Paediatric Scoliosis Services: Statements

I welcome the Minister of State at the Department of Health. The Minister of State has six minutes.

On behalf of the Minister for Health, I welcome the opportunity to address the Seanad on this important matter. At the outset, I acknowledge that waiting times for many hospital procedures and appointments are unacceptably long. I am acutely aware of the great distress that this causes patients and their families. I remain committed to working to reduce waiting times for patients and bring them in line with Sláintecare targets. It is of particular regret that children can experience long waiting times, especially for time-sensitive procedures such as scoliosis treatments. I remain acutely aware of the impact that this has on children and their families. The priority of the Minister for Health, and that of the Government, is to improve waiting times for all patients accessing hospital treatment. Reducing paediatric waiting lists for orthopaedic procedures remains a priority within that.

Through investment in 2019, Children's Health Ireland achieved the delivery of the target of 382 spinal treatments. Activity levels were significantly impacted in 2020 as a result of the Covid-19 pandemic. Despite these challenges Children's Health Ireland delivered 322 spinal treatments, of which 163 were spinal fusions. Overall scoliosis activity figures for 2020 were 16% lower than the previous year despite significant social distancing measures, and infection, prevention and control requirements. By the end of October 2021, 295 spinal surgeries had been carried out, which is a significant increase on the same period last year when 255 spinal surgeries had been carried out. This activity level was achieved despite the ongoing challenges of Covid-19, and the very serious and significant impact that the cyberattack had on the services of Children's Health Ireland in May.

The Department of Health, the HSE and Children's Health Ireland have worked to deliver improved paediatric orthopaedic services and enhanced access to scoliosis services. In 2018, Children's Health Ireland, previously the Children's Hospital Group, was provided with an additional €9 million in funding to address paediatric orthopaedic waiting lists, including the provision of scoliosis services. This funding is recurring and has been provided in the base HSE allocation each year since 2018 to fund orthopaedic services. The additional funding supported the recruitment of approximately 60 whole-time equivalents, WTEs, in 2018 and 2019 to enable the expansion of paediatric orthopaedic services. The posts relate to the multidisciplinary team at diagnosis, pre-assessment, during surgery in theatre and post-operatively. The posts include a number of grades and specialties, including consultants, registrars, radiographers, clinical nurse managers, staff nurses, physiotherapists, occupational therapists and associated administrative posts. The most recent appointment was an orthopaedic consultant with a special interest in neuromuscular conditions who started in the Temple Street in September.

Only the post of consultant neurophysiologist remains vacant. A recruitment campaign commenced in October 2021 and, in the interim, there is a contract with a specialist service provider.

The orthopaedic implementation group was established in 2018, as was the scoliosis co-design group. Representatives of Children's Health Ireland, the orthopaedic spinal team and advocacy groups continue to meet as part of the co-design framework on a quarterly basis. The central aim of the group is to assist in the design of a contemporary values-based and patient-centred approach to service delivery in scoliosis services. Children's Health Ireland has advised the Department of Health that work with the advocacy groups is under way to strengthen disengagement and to develop more positive communication with the advocacy groups, including the Scoliosis Advocacy Network and patients' families. Scoliosis activity is just one element of the wider orthopaedic services provided by Children's Health Ireland, accounting for approximately 70% of orthopaedic activity and children with a range of needs rely on the orthopaedic services of Children's Health Ireland, for example, children with spina bifida, hip deformity and other orthopaedic needs. The complex needs of these children remain at the forefront of service provision.

Of the children who receive a diagnosis of scoliosis, not all are referred for surgery, with other treatment options in the form of orthotics or spinal bracing also used, as appropriate. All patients referred to the inpatient waiting list for surgery require a preoperative work-up prior to spinal surgery, including multi-diagnostic investigations and review by a multidisciplinary team. The plan of care which is implemented for each patient is tailored to best meet the patient's clinical requirements and the complexity of a child's total medical conditions dictate the level of planning and preoperative work and time needed.

Children's Health Ireland has developed a new fast-track pathway as part of the outpatient reduction plans and paediatric active clinical triage has been introduced for those waiting for the longest time, 12 months or more, on the paediatric outpatient list. This has reduced the number of long waiters from 987 to 403 since the start of October 2020.

