University Hospitals Birmingham NHS Foundation Trust (UHB) completed a merger by acquisition of Heart of England NHS Foundation Trust (HEFT) on 1^st April 2018.  For the purposes of this request we have answered on behalf of the pre-merger UHB i.e. Queen Elizabeth Hospital.

Freedom of Information Request: FOI 0373

This FOI relates to the Queen Elizabeth Hospital Audiology Centre.

We seek to determine the price paid to providers of cochlear implant services for elements of the care pathway (outlined in D09/S/A NHS Standard Contract for Cochlear Implants. Schedule 2. Service Specifications*). Specifically, we seek to determine the price paid to providers for elements included in the care pathway that are not covered by the National Tariff payment for cochlear implant (HRG42 and HRG41).

* https://www.england.nhs.uk/commissioning/wp-content/uploads/sites/12/2014/04/d09-ear-surg-coch-0414.pdf

Please could you provide the price paid to the cochlear implant centre for:

1. A multi-disciplinary assessment prior to cochlear implant surgery:

• What is the price paid per patient to the centre for this assessment?

First attendance Multi Professional £149

Followed by Audiology appointment (£0) and clinical decision appointment  £1,068.34

• Is this price altered if the patient is being assessed for unilateral or bilateral implants?

No, the tariff is based upon attendances.

2. Annual maintenance payment for rehabilitation and continuing care from 12 months post-implant surgery:

• What is the annual price paid to the centre for the maintenance (rehabilitation and continuing care) of a patient with a cochlear implant? £1987.24
• Is the price paid per ear or per patient? Per ear
• Which elements of the care pathway are included in this price? This covers all routine  audiological aftercare associated with the implant and maintenance so will include any audiological follow up, hearing therapy, all repairs, reassessment and timely upgrade of device approximately every 5 years. It also Covers any loss of devices or damage beyond repair that are not covered under warranty
• Which elements of the care pathway are not included in this price?  Further ENT Activity, ENT Outpatient Procedures, ENT Revision Surgery, Non CI Audiology work such as provision of bi-modal hearing provision.
• Does the annual maintenance payment vary according to time since implant surgery? If so, how? No
• Does the annual maintenance payment vary according to patient-related factors, such as co-morbidities? If so, how? No
• Is the payment paid according to activity/number of patients (PbR) or block funded on an annual basis? It is a fixed payment per ear, paid on a cost per case basis
• If paid on an annual basis, please provide the annual amount budgeted per patient/ear for rehabilitation and continuing care. Please specify if this is per ear or per patient. £1987.24 (per ear)

3. What percentage of cochlear implant users under your care do you see for review:   
4. annually?
5. at two yearly intervals?
6. at intervals longer than two years?
7. there is no regular attendance pattern and patients are seen in clinic only if and when required?

We do not hold this information. However we can tell you that based on 2017/18  the data indicates that over 70% of patients had an annual review.  All patients are offered annual review, patients commonly attend more frequently than annually for repairs etc.

4. Does the cochlear implant centre receive an annual maintenance payment for the ongoing care and maintenance post cochlear implant surgery regardless of whether or not a patient attends an annual review? Yes, all spares, repairs and upgrades of the implant are managed regardless of in person attendance.