Cochlear implant funding
There are more than 4,000 adult and children cochlear implant users in the UK today and over 20 cochlear implant centres around the country. However, 698,000 people in the UK are severely or profoundly deaf. So you may well be thinking — the figures just don’t add up, why so many profoundly deaf people and so few cochlear implants?
Well, obviously a cochlear implant is not going to suit everyone. But the main reason for so few cochlear implant procedures is a lack of funding. There simply isn’t enough money to go round in the NHS for cochlear implants — deafness, after all, isn’t life threatening like heart disease or cancer.
The pro-cochlear implant lobby does not want to take money away from other treatments or operations. They just want a fair share and that is obviously not happening.
What is worse is that the funding situation varies from one part of the country to another, from one Primary Care Trust (PCT) to another. This is known as postcode lottery funding.
Cochlear implant funding in the UK
There are now 24 adult and paediatric cochlear implants centres in the UK but it would be invidious to put them into a table because implant rates at the centres vary due to their geographical position and the size of population that they serve. But it is interesting to note, in passing, that in 2005, Manchester headed the UK league table in terms of the number of implant treatments, followed by Nottingham and then the RNTNE in London.
A total of 571 implant treatments were performed across the UK in the calendar year 2005 (the map on the left shows the total number in each area). The 571 implant treatments shows an increase of 13% on the 2004 figures. This is encouraging, but still modest in terms of the overall demand level and the length of waiting lists.
In 2005, 239 adults were implanted and 332 children, compared with 225 adults and 280 children in 2004. Here the larger growth in paediatric implantation, up 19%, is welcome and reflects the increasing neonatal referrals from the now standard post natal screening process. Unfortunately this may, in part, have been at the expense of the adult implantation rate, which has increased by only 6%.
These patterns are not, however, uniform and regional differences exist as shown below.
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The funding allocations outside England are centrally controlled by the Welsh Health Authority, the Scottish Medical Executive and the Northern Ireland Authority respectively. This regional control of precious funds is more effective in the circumstances as the results in the graph above demonstrate. The UK implant rate per million of population was 9.5 nationally for the calendar year 2005, whereas it was 14.0 in Northern Ireland and 11.5 in Wales.
Funding allocations
While the majority of implants in the UK occur within England, the funding allocations here are handled by 302 individual Primary Care Trusts (PCTs) and the variation in funding translated into implant rates per numbers of population shows enormous variations.
Due to the large number of authorities involved it has not been possible, at this juncture, to construct any sensible information about this critical topic. However, it is known that some PCTs budget and provide funds for an implantation rate as high as 43 patients per million of population whereas others have abysmal rates.
This is because of the postcode lottery situation in which, in some areas of England, PCTs do not even fund adult implants at all.
A European comparison
While some may not welcome comparisons abroad, it is worth examining the position across Europe.
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The NCIUA is a member of the EURO-CIU (Cochlear Implant Users Associations across the EU). Data is collected from all the members and the topline figures of those members, for 2004, are shown above. These are the cumulative implant levels at the end of 2004 and here the UK lies well down the table in seventh place.
• Whilst the basis of cochlear implant provision varies from one country to another, all include the State element in the funding provision, so comparisons to the UK are meaningful.
• Germany are league leaders in this subject and whilst they aspire to still higher implantation rates, in general terms they do implant to satisfy a clinical need as opposed to the artificial rationing system situation that appears to exist in the UK.
• Funding alone is not the sole issue in the provision of cochlear implants. Implant centres comprise of ENT professionals, audiologists and speech & hearing therapists, and the staffing levels of these components can also be a constraint on service provision. ENT News (a magazine read by ENT professionals) Jan/Feb 2005, gave a table of ENT physician staffing levels across Europe. Expressed as the numbers of physicians per thousand of population, the best figures were 1 in 16 for Germany, 1 in 20 for Austria, 1 in 30 for Sweden and, 1 in 66 for the UK.
Source: NCIUA. The NCIUA is an organisation which represents all cochlear implant users in the UK. It is open to all implant users, their family and friends. The organisation is particularly active in a number of initiatives, including the chance (or lack of chance) of receiving an implant dependent upon where you live, otherwise known as ‘postcode lottery funding’.