All of these examples highlight the focused work being carried out to improve orthopaedic services for children and the Government remains committed to improving access to these services, particularly for the children awaiting time-sensitive procedures. I thank the Seanad for this opportunity to update the House on this service.

I thank the Minister of State for outlining those facts and figures. As he said on several occasions, this is time-sensitive surgery. Any delay is crucial to the well-being of these children and the outcomes of the surgery. Everybody here has heard from families in our communities and around the country who are, unfortunately, waiting unacceptable lengths of time for the proper surgery. On top of dealing with the condition and the challenges the condition presents for very young members of our society and their families, they are dealing with the stress and anxiety of not knowing when they are going to get the appropriate treatment. Parents can see their children deteriorating before their eyes every day.

While there has been an improvement, it is still the position that children and their families must take to the national airwaves to get the treatment to which they are entitled. That is not acceptable. It is traumatic, undignified and unnecessary. Families should not have to go and talk about this very difficult and private health situation on the national airwaves to get a bit of action. I do not think there is any lack of commitment on behalf of the Minister of State, the Minister, Deputy Donnelly, or the medical professionals. I and my colleagues have raised this matter within our own parliamentary groups and in this Chamber. We are constantly told that the delays are not the result of a lack of money and the money is there. It is obviously a lack of joined-up thinking between the specialists, the Department and the primary carers.

I would like to make a suggestion that might improve the situation. There should be an official within the Department of Health with whom families can link in. That person should then liaise with all the others involved. These families are dealing with enough. It is a busy enough time when someone has young children but if a child has additional and complex health needs, it is a very busy and difficult time. Those parents do not have time to go chasing up and trying to co-ordinate different medical professions. They should not have to do that. It is unacceptable that this extra stress and strain is placed on families who are going through challenging times with their children. It is undignified that small children must deal with the stress and worry, and take to the national airwaves to get a bit of action. I do not want to see any more families forced into that situation.

I acknowledge a commitment has been made and I trust the Minister of State when he says waiting times have improved. He also reference he made to different co-ordinations. I understand we are dealing with a pandemic and the aftermath of a cyberattack. All of that is immaterial if one has a child with a serious and deteriorating medical condition. If we cannot pull out the stops, as a developed and wealthy state with modern health facilities, I do not know what we can do. I hope we will not discuss these figures and beg for action again in the future. Some of the affected families are listening to this debate and I am sure they do not want to sit there and bang their heads off a brick wall again while they watch their children deteriorate before their eyes.

I welcome the Minister of State to the House. He has a difficult task because he has come to this Chamber not once but twice to convey I do not know what to this House. I submitted a Commencement matter relating to scoliosis on 19 October in the hope the Minister would come to the House. I printed it off earlier because I wanted to read it again. Of course, the Minister could not come to the House. He is a busy man, and I appreciate that. The Minister of State, Deputy Feighan, came to the House instead and the same Minister of State is here today. The transcript from that date reads better than the speech he was given to read into the record today.

I welcome the parents and people involved in the Scoliosis Advocacy Network and support group who are tuned in tonight. Many of us have received emails from them over the past few days. I wrote to them and told them this debate was going to happen. I thought the Minister would be here because that was my initial understanding. I raised the issue with the Minister of State during that Commencement matter on 19 October and told him how disappointed we were. We did not want a history lesson then and we do not want one now. I do not mean to be argumentative with him because I have a lot of time for him and respect him greatly. He is, ultimately, given a briefing note and must come to the House and deliver the message. We do not want any more history lessons; we want answers.

On a recent episode of "Today with Claire Byrne", the co-founder of the Scoliosis Advocacy Network, Ms Claire Cahill, said there had been no engagement with the Minister for Health despite repeated requests. I raised it as a concern at that time. The Minister of State is not in a position to tell me now whether the Minister has engaged with that group. I put on the record of the House what those people had told me. They said they had difficulty engaging. I then asked that we would have further meetings and was told by the Department and the officials that it was not possible because the Minister was under pressure. I also understand that. However, today was set as the date for an engagement and there was an expectation that the Minister could come to the House. I understand he cannot be with us, but I would have thought he would have equipped Deputy Feighan or another Minister of State in the Department with an answer.

