.uk/guidance/ng98/chapter/Recommendations

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, if he will ensure every GP in England is able to offer an earwax removal service as a routine procedure.

Answered by Neil O'Brien

The National Institute for Health and Care Excellence (NICE) has issued guidance no longer advising manual ear syringing due to risks associated, such as trauma to their ear drum or infection. NICE guidance suggests alternative arrangements for treatment of excessive ear wax, such as considering ear irrigation using an electronic irrigator, micro suction, or another method of earwax removal (such as manual removal using a probe).

General practitioner services follow this guidance and are increasingly recommending self-care methods as the primary means to support the safe removal of ear wax, such as in cases of deafness.

Commissioners should ensure that there is appropriate access to ear wax removal services which are free at the point of use, where these are necessary and clinically appropriate for a patient.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether his Department has taken recent steps to help increase access to ear wax removal for people who cannot afford private treatment.

Answered by Neil O'Brien

As recommended in guidance by the National Institute for Health and Care Excellence (NICE), ear wax removal services are available on the National Health Service when there is a clinical need. Integrated care boards are responsible for commissioning local health services to meet the health needs of local people. This includes arranging the provision of ear wax removal services on the NHS for patients in line with the recommendations on ear wax removal services in the NICE guidance.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether his department has made an assessment of the potential merits of updating guidance ear wax removal services, to allow the service to be made available at GPs.

Answered by Neil O'Brien

The National Institute for Health and Care Excellence (NICE) has issued guidance no longer advising manual ear syringing due to risks associated, such as trauma to their ear drum or infection. NICE guidance suggests alternative arrangements for treatment of excessive ear wax, such as considering ear irrigation using an electronic irrigator, micro suction, or another method of earwax removal such as manual removal using a probe.

General practitioner services follow this guidance and are increasingly recommending self-care methods as the primary means to support the safe removal of ear wax, such as in cases of deafness.

Commissioners should ensure that there is appropriate access to ear wax removal services which are free at the point of use, where these are necessary and clinically appropriate for a patient.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, what discussions he has had with the Care Quality Commission on withdrawing ear wax removal services provided by healthcare professionals from their scope of registration.

Answered by Neil O'Brien

The Department has undertaken a post-implementation review of three sets of Care Quality Commission (CQC) regulations. The Department will give careful consideration to any changes to legislation, including the advantages and disadvantages of continuing to include ear wax removal services provided by healthcare professions in scope of services which require CQC registration.

Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, if he will take steps with the Care Quality Commission to review the impact of the decision to require the registration of healthcare professionals providing ear wax removal services.

Answered by Neil O'Brien

The Department has undertaken a post-implementation review of three sets of Care Quality Commission (CQC) regulations. The Department will give careful consideration to any changes to legislation, including the advantages and disadvantages of continuing to include ear wax removal services provided by healthcare professions in scope of services which require CQC registration.