I propose to take Questions Nos. 1173 and 1174 together.
The long-term strategy to develop sustainable scoliosis services from 2018 and into 2019 is a priority for my Department and for the HSE. The HSE advise that the impact of investment and the implementation of the Scoliosis 10 Point Action Plan is now delivering results with a consistent reduction in waiting times being recorded.
The Ombudsman for Children published his report, 'Waiting for Scoliosis Treatment; A Children's Rights Issue' in March 2017 and in August 2018 he published an update on that initial report which welcomed actions taken to generate improvements in scoliosis services, such as the increase in the number of surgeries that take place, fewer children waiting over 12 months for surgery, increased capacity, and additional resources. The Ombudsman has met with me and my Department, as well as other stakeholders, in relation to this matter, and consequently has stated that there is a clear and absolute commitment from all involved to address the matter of scoliosis in the best interest of the children.
While the most recent update welcomed the improvements in scoliosis services, the Ombudsman's August update also pressed for the need for continued action to address waiting lists for initial assessment, access to diagnostics, and increased treatment activity. My Department continues to work with CHI to ensure that these issues are addressed, that activity levels continue to increase, and that waiting lists are reduced.
CHI published an update on the Scoliosis 10-Point Action Plan on 12th July 2019. This marks the second update to the plan, following an interim progress report issued in October 2018. The plan, which was co-designed by clinicians and managers in paediatric orthopaedics and with the three scoliosis advocacy groups-Scoliosis Advocacy Network Group (SANG), Scoliosis Support and Awareness Ireland, and Scoliosis Ireland - sets out how additional funding provided by the HSE is invested to support children and young people with scoliosis.
CHI advise that their priority for 2019 is to ensure that capacity is available to schedule patients that require surgery based on clinical priority. The addition of a new orthopaedic consultant post and the extension of the opening hours of theatre number eight to five days a week will continue to support the management of general orthopaedic waiting lists and enable consultants to better manage both spinal referral patients, and general orthopaedics, in order to reduce the number of patients waiting for a surgical procedure.
CHI further advise that a total of 30,293 children attended the paediatric orthopaedic outpatient departments at CHI and Cappagh National Orthopaedic Hospital (CNOH) in 2018. An additional 800 outpatient (OPD) appointments were given to patients in CHI at Crumlin in 2018 compared to 2017 which contributed to a 31% reduction in the overall orthopaedic outpatient waiting list. In addition, an outpatient initiative for long waiters carried out at CHI at Crumlin facilitated 443 appointments from the orthopaedic OPD waiting list.
When a child is referred for an initial spinal outpatient assessment they may not have a confirmed diagnosis of scoliosis. A definitive diagnosis of scoliosis is confirmed based on physical examination and radiological imaging. In CHI at Crumlin patients waiting for a spinal consultation make up approximately 1% of the overall orthopaedic waiting list.
In terms of child specific waiting lists and associated targets, Key Performance Indicators (KPIs) are set for children's waiting times within the HSE's National Service Plan including targets for the percentage of children waiting less than 15 months for inpatient or daycase treatment. Progress against these KPIs is published in the HSE's monthly Performance Reports.
Improving timely access for patients to scheduled and unscheduled care is at the heart of Sláintecare. The Sláintecare Action Plan 2019 which was published by my Department, includes a specific workstream on Access and Waiting Lists. Sláintecare emphasises the need to invest in increased capacity while also shifting the balance of care from hospitals to community services for better health outcomes and a more sustainable health service. In addition, many of the other service reforms and enhancements included in Slaintecare will support timely access to care for patients in the coming years, including the application of waiting time targets and guarantees.