The people want no more history lessons. They do not want any more hysterics or promises. They certainly did not find what it helpful that the Taoiseach, when asked about this issue, said that the delays in treatment are not because of the lack of resources but reflect a systemic failure. What does "systemic failure" mean? I know what it means. What is he saying? If this issue is not about resources but is the result of a systemic failure, how he is going to address the systemic failure? How are we going to deal with the families? Their children are in agony. When I spoke to the Minister of State in October, 172 patients were waiting on the list. We heard excuses about the cyberattack and Covid-19. We are talking about paediatrics.

We are speaking about the hospitals in Crumlin and on Temple Street. We are speaking about specialist hospitals doing specialist care with children. Why are people waiting? No disrespect to the Minister of State but he has come in here and spoken about what was done in 2018 and 2019 in his speech. Towards the end of his speech he mentioned the 2018 investment. For God's sake, I am not interested in what happened in 2018. I would like to think all of those children have been treated but, as the Minister of State and I know, they have not all been treated.

What is important today is what the people want. They want to meet the Minister. This is the message I want the Minister of State to take back. I am putting everyone on notice that I will stand here next Tuesday to ask somebody to tell me whether the Minister has agreed to meet them with the date, the venue, the time and what will happen. People want a timeline for these operations and no more excuses. What is happening? They do not want to know what we did in 2017, 2018, 2019 and 2020. They want to know what we will do for these children now in 2021 and 2022. Let us be upfront with these people and stop making excuses. One thing these people have is the support of their organisations and their families. They want to support their children. More importantly, they have support of the surgeons, the nursing staff, the occupational therapists and all of the rehabilitative staff involved in treating the children.

These are young children with scoliosis. Does another mother have to push a pram into RTÉ to go on "Drivetime" or "Prime Time" and pour out her heart, tell her story, bring her child to the front and make an example of him or her to beg this coalition Government of three parties, Fianna Fáil, Fine Gael and the Green Party, for assistance? Let us have some humanity for people and their children and give them the treatment they deserve. The Minister of State was sent in here to read the same old story with a history lesson of what they did, when today there are more than 160 people on the list. What can the Minister of State say to the parents looking in here? Do they have to go back on Joe Duffy and other programmes next week?

I respect the Minister of State. I know he is supportive. I know he is a decent man and a decent politician. He has children. He knows what we are speaking about. We all know what we are talking about. Let us call a spade a spade. Give these families the support and timelines they need to plan to have essential treatment for their children. Above all, please go to the Department tomorrow and ask the Minister, Deputy Stephen Donnelly, whom I also respect, to shape up and meet the people and tell them the timelines for the treatment of their children. It is reasonable and it is fair. This is all I request.

It is good to see the Minister of State back in the House. I know he had a difficult couple of weeks. He had all our best then and we are genuinely delighted to see him back. He is a colleague who served with us and who has public service at the forefront of everything he does. He is here this evening for a difficult debate. I do not disagree with anything said by Senator Boylan because he is correct. It should not take a child - not the parents but the child - having to go on the media at budget time to speak about the pain he suffers, how debilitating and difficult it is and how he is constantly in pain. I heard live the two Ministers the following day responding to it. They responded in a very humane way and I would expect nothing less from either of them. We are raising this issue and it is on the agenda because we really need results. I sincerely hope the young chap in Cork is getting the treatment he should have received long ago.

The other 160 children also need to get their treatment without delay, without complication, without difficulty, without having to go public and without having to share their story with others. We are a society. We are a First World country. We are one of the most successful countries in the world. We do things well here but we are not doing this well and we really need to because it is what our young people deserve.

We all know that when interventions are delayed it has an effect, particularly in young people. I know this from my knowledge of eye difficulties and the challenges young people face. If their eyes are dealt with very quickly there is some chance they will retain most of their vision, but if a procedure is delayed unnecessarily it will have a profound effect. It is not rocket science; it is very simple and clear.

People have emailed all of us about this and rightly so. People from Clare, Cork, Tipperary and Kerry have shared their stories with me by email. I read them all and my heart went out to them. They are now coming together as a group and they are doing so very successfully as we are here having this debate. It is no use unless we get a result. We need a result for these young people. They deserve it. Our society deserves to do better. The "Late Late Toy Show" will be on Friday night, which is great and people will spend time with their children. This is simple stuff and we need to make sure it happens. I know of the Minister of State's commitment to it. I know he will send the message up the line.

