I propose to take Questions Nos. 273, 277 and 278 together.
Last year, the HSE published the Scoliosis Waiting List Update and Service Development Plan, which addressed treatment for children requiring corrective surgery for scoliosis. The approach set out in the Plan included insourcing of surgical procedures in the Children's Hospital Group (CHG), and the broader public hospital sector, as well as outsourcing initiatives, including private providers nationally and abroad.
In 2017, as part of the outsourcing initiative, families were offered the opportunity to have their child's surgery abroad. CHG advise that in total as part of this initiative 28 patients have had their treatment abroad and that arrangements have been agreed with services in the UK to undertake follow up reviews to ensure those children who received outsourced surgery in the UK receive appropriate follow up care as per the agreed protocol. This will include face to face outpatient clinics in Our Lady's Children's Hospital Crumlin, in addition to phone call and Skype follow up, if needed. These reviews are scheduled according to the patient's clinical care plan.
As a result of the additional €9m provided to the HSE in Budget 2018, the CHG advise that the increased investment has started to see the service stabilise and the current capacity expand to meet the demand for timely scoliosis treatment. As a consequence, there has not been the demand to send patients abroad for surgery.
Notwithstanding, this year a small number of families were offered the opportunity to have their child's surgery abroad, but did not avail of the offer as they did not want to travel abroad. One child did have surgery abroad in 2018; this was a procedure that was due to have taken place in 2017, but which was deferred until 2018.
The CHG advise that the investment in paediatric orthopaedics this year, which includes scoliosis services, has already improved access for surgery and outpatient review. The impact of investment is now starting to deliver results, with a consistent reduction in waiting times being recorded. By September 2018 there had been a reduction of 26% in the waiting times experienced to access surgery since the start of the year. This year the CHG aims to deliver 447 procedures, compared to 371 in 2017, and 224 in 2016.
The CHG advise that details of the costs associated with outsourcing are subject to confidentiality that applies to the procurement process with regard to information supplied by bidders, including costs. The same policy also applies to follow-on costs.