An RBL commissioned research report conducted by
Table of contents:
Hearing impairment, including hearing loss and tinnitus, is one of the most common long-term and progressive health issues faced by the Armed Forces community, often caused by harmful levels of noise during Service.
Despite this, there
has been limited evidence on how it affects working-age veterans in the UK and whether current support is meeting their needs.
The Royal British Legion (RBL) has long recognised the challenge Service-related hearing impairment presents
for veterans and their families.
Building on previous work, including Lost Voices research (2014) and delivery of the Veterans’ Hearing Fund (2015), RBL commissioned the University of Chester to conduct research exploring how
hearing impairment affects working-age UK Armed Forces veterans (18 to 67 years old).
It examines whether current support adequately meets their needs and provides evidence-based recommendations to improve services, ensuring that
those affected receive appropriate and timely support.
A mixed-methods approach was adopted to build a comprehensive understanding of the issue. This included a matched comparison study using primary healthcare (PHC) data to compare rates of hearing impairment among veterans and non-veterans of similar age
and gender. In addition, 658 veterans with hearing impairment completed surveys and 34 participated in one-to-one interviews.
To validate these findings and ensure they reflect the lived experiences of those with Service-related hearing
impairment, two focus groups were conducted with participants from across the UK.
The first brought together members of an Expert Reference Group (ERG) including clinical experts on hearing impairment, while the second involved veterans
who had participated in the interview stage of this study.
The findings of this study should not be taken to be representative of all UK Armed Forces working-age veterans. The survey and follow-up interviews were self-selecting –
respondents were people who wanted to share their experiences of being a working age veteran with Service-related hearing impairment, and resulted in a sample that is predominantly White British, ex-Regular Armed Forces, male, and relatively long-serving.
Primary Health Care (PHC) data draws from only one region of England, and identification of veterans within it depends on this status and their hearing impairment being recorded on GP records.
However, this research breaks new ground
in engaging large numbers of veterans and drawing new insights from analysis of PHC data.
To read more about the methodology, please see the 'Strengths and Limitations' section in the full report.
The findings presented below
bring together new evidence on the prevalence of hearing impairment among working-age veterans and highlight the key challenges it creates for their health, wellbeing, and access to support.
1. Quantitative Evidence from Primary Healthcare Data
2. Survey, Interview, and Focus Group Findings
The recommendations from this research have been grouped under three overarching themes:
These recommendations are intended to complement the significant work already undertaken across health services, the voluntary sector and government to improve support for hearing impairment and the Armed Forces community.
RBL will use
these insights to continue championing further improvements ensuring this momentum is sustained and strengthened.
In these recommendations, the term hearing impairment refers to both hearing loss and tinnitus, unless stated otherwise.
The Ministry of Defence must strengthen guidance issued to all Service personnel, and their families, transitioning out of the Armed Forces. Guidance must provide clear and consistent information regarding support for hearing impairment regardless of
how long after transition this condition may present, or their reasons for leaving Service.
This should include clear and practical information about the circumstances under which compensation is available, and how to pursue this.
Information and communication methods must be appropriate for, and accessible to, Serving personnel, veterans and their families, and informed by those with experience of service-attributable hearing impairment. It ought to be provided in multiple
formats and accessible to personnel after they have left Service.
Statutory and charity services providing support for the Armed Forces community affected by Service-attributable hearing impairment and/or tinnitus should undergo robust systematic monitoring and evaluation. This will ensure that services are evidence-based,
and experiences of those accessing support are captured, to continually improve tailored hearing impairment services.
This project has identified research priorities which could broaden understanding and inform more tailored support for specific groups within the Armed Forces community in relation to hearing impairment and tinnitus.
Further research
is recommended to examine additional health conditions and population needs, including:
The Ministry of Defence and Veterans UK must do more to understand and address barriers veterans experience to accessing appropriate and timely compensation for Service-attributable hearing impairment, including exploring whether the impact and progressive nature of hearing impairment is adequately recognised within compensation policies, tariffs, and frameworks for assessing eligibility.
NICE (England & Wales), SIGN (Scotland), and Department of Health Northern Ireland (DoH NI) must produce an evidence-based review on the most effective treatments and support for veterans experiencing Service-attributable hearing impairment and/or tinnitus. This must be informed by large-scale trials and further high-quality research that enables full cost-benefit analysis and identification of the most effective interventions for addressing these conditions and related impacts, including wellbeing and mental health.
The Ministry of Defence must reinstate dedicated funding for veterans’ hearing support, financed by HM Treasury. The Veterans’ Hearing Fund should function to provide hearing aids and related support for needs not met through statutory services and mitigate potential disadvantage owing to the unique experiences of military Service.
The NHS across all UK nations must implement regularly updated training modules, and supplementary guidance, on Service-attributable hearing impairment. Training must reflect the unique experience of the Armed Forces community and address the wider impact that hearing impairment can have on wellbeing. This must be delivered within professional development frameworks, such as the Veteran Friendly GP Practice programme and Devolved equivalents, as well as being embedded in staff guidance and accessible patient information materials.
The Ministry of Defence must implement standard timelines for reviewing policies in relation to hearing protection and impairment. These policies must reflect the implications of hearing impairment, as well as lived experience through co-production with affected serving and ex-serving personnel and families. This could include exploring ways to ensure that hearing tests during Service are as accurate as possible, and that barriers to help-seeking are minimised where possible.
NICE (England & Wales), SIGN (Scotland), and Department of Health Northern Ireland (DoH NI) must recommend, and the NHS must ensure that audiology assessments are embedded as a routine element of treatment and care pathways for veterans experiencing Traumatic Brain Injury(s) (TBI) and any mental health conditions. This would facilitate early intervention and treatment to minimise the impact of Service-attributable hearing loss.
The NHS must strengthen clinical coding guidelines to ensure the regular and accurate recording of specific hearing impairments (including tinnitus), and veteran status, across primary healthcare practices. This coding must be applied by practices, with support from external providers, to facilitate the timely transfer of relevant medical information, to inform appropriate and coordinated support pathways.