It is lovely to see the Minister of State. I hope he is on a good road to recovery. All the eloquent speeches in the world are not as good as the words of a mother so I will put on the record of the House an email I received this week.

I am writing to you as an upset, anxious parent of my child, Callum ... living with scoliosis waiting for spinal rod treatment.

The delays in treatment times have now become a children's rights issue that was a problem long before covid and the cyber-attack. This has made the orthopaedic list worse. I see Callum deteriorate every day he is left waiting.

Callum was born on 19th February 2019. At around 6 months old we noticed something was not right with his back and our GP referred us to Temple St for assessment (x-ray, MRI). Mr Connor Green, who recently advocated so passionately for Irish children at the Oireachtas Health Committee, diagnosed Callum who is now nearly 3, with early onset idiopathic scoliosis. Initial treatment involved casting Callum which we did twice. However Mr Green had to halt that process and move instead with a plan to do spinal rod surgery. Callum has been on the waiting list for his first set of rods since February 2021. His curve back then was around 55 degrees. We don't know what it is now, only that is worse. As the curve continues to increase in magnitude, this-limitation in respiratory function will shorten Callum's life period. We were originally told he would be seen no later than July/August. It is now November and we still have no date. The wait is agony as I hope you can imagine. We live in limbo with constant uncertainty, worry and stress. Callum is so small. Every day that passes is a lost opportunity.

Children's Health Ireland has submitted plans that require funding from the HSE, to help alleviate the pressure on Temple Street and Crumlin.

I would like you to ask Health Minister, Stephen Donnelly [who sadly is not with us, with all due respect to the Minister of State] and Paul Reid, CEO of the HSE if the funding will be approved? Can they guarantee that this will be approved and when? Callum like many more children need help now and this desperate crisis resolved sooner not later. We need you to continue to ask these questions from those that hold the key to the funding.

Callum does not have time on his side. Growth is not his friend. We have some of the very best surgeons in the world, PLEASE let them do their job before they go elsewhere to do it.

The Minister of State is very welcome. We are constantly standing up here to speak about cherishing all of the children equally. This is a classic case where we are failing to do so as a country. In October, 170 children were on a waiting list for scoliosis surgery. None of the explanations give much solace to a parent such as the one quoted by Senator Seery Kearney. It is really frustrating for us but it is 1 million times worse for a family that has no control over the situation.

Such families would do it themselves if they could but they are reliant on the State for this type of surgery. I believe that both the Minister of State, Deputy Feighan, and the Minister for Health want to do their very best but, as many have outlined, it is beyond time for action. I have heard some of the explanations involving Covid and the cyberattack, but this has been ongoing for years. People have been saying for years that they are waiting. What really hit home for me is that growth is not these children's friend. That is what makes this different, what makes the waiting lists for scoliosis surgery different from those for other types of surgery and what makes this so urgent. I know that €250 million was put into the budget for 2022 to deal with waiting lists, and that was really welcome, but it seems to me that there are a number of problems here. One is the shortage of consultants and nurses, another is that the facilities and infrastructure are not up to scratch and the third is beds.

As for consultants and nurses, there are no orthopaedic surgeons all along the west coast of Ireland. That has to be addressed first. It just shows that there are facilities that could open their doors for this kind of surgery but just cannot at the moment because they are not getting the support. This issue has been before the Joint Committee on Health, and Connor Green spoke eloquently about it and outlined the real, heartbreaking stories of families. I will not repeat those stories here. They have been outlined by previous Senators and I am sure they will be again. I know that the Minister of State hears them because we have all been hearing similar stories for many years.

This debate is really welcome because it is the right thing to do to bring this topic to every single forum we can in order to address it. I commend Senator Boyhan, who I know brings up this issue frequently and who had asked for the debate, and thank the people from all parties who have engaged in this conversation, put down parliamentary questions and Commencement matters and brought the matter to the Oireachtas Joint Committee on Health. I absolutely concur with some of my colleagues that now is the time for action and that we have to see the delivery of services as soon as possible. I completely understand that in every single area there are waiting lists, but I ask the Minister of State to remember the point about why this one is so important, that is, because it is to do with growth and children's development. That is why it is critical.

