19. Before we decide if we should conduct a detailed investigation of a complaint, we look at whether there are signs the organisation has got something wrong. We do this by comparing what should have happened with what did happen. We have done this and have not found any indications that something has gone wrong.
Reimbursement of costs for replacement hearing aids
20. Mrs L says she called the audiology department in the middle of June 2024. She says staff told her if she paid for replacements of the lost hearing aids, the Trust would reimburse her. She says that the staff member did not inform her there were specific conditions to qualify for a refund and that the Trust was wrong to refuse to reimburse her.
21. We are sorry to hear that Mrs L did not get the refund she was expecting and that the issues caused her to feel inadequate.
22. In its complaint response in December 2024, the Trust said it could not find evidence to suggest that audiology staff gave Mrs L the impression it would reimburse her for the cost of replacement hearing aids. The Trust said that Mrs L does not meet the criteria for reimbursement set out in the contract between the ICB and the Trust so it could not offer a refund.
23. During our investigation we have been unable to verify whether this call took place, and if it did, what was discussed.
24. Shortly after Mr L paid for the replacement hearing aids, Mrs L emailed the audiology services manager and requested a refund of £170. She said it seemed discriminatory that she had been charged when the loss happened when she was not taking hormone replacement therapy (HRT), causing severe menopause effects. Mrs L said she only lost the hearing aids because of ‘menopause brain’ which she described in a further email as brain fog, memory loss and mood swings. Mrs L did not refer to any previous conversation with audiology staff in this email.
25. Funding for NHS services is managed by a process called commissioning. Services are commissioned by integrated care boards (ICBs), which allocate funding to service providers. In this case, the commissioner for funding of hearing aids is Derby and Derbyshire ICB and the provider is the Trust.
26. The evidence shows the Trust made enquiries with the ICB. The ICB told the Trust that Mrs L falls outside eligibility for a funded replacement, and any costs would not be covered under the contract it has with the Trust.
27. At the end of July, the audiology services manager emailed Mrs L and said they had enquired with the commissioner of the audiology services. They explained that the commissioners said that funding for a replacement hearing aid could only be given if the person has a diagnosis of dementia, learning disability or blindness, confirmed by a GP.
28. Mrs L replied the next day and said she has dyslexia, which she says is a learning disability, and autistic traits. Mrs L did not refer to any previous conversation with audiology staff in this email.
29. The NHSE contract for audiology between the ICB and the Trust says:
‘It will be the responsibility of the patient to fund replacement aids in the event of loss or damage…unless the patient has a diagnosis of dementia, learning disabilities or blindness confirmed by the referring GP, in which case the provider can supply replacements free of charge to patients and claim reimbursement under the supply and fit tariff.’
30. Mrs L does not have a diagnosis of dementia or blindness.
31. NHS guidance, ‘People with a learning disability, autism or both’ says that someone with a learning disability has ‘a significantly reduced ability to understand complex information or learn new skills (‘impaired intelligence’), a reduced ability to cope independently (‘impaired social functioning’), and a condition which started before adulthood and has a lasting effect.’ The NHS website says a learning disability affects the way a person learns new things throughout their life.
32. The NHS guidance says, ‘the term learning disability is not to be confused with a learning difficulty which is used to refer to specific problems in processing information that substantially affects a person’s ability to learn’. NICE CKS also says learning disability differs from a learning difficulty.
33. The NHS website on menopause says one of the symptoms women may experience is ‘brain fog’, which it describes as problems with memory and concentration. This does not say menopause symptoms are a learning disability and we have not identified any recognised guidance which says it is.
34. The NHS website provides an overview of dyslexia. This says it is a common learning difficulty that mainly causes problems with reading, writing and spelling. It says, unlike a learning disability, intelligence is not affected. NICE CKS also says dyslexia is a learning difficulty not a learning disability.
35. In October 2025, Mr L informed us that Mrs L has been diagnosed with autism and ADHD and is likely to have had these all her life. We recognise that these diagnoses came after Mrs L complained to the Trust.
36. NHS guidance says autism is not classed as a learning disability. NICE CKS says ADHD is a learning difficulty, not a learning disability.
