This study considers the process of prioritisation undertaken by Hearing Impaired (HI) Support Services in England in a context of change driven by early screening, early intervention and reform in children's services. The aim of prioritisation is to identify the relative needs of deaf children and their families fairly, transparently and effectively utilising finite resources. Data were collected by means of a postal survey (27 HI Support Services responded representing 33 local education authorities) and structured interviews (with five peripatetic teachers of the deaf). Qualitative data were analysed using a thematic content approach and quantitative data using non-parametric statistics. The study identified that two thirds of HI Support Services had produced formalised systems for prioritising caseloads. The Newborn Hearing Screening Programme (NHSP) was considered the most important influence on prioritising caseloads. Three quarters of HI Support Services used criteria for prioritisation that predominantly focused on impairment. There was relative inattention to needs relating to the child, the family or the school in determining prioritisation. Findings are discussed in the light of holistic approaches to service delivery adopted by Early Support, the principles of Every Child Matters and the introduction of the Common Assessment Framework. Copyright © 2009 John Wiley & Sons, Ltd.