Cuirim fáilte roimh an Aire Stáit. I think this is the first opportunity I have had to engage with the Minister of State, Deputy Feighan, since he took up his appointment, so I welcome the opportunity to do that and welcome him back to the Seanad.

I will begin like Senator Seery Kearney. Joanne Rodgers's email will form an awful lot of my remarks because they are impactful. While probably a lot of what I will say has been said by Senator Seery Kearney, it will not do any harm to reassert her words and, through Joanne's words, the lived experience of so many families. I am very conscious of that. I am very conscious that when Jim from my office asked Joanne whether she would mind if we shared her story, it is not just their story alone and that, as other colleagues have said, this is the experience, unfortunately, of so many others.

Callum Rodgers is nearly three years old. He was born on 19 February 2019, and at around six months his parents noticed that something was not right with his back. He was referred to Temple Street Hospital. There, Mr. Connor Green diagnosed Callum with early onset idiopathic scoliosis. Callum was initially placed in a cast on two occasions, but the doctor moved speedily to carry out spinal rod surgery. Callum has been on the waiting list for his first set of rods since February 2021. Then the curve in the child's back was about 55°. The family do not know what it is today but they do know that it is worse. Callum's mother, Joanne, sent an email describing her son's worsening condition. She said:

As the curve continues to increase in magnitude, ... [it] will shorten Callum's life period. We were originally told he would be seen no later than July/August. It is now November and we still have no date. The wait is agony as I hope you can imagine. We live in limbo with constant uncertainty, worry and stress. Callum is so small. Every day that passes is a lost opportunity.

...

Callum does not have time on his side. Growth is not his friend. We have some of the very best surgeons in the world. PLEASE let them do their job before they ... [move] elsewhere to do it.

Ms Rodgers's emotional email is about her son but she also makes it clear in the email that he is not alone. She says, "Callum like many more children needs help now." There are nearly 44,000 children with orthopaedic conditions such as scoliosis, spina bifida, cerebral palsy and hip and limb deformities. Callum's mother specifically appeals to the Minister for Health, Deputy Stephen Donnelly, and Paul Reid, the CEO of the HSE, for funding for Temple Street Hospital, where Callum is being treated. Nearly five years on from the Ombudsman for Children's highly critical report on failures to treat scoliosis in a timely fashion, these professionals on the front line are still saying there are deficiencies in specialist staffing levels, access to and the number of surgical theatres and a lack of safely staffed paediatric critical care and high-dependency beds.

When Callum's doctor, Mr. Green, attended the Joint Committee on Health a few weeks ago, his remarks were hard-hitting and alarming. He described a dysfunctional system, inadequate to the task and in a chaotic state, which is "failing our children". He rejected claims that this was so because of the pandemic or the cyberattack because the shortcomings were there before both, although the pandemic and the cyberattack have made a bad situation worse. It is quite clear from what we are being told that not enough has been done in the past four or five years to boost capacity in paediatric orthopaedics for the treatment of scoliosis, spina bifida and other conditions. Children like Callum and many more are being left in pain, waiting too long for treatment and up against cancelled procedures because of a lack of reserved beds. Long waits and cancellations, along with the conditions themselves, have a real psychological toll on the children affected and, of course, their families. Mr. Green said we need to resource our ICU staffing better, we need to ring-fence an intensive care bed before elective surgery and we need to support our intensivists and recruit more of them in order to look after patients afterwards. He also urged the Government to be honest with the families of children facing scoliosis and other orthopaedic problems and not to mislead them that the prospects of improving the system can be done by next year. The families are carrying enough emotional pressure and stress without false hope being added. Mr. Green said he fights one day at a time and tries to get to Friday.

I urge the Minister of State and, through him, the Minister, Deputy Stephen Donnelly, to listen to Callum Rodgers's mother and other families like hers, to listen to Mr. Green and other professionals like him, to collaborate with them and implement a credible plan for the more than 44,000 children and their families and to end the widespread uncertainty and worry by resourcing the health service and the professionals to do the job we all know they are not only keen to do but more than capable of doing.

