Dáil Éireann Debate, Tuesday - 23 October 2018
66. Deputy Louise O'Reilly asked the Minister for Health the number of children on the suspended list for scoliosis surgery; the number who have been treated abroad in 2018; and if he will make a statement on the matter. [43878/18]
View answerThe parents of children waiting for scoliosis surgery have described the manner in which the lists are treated as an exercise in manipulation, with people being moved from one list to another, and letters being sent to the parents of sick children expecting unrealistically quick replies. "Manipulation" is their word but I do not disagree with them. Can the Minister provide us with information about the suspended list for scoliosis surgery and how many children have been treated abroad?
I thank the Deputy for highlighting this important issue and continuing to return to it, as we rightly should. The development of a sustainable scoliosis service has been prioritised by my Department and the HSE in 2018. An additional €9 million was provided to the Children’s Hospital Group, CHG, in 2018 to support the development and implementation of a sustainable and safe paediatric orthopaedic service for children and young people.
The increased investment in scoliosis has brought stability to the service and the current capacity for services has expanded. The CHG advises that 446 procedures will be delivered this year, compared to 371 in 2017, and 224 in 2016. This represents a doubling of activity since 2016. I acknowledge that it is not her word, but when the Deputy refers to manipulation, we should be clear that the number of procedures being done each year is increasing and will have doubled since 2016.
Waiting list figures for 12 October show 130 patients waiting, which includes patients who have been asked to come in for a procedure, those who have been given a date for a procedure in the near future - often one needs a date that works for the patient both clinically and logistically - and those who are waiting for a date for a procedure. This represents a significant reduction of 61 or 32% in comparison to the same week last year when the list stood at 191 patients.
The CHG advises that a number of families were offered the opportunity to have their child's surgery abroad this year but did not avail of the offer. I can fully understand why this might be the case. This year, one patient has had surgery abroad having deferred the procedure from 2017.
The CHG advises that as of 12 October there were 42 patients on the suspended list for spinal surgery across the hospital group.
The placement of patients on the suspended list for surgery is a clinical decision and is made by the treating clinician in consultation with other medical professionals, the patient and their family. Patients are placed on the suspended list for clinical reasons such as being clinically unwell and unfit for surgery, requiring further investigations and procedures prior to their scoliosis treatment, or their condition being managed conservatively and not requiring surgical intervention at this time.
Families may also request a suspension for non-clinical reasons, which is also understandable.
I understand that 347 surgeries have been performed to date. The Minister gave the target for this year. To hit that, 100 further surgeries must be performed between now and the end of the year, including the Christmas period. Is the Minister confident that these will take place? To be straight with him, I would not.
I refer to the number of surgeries abroad that are offered and not taken. I have spoken to many parents who are involved in this and their advocates. They say that it is not a significant number and the factor which influences this is the availability of follow-up care here. Even where it has been offered, parents cannot avail of it without the follow-up care here which is not always available. What is the precise number? Is he confident that 100 surgeries will be performed, based on the figures to date?
I do not have the figure for how many people have been offered surgery abroad but I will get it for the Deputy quickly. I want to re-emphasise that the CHG advises that clinical criteria for determining a care plan for scoliosis-related surgeries and other spinal procedures is complex, which we appreciate, and is based on established clinical guidelines and best practice, both nationally and internationally. These are decisions being made by good surgeons who are operating in our health service.
I am confident that the hospital Group will meet the target for procedures. They did 224 in 2016. The Deputy may have asked me the same question last year, when they reached 371, and now they will build on that again to reach 446. Not only has there been additional recruitment of consultants but Cappagh hospital is also doing more work. It is envisaged that the hospital will complete 50 paediatric spinal surgeries in 2018, against a target of 39 for this year. That is a good example of increasing capacity for scoliosis surgeries in Ireland, which we need to do. This year the CHG aims to deliver 446 procedures, which represents an increase in activity of 99.5% on 2016. We have a lot more to do but we are making progress.
This is complex but complications can also arise for these children as a result of having to wait. Their condition can deteriorate to the point where surgery may not be viable. This morning, I spoke to a parent who asked what will happen to children who are left with permanent impairment as a result of delays.
Whether we accept the extent to which they are being dealt with effectively, we all acknowledge that there are delays. Will the Minister apologise to those children and consider offering them some form of compensation? Some of them will live with this damage for the rest of their lives. They are still young.
I want to draw attention again to the fact that the theatre in Crumlin hospital is still only open three days a week. If it was open five days a week, that would be a statement of intent that we are serious about sorting out the problem.
Funding has been provided to increase the capacity for additional consultants in order that even more procedures can be carried out in the hospital. The reconfiguration of the existing orthopaedic post in Crumlin hospital is being worked through the consultant appointment approval committee. Funding for an additional two new consultant posts for paediatric orthopaedics has been provided this year. Those posts are currently being processed and we expect that appointments will be made by the end of this year. These posts are allocated to Crumlin and Temple Street hospitals for paediatric orthopaedics in order that existing consultants can focus on spinal surgery services. The Mater Hospital has also been successful in the recruiting consultants ahead of profile.
We are making a lot of progress on this. I accept that children can often be clinically suitable for surgery one week, but because of the complexity of things can find themselves, on the basis of clinical advice, not being able to have surgery a week or two later, which causes significant difficulties and stress for families. For that reason, the scoliosis co-design team is working with three advocacy groups, the consultants and Mr. Brian O'Mahony as the independent chair, to come up with a pathway of care. It is the appropriate thing to do. I am confident that much good progress has been made in this area, but I am also confident that the solution will involve a sustainable service that will mean we do not have to rely on outsourcing. We should not just seek to fix the problem this year but ensure we are able to look after our children in this country. We are seeing a lot of progress in this area.
