Dáil debates

Tuesday, 12 March 2013

Topical Issue Debate

Cochlear Implants

6:50 pm

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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I welcome the Minister to the House and thank him for attending personally. This issue is topical. There have been interviews in recent days involving parents of children who are waiting for a bilateral cochlear implant. The debate has been passionate at times. I record the words of the mother of Anna Murphy, the little girl who featured on TV3's "Temple Street Children's Hospital" and "Ireland: AM" programmes last year following her cochlear implant surgery. Her mother contacted us and I sought permission to relay her words to the House. She said:

At present children in Ireland are implanted in one ear only, which, while fantastic that the child hears, is not acceptable as bilateral implants are recognised as international best standard. Ireland is one of the only countries limiting children to one implant. Beaumont Hospital has been begging for this funding since 2009 and the HSE acknowledged that this is best practice in its audiology report of 2009. However, after four years the HSE is still not funding bilateral implants and this is affecting 350 children in Ireland who time is running out for. These children have a window of three and five years between the first and second implant, including my daughter Anna. After this time the nerve dies and there is no hope of implantation.
We also heard from Julie Anne Cunneen who spoke passionately on behalf of her son, Liam. I realise that times are very difficult with the budgetary position that the Minister is faced with on a daily basis but we must act if we are to allow children to reach their full potential. By allowing only implantation we are compromising their ability to flourish and their ability to fulfil their ambitions and hopes and aspirations. I recognise that advances have been made and I realise there has been a meeting with the HSE chief operations officer, Laverne McGuinness, and some representatives of children who are waiting for the second implant. I urge for this to be made a priority and for the sequences needed to be set out to ensure the resources are in place following the appointment of Dr. Gary Norman as the national audiology clinical lead.

I realise that not much can be done between now and the Estimates for 2014 but at least a process could be put in place and the services could be nailed down. Then we could go ahead with the sequential implantation and simultaneous implantation for those who are born from here on. I urge the Minister to use this opportunity to put in place the necessary procedures. I realise there will be a significant drain on resources in Beaumont Hospital because it will have to play catch up with the sequential implantations but this change is necessary and time is not on the side of some of these children. If we are to allow them to have an opportunity in life to play their fullest and most meaningful role in society then surgery for a bilateral cochlear implant is a necessity. It complies with best international practice and this fact has been acknowledged by everyone concerned.

While people welcome the fact that one implant is provided at this stage most take the view we must proceed in the interests of giving children born with disadvantage and who will confront many obstacles a better service. Giving them one implant gives them hope but by giving them two it would give them opportunity. I hope the Minister can provide a positive response to the impassioned pleas of Julie Anne Cunneen, the mother of Liam, and the mother of little Anna who spoke passionately about the need to have this programme rolled out as quickly as possible.

Photo of James ReillyJames Reilly (Minister, Department of Health; Dublin North, Fine Gael)
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I thank the Deputy for raising the issue of cochlear implantation services. The Taoiseach addressed the matter during Leaders' Questions today.

The Deputy has pointed out that Beaumont Hospital is the centre for delivering Ireland's national cochlear implant programme, with surgical provision for patients under the age of six years carried out in the Children's University Hospital, Temple Street. Since the national cochlear implant programme commenced 17 years ago more than 700 patients have received cochlear implants. I understand that in 2012 a total of 90 cochlear implants were carried out with 42 children and 48 adults Receiving implants .

In 2009 a national review of audiology services was carried out by the HSE to examine the services provided to children and adults nationwide and to formulate a national plan for the services. The report of the national audiology review group, published by the HSE in 2011, provides the blueprint for the planning, development and delivery of HSE audiology services from new-born screening to assessment and management of adults and children with hearing problems, including cochlear implantation. Two of the main recommendations in the report include the national roll-out of a universal new-born hearing screening programme and the establishment of a bone-anchored hearing aid programme. The report also included a recommendation that continued ring-fenced financial support be provided for the cochlear implant programme, but at levels which allow for simultaneous bilateral implantation for children.

While no dedicated programme for simultaneous or sequential implantation is being carried out in Ireland at the moment some bilateral implantation has already occurred for patients, mainly very young children with certain medical conditions such as a history of meningitis or blindness. It is estimated that there are approximately 200 children in Ireland today who may be suitable for a second implant. The HSE has established a national clinical care programme for audiology, which is overseeing the implementation of the recommendations detailed by the report of the review group. Progress is being made on the modernisation of audiology services in Ireland. The introduction of a universal national programme of new-born hearing screening is a key priority, the aim of which is that all babies have their hearing screened shortly after birth. One recent development has involved the appointment of a national audiology clinical lead, as Deputy Kelleher noted. In addition four assistant national lead posts have been advertised to support the implementation of the audiology clinical care programme.

The HSE is working closely with Beaumont Hospital to progress plans for both simultaneous and sequential bilateral implantation. I understand that representatives from Beaumont Hospital, HSE management and the HSE's audiology clinical care programme have met recently to discuss a joint process to identify the options for developing and resourcing a programme of simultaneous and sequential cochlear implantation. An important element of this process will be the development of clear clinical criteria to prioritise clients for assessment and follow-on implantation. Each child must be assessed to determine if he or she is suitable for a bilateral implant. The provision of information about the advantages and potential disadvantages of bilateral implantation is required to facilitate an informed decision on whether to proceed. Not all suitable patients proceed with the second implant when appraised of all the issues involved. The development of the service will require additional resources for Beaumont Hospital. I am pleased to report that these plans will be progressed through the HSE 2014 Estimates process.

Photo of Billy KelleherBilly Kelleher (Cork North Central, Fianna Fail)
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The parents of the children in question are committed to ensuring that their children are allowed to reach their full potential. Clearly what is needed in the context of the clinical lead care programme is a commitment that funding will be provided. I realise it is difficult for the Minister to give a guarantee in the House today. However, the sequential implantation process should be given priority as should the simultaneous implantation process for those born thereafter.

Time will run out for some of these children if the resources are not made available in 2014.

I do not expect the Minister to make a grand announcement today, but the priority must be the establishment of the clinical lead and the appointment of Dr. Gary Norman, followed by an assessment of who is suitable for sequential implantation. It will be a demand-led scheme for several years because if a cap is put on the amount of funding available prior to completion of an audit of suitable candidates, some children will be placed at a disadvantage. Until the backlog is addressed, all those deemed suitable for cochlear bilateral implants should be treated. I urge the Minister to make every effort to convince those who have a say in budgetary matters that it is critical to maximise the opportunities for the children concerned in their future lives.

7:00 pm

Photo of James ReillyJames Reilly (Minister, Department of Health; Dublin North, Fine Gael)
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I do not wish to make a political argument on this issue. The Deputy and I want to give children the opportunity to reach their full potential. It has not been possible to implement the recommendations made in 2009 because of budgetary considerations, but we are providing as many children as we can with single implantations in order that we can begin sequential bilateral implantations in 2014. I have discussed the matter with the director general designate as recently as this morning. High priority is being given to this matter and, without being a hostage to fortune, we will have provision to undertake the bilateral implantations next year in order to give children the best chance. I do not want any child to miss out on the opportunity to have bilateral hearing and the same chances as other children. The Estimates for this year do not allow us to immediately engage in bilateral implantations, although some have been carried out. It is a priority for me to start providing them next year and we will enter into negotiations with Beaumont Hospital in this regard.