As other colleagues have said, we need no more retrospective statements. We need a timeline outlined. We need the Minister for Health to meet with the families and listen directly to their concerns. As has been said, and as I am sure all colleagues across the House will agree, we just need to help these children. I do not want to play an emotional card. The Minister of State has a job of work to do in his Department, and I appreciate it is not an easy one, but there are children suffering out there and we are being told that constantly. Their stories are being shared. We know historically the damage it does when we let generations of children suffer. I would have thought that as a society we have woken up to the trauma and the harm that does transgenerationally. While I appreciate entirely that these are different circumstances, the fundamental issue remains the same. There are people out there who are in need of urgent help and who are worthy of our help and, because of that, we really need to do more to act now.

I thank the Minister of State for coming here to listen to the debate on this very important issue. I compliment all the people who have sent us emails highlighting their experiences and what their children are going through.

We are all here as legislators but, at the end of the day, children and their futures are really important to all of us. Scoliosis and other orthopaedic problems can have an awful impact on children as they grow up.

In 2013 or 2014, a number of people I know personally were impacted by scoliosis. At the time, when I engaged with the surgeon and the various healthcare staff, it was not even about funding. Rather, it was that theatres were not available and that was a big issue. My understanding is that is what the problems relate to now. At that time, the Minister of the day engaged with surgeons, lobbying groups and parents on behalf of children and provided funding to other hospitals in order that minor surgeries that needed to be carried out could be transferred to them, which freed up time for these surgeries to be carried out. I recall the case of a girl who was about 13 years of age. She was undergoing a growth spurt and her height grew but her body did not grow with it, and that was the problem. She was told that if the issue was let go much longer, she could end up needing to use a wheelchair. Her condition was very serious. She underwent surgery in Crumlin hospital, however, because people with less urgent needs had been moved to other hospitals to free up theatres. Perhaps this is something the Minister of State could propose to the Minister for Health for consideration. I am sure theatres are available in different hospitals. I am not suggesting sickness is ever minor but sometimes certain surgeries can be carried out in other hospitals. My understanding is that surgery for scoliosis requires certain machinery, so it cannot be carried out in every theatre.

This is a serious issue affecting many children throughout the country and, as Senator Pauline O'Reilly said, nobody on the western seaboard is dealing with this. Children from the west, the mid-west and the south have to travel to Dublin for surgery, so spreading out the treatment should be considered. Moreover, there is a shortage of specialised surgeons and nurses to support that and it needs to be seriously examined. We cannot afford to allow children at that age to be left with debilitating conditions. Some of them end up needing to use a wheelchair. Having read some of the stories, I know the real-life experiences can be harrowing, not only for the children but for their families as well.

I acknowledge the Minister of State's commitment and know he will do his best, but he might consider some of the proposals I have outlined to reduce the waiting lists.

I welcome the Minister of State. I will be brief, given much has been said. The fact is we are again talking about this issue in the House but we should not be. We should not have to stand here, time and again, on behalf of families and make phone calls on their behalf. As Senator Maria Byrne noted, their children are becoming disabled because of a failure of the State and the HSE to do their duty and undertake these critical operations. This has been going on for so long. There are many different reasons, excuses and problems. The HSE, the doctors and the medical staff know what the problems are. They have come to the table with many remedies and actions - far more than any of us in this Chamber or the Department of Health. If the resources are provided, we can get the operations done, save these wee children's lives and improve the quality of life for them and their families. It is as simple as that.

It is outrageous that, time and again, we discuss in one of the Houses or at committee meetings the issue of failing our children. Our previous debate this evening related to children in care. At the Joint Committee on Disability Matters, we have discussed the State's failure in regard to children’s assessments of need and access to therapy. Again and again, the most vulnerable, that is, the people who cannot shout out, rely on the State to provide care and it is not providing it.

I accept the Minister of State is not the line Minister for this. I will raise this issue at my parliamentary party meeting as well because this has gone beyond statements. We need actions.

I reiterate my thanks to the House for the invitation and the opportunity to discuss the issues surrounding access to paediatric orthopaedic services. The Government remains committed to improving access to all types of healthcare, both in the community and in primary care settings, as well as in the acute hospital sector. Improving paediatric orthopaedic services remains a priority within the wider reform and improvement of healthcare services. As noted during the debate, it is critical that paediatric orthopaedic services be provided with the levels of capacity and staffing needed not only to improve waiting times but to address the backlog in demand. Senator Clifford-Lee stated there should be someone in the Department of Health who liaises with families. That is an interesting and innovative idea I will convey to the Minister-----

A sort of a one-stop shop.