37. To summarise, Mrs L has diagnoses of dyslexia, autism, ADHD and has symptoms related to the menopause. None of these medical conditions are classified as a learning disability.
38. As we explained, the Trust is a service provider. It has to make decisions about the funding of lost hearing aids based on the NHS contract provided by the commissioner for the services (the ICB). The Trust decided it could not reimburse Mrs L for the cost of her replacement hearing aids and we consider this was in in line with the NHS audiology contract.
39. For these reasons, we do not consider the Trust did anything wrong and we will not be investigating this further.
Complaint handling
40. After making initial enquiries with the Audiology Department manager, Mrs L complained to the ICB at the beginning of August.
41. We are sorry to hear that the way the Trust handled Mrs L’s complaint caused her further frustration.
42. The Trust’s Complaint handling policy says it will be thorough and fair in its approach to complaints and it will provide fair and accountable responses.
43. The policy says the Complaints Team will allocate a complaint investigation to a complaint handler in the appropriate divisional governance team. It says this complaint handler is responsible for ‘overseeing and co-ordinating the handling of the complaint and sending the response to the complaint.’
44. It says, ‘where possible, complaints will be looked at by someone who was not directly involved in the matters complained about.’ It also says The Trust will provide a final written response within six months.
45. At the beginning of September, the complaints team at the Trust emailed Mrs L, apologised for the delay and said it would raise her concerns with senior staff in the division for investigation. The Trust allocated the complaint to the clinical director of the Head and Neck Care Unit.
46. Later in September, the Trust emailed Mrs L and asked for further details regarding her medical conditions. Mrs L replied the same day explaining that she has poor working memory and slow processing speed.
47. In late October, the clinical director called Mr L. They referred to the audiology contract and said they would need a GP letter to clarify Mrs L’s conditions. It was during this conversation that Mr L told the clinical director that audiology staff had told Mrs L it would reimburse her for the costs of replacement hearing aids.
48. At the request of the clinical director, the Trust made enquiries with Mrs L’s GP practice, which responded at the beginning of November and said Mrs L has dyslexia with poor working memory which slows Mrs L’s processing. The GP practice said Mrs L has a learning difficulty not a learning disability. It said she also had colour blindness.
49. At the beginning of December, the Trust responded to Mrs L’s complaint.
50. Following this, Mr L emailed the Trust and said it had not taken Mrs L’s menopause symptoms into account. Mr L requested copies of call recordings.
51. The Trust responded on the same day and provided Mr L with the email address for freedom of information (FOI) requests.
52. Mr L emailed again the following day and said he had made an FOI request for call records. He also said it was inappropriate to involve the audiology manager in the investigation as they had been involved with the issues in relation to the reimbursement.
53. At the end of January 2025, Mr L contacted the Trust and asked for an update on who is concluding the matter.
54. In early February, the Trust confirmed the response in December is its final response.
55. The clinical director for the relevant Trust division managed the investigation. The evidence shows they asked staff for clarification of the NHS contract in place. Staff spoke with the ICB in August 2024 which confirm costs would not be covered under the contract.
56. The clinical director also asked if any call recording of Mrs L’s call to audiology could be identified and staff reported that it could not. The complaints manager made further enquiries in relation to this on our behalf and they also could not locate any record of this call.
57. The Trust provided Mrs L with its response in early December, which was just over three months after she made the complaint. When Mr L asked, the Trust confirmed it did not have anything further to add in early February which was six months after Mrs L complaint.
58. We consider the clinical director was a suitably independent person to manage the complaint in line with the Trust’s complaint policy. We consider they arranged the appropriate enquiries to be made to investigate Mrs L’s complaint.
59. We consider it was appropriate for them to communicate with the audiology managers to clarify what enquiries had been made with the ICB and in relation to call records. The clinical director provided a detailed response which addressed the issues Mrs L had raised and did this within six months.
60. We consider the Trust handled Mrs L complaint in line with its complaint handling policy. For these reasons, there is no indication the Trust did anything wrong here and we will not be investigating this further.
61. We would like to thank Mrs L for bringing her complaint to us. We appreciate this is not the decision she had hoped for. We hope our report reassures her that the Trust made its decision in line with its contract with the ICB and complaints standards.