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Health Services

Dáil Éireann Debate, Friday - 3 December 2021

Friday, 3 December 2021

Questions (91)

David Cullinane

Question:

91. Deputy David Cullinane asked the Minister for Health his plans for addressing the problems in paediatric orthopaedic services; and if he will make a statement on the matter. [59111/21]

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Oral answers (6 contributions)

The provision of paediatric orthopaedic services has been a long-running issue. The Minister will be aware of all of the issues that stem and flow from it, including the impact it has on children with scoliosis, spina bifida and other hip deformities and orthopaedic conditions. We need to get to a space where the capacity is in the system. The issues have come into sharp focus again over the past number of weeks because a number of children have had to go public and talk about their experiences. It should not take that to put the pressure on the political system to provide the services people need. What additional capacity will be provided in this area over the next number of weeks and months?

I thank the Deputy for the question. It is such a critical issue and it has to be solved permanently. We are all very aware that waiting times for hospital procedures and appointments are unacceptably long