Yes, possibly.

Children's Health Ireland, CHI, continues to examine and implement new and innovative ways to provide orthopaedic care to patients. The strategic alliance between CHI and Cappagh orthopaedic hospital is considered a key to CHI being able to address the current challenges to access elective and age-specific orthopaedic care. CHI has advised the Department of Health that the HSE has agreed to the proposals to recruit additional paediatric theatre nurses and additional support.

Senator Boyhan proposed arranging a meeting with the Minister and indicated he wants to hear timelines for treatment at that meeting. I will convey both those to requests to the Minister. Senator Ó Donnghaile made a similar point.

I welcome the expansion of paediatric orthopaedic services this year at Cappagh orthopaedic hospital and the appointment of a paediatric clinical director to provide clinical governance to this service. This strategic alliance will be of great benefit in the interim as CHI prepares to move to the new children’s hospital. CHI has informed the Department of Health that in 2022, it plans to undertake 196 day cases, 540 inpatient appointments and 1,200 outpatient appointments at Cappagh orthopaedic hospital.

Senator Conway articulated the difficulties of children having to appear in the media and stated he wants to get results in respect of treatment for young people, something with which I very much concur.

Cappagh orthopaedic hospital is not the only additional resource being used to improve access to paediatric orthopaedics. The HSE has a procurement framework in place seeking additional private sector capacity, including for patients with scoliosis. It should be noted, however, that scoliosis procedures require detailed pre-operative, multidisciplinary planning to meet the needs of the patient. The complexity of scoliosis surgery and the specific medical staffing and infrastructural needs for such procedures mean outsourcing to private hospitals is not often a suitable alternative. In addition, private hospitals with a facility to treat patients are limited. For these reasons, it is of central importance that CHI and the HSE continue to invest in additional capacity and staffing for orthopaedic services. I look forward to the benefits the opening of the new children's hospital will bring to orthopaedic services and wider paediatric services.

Senator Seery Kearney outlined the case of Callum Rodgers, his difficulties and the fact he was due to be seen in July or August but still has not got a date. Senator Ó Donnghaile mentioned his case too. I will raise it with the Minister.

As has been said, Callum does not have time. I hope we can get more urgency in respect of this matter. We have tried to investigate what is happening there.

In terms of accessing other forms of additional capacity, Children's Health Ireland has advised the Department that recent experience has demonstrated that previous strategies that looked at outsourcing spinal patients to external providers in the UK and Europe have not been overly successful. This is primarily because spinal patients often require additional follow-up and the management of post-operative complications on return to Ireland. Such issues are also now compounded for patients by the need to travel overseas, especially during Covid-19. As a result, it is imperative that we continue to seek solutions within the current health system to provide the activity and services needed to reduce orthopaedic waiting times.

Senator Marie Byrne mentioned that there should be funding for other hospitals to free up theatres. Hopefully, we can work on that. Senator McGreehan said that the HSE needs to do its duty and get these appointments done.

Senator Pauline O'Reilly mentioned that surgeries need to be spread out because there are no surgeons in the west, the mid-west or the south west. This is an issue that needs to be addressed.

Any plans to improve waiting times are reliant on good-quality, accessible and transparent data. Improving the waiting times that children experience is just one element of a wider plan to reform and improve acute hospital waiting lists.

To support the work of the task force, €350 million has been committed to improving waiting times in 2022. The latter includes €200 million in additional funding for the HSE. In addition, there is funding of €150 million for the National Treatment Purchase Fund.

I would like to conclude by reaffirming the Government's commitment to improving the waiting times that children and all other patients experience when accessing hospital appointments and procedures. Through continued investment and detailed and strategic planning, we will continue to dedicate time and resources in order that patients will not be left waiting on lists, but, rather, will be provided with their procedures in a clinically suitable timeframe and in line with the targets provided for in Sláintecare.

Sitting suspended at 7.33 p.m. and resumed at 8 p.m.