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We would like to thank all those who submitted their views about who should be able to receive cochlear implants on the National Health Service in the United Kingdom. We received submissions from over 160 people including cochlear implant users and their parents, those unable to access cochlear implants, and clinicians who provide cochlear implantation services.
These views directly informed a national consensus meeting held in London on 9th March 2017. Representatives from over 30 stakeholder organisations attended what was a very successful day of discussions about candidacy.
A statement has now been prepared that summarises the issues on which consensus was reached.
The aim of the exercise is to bring together everyone with an interest in who should be able to receive cochlear implants on the National Health Service in the United Kingdom.
This includes adults who have received cochlear implants, the parents/carers of implanted children, individuals who have been refused cochlear implants, representatives from charities who represent individuals with hearing loss and cochlear implant users, and clinical professionals involved in the delivery of cochlear implantation services in the United Kingdom.
The goal of the exercise is to achieve a consensus within the clinical and patient communities on who should be considered eligible to receive a cochlear implant based on the latest evidence from research, clinical experience, and the lived experiences of patients.
The purpose of the exercise is to create a single unified message about who could benefit from cochlear implantation to guide any future changes to service provision in the UK.
This exercise is an initiative of the candidacy working group of the British Cochlear Implant Group.
The exercise has been designed and is being conducted by Dr Pádraig Kitterick from the NIHR Nottingham Biomedical Research Centre and Dr Debi Vickers from the UCL Speech Hearing and Phonetic Sciences (SHaPS).
On behalf of the British Cochlear Implant Group Candidacy Working Group
Cochlear implants restore important aspects of hearing in people whose degree of hearing loss means that they cannot benefit from conventional acoustic hearing aids. The British Cochlear Implant Group (BCIG) represents providers of cochlear implantation services for adults and children across the United Kingdom. The BCIG candidacy working group ran a national exercise to find out if there was agreement among the major stakeholders in cochlear implantation (patients, clinicians, national organisations, charities, manufacturers and commissioners) on who should be able to receive a cochlear implant on the NHS in the UK. The provision of cochlear implants in the UK currently follows guidance from the National Institute for Health and Care Excellence (NICE) that recommends cochlear implants for adults and children with profound deafness in both ears who do not receive sufficient benefit from acoustic hearing aids.
Consensus was reached among representatives from over 30 stakeholder organisations. The key points on which consensus was reached were:
Summary of the consensus process
The exercise involved over 30 organisations including cochlear implant centres from around the UK, organisations that represent those with hearing loss and those who use cochlear implants, organisations that represent the clinical professionals involved in providing cochlear implantation, organisations conducting research for cochlear implants, manufacturers of cochlear implants, and those who commission cochlear implantation services.
A stakeholder panel made up of representatives from those organisations were asked to indicate if they considered cochlear implantation appropriate for 600 different patient scenarios. By appropriate, we mean whether the benefits of cochlear implantation outweigh the risks. The stakeholder panel also voted on a range of statements about candidacy.
The choice of patient scenarios for consideration and statements for voting was based on responses to an online survey. The survey asked for views on who should be able to receive a cochlear implant. The survey was completed by 161 individuals including cochlear implant users & parents of implanted children, people who had been refused an implant or would like one, and clinicians and researchers.
Each member of the stakeholder panel first considered their views independently, and then met in person to discuss the patient scenarios and statements. The stakeholders were allowed to change their views after these discussions. The exercise used established scientific methodologies to identify where consensus was reached on the appropriateness of cochlear implantation across the patient groups and on agreement with the statements.
Results of the consensus process
Consensus was reached on the following points:
Appropriateness of cochlear implantation
Access to cochlear implantation
Candidacy assessment process
Audiometric definition of eligible patient groups
Determining sufficient benefit from acoustic hearing aids
Acknowledgements and disclaimers
The national candidacy consensus exercise was an initiative of the candidacy working group of the British Cochlear Implant Group. It was designed and co-ordinated by Dr Pádraig Kitterick from the NIHR Nottingham Biomedical Research Centre and Dr Debi Vickers from the UCL Speech Hearing and Phonetic Sciences (SHaPS). If you require further information about the process or the results, please contact Pádraig Kitterick (firstname.lastname@example.org) or Debi Vickers (email@example.com). Both individuals declare having previously been the recipients of unrelated research grants directly or indirectly from manufacturers of cochlear implants.
We wish to acknowledge the input of the other members of the BCIG candidacy working group: Carl Verschuur (Southampton Auditory Implant Service), Caroline Leal & Louise Jenkinson (Guys & St. Thomas’ Hearing Implant Centre), and Fiona Vickers (Cochlear Implant Department, The Royal National Throat Nose and Ear Hospital). We wish to thank all the stakeholders for their contributions.
This statement was reviewed by all stakeholders who participated in the exercise.
The costs of the exercise were met through support from the NIHR Nottingham Biomedical Research Centre, UCL Speech Hearing and Phonetic Sciences department, and the BCIG.