The idea that funding for bilateral CIs will reduce resources for unilateral CIs assumes that resources for deaf patients can only be considered at the expense of other deaf patients. If PCTs were to take such a ring-fenced view, they would never be able to respond properly to the needs of different patient groups or ensure that they were making the best use of their resources to deliver cost-effective healthcare by evaluating all health expenditure. Such a position would be absurd from any rational view of public health which requires consideration of expenditure across the board.

Many countries are already commonly funding bilateral CIs including countries where health expenditure as a proportion of GDP is actually lower than the UK such as Spain. As we show in ‘funding facts’, there is considerable scope for a significant expansion of access to cochlear implants as well as the provision of bilateral CIs for all patients who need them. The cost of such a CI programme is dwarfed by the amounts of money that the Chief Medical Officer says is currently being wasted on ineffective treatments.

Even though all four CI manufacturers offer discounts of up to 50% on second (bilateral) CI devices, the study of cost effectiveness commissioned by NICE makes the assumption that the device cost of bilateral CIs is double that of unilaterals. The current reality is that device costs are often only 1.5 times that of a unilateral, whether it is a simultaneous or a sequential CI operation. There are further synergies to be gained from adopting a bilateral patient model, for example in audiological management and administration.

There is nothing ‘experimental’ about either cochlear implant technology or the goal of binaural hearing. Cochlear implant technology has been established for some two decades. Bilateral CIs are increasingly common in other countries and there are now over 3,000 people using bilateral CIs, 1,800 of them children. binaural hearing is the mode of hearing that the human brain is designed for and is essential for sound localisation and good speech perception in busy environments.

This myth has been expressed and its proponents come close to saying ‘profoundly deaf people should feel lucky to hear with one ear alone’. Profoundly deaf children and adults appear to suffer the distinction of being the only patient group where modern healthcare has the ability to equip them with full or near-full functionality but denies them. Bilateral CIs are vital for many of the key dimensions of hearing, particularly those that are vital for people to participate equally in the busy and bustling world of education, work and social life. The NHS would not prescribe just one hearing aid for someone who was bilaterally mildly or moderately deaf; it would not prescribe just one lens in a pair of glasses; perform corrective eye surgery on just one eye or knee surgery on just one knee where patients needed bilateral treatment. The difference, of course, is cost but, as our ‘funding facts’ section shows, the extra cost of a bilateral CI and follow-up habilitation is only around £1 for each day of the rest of a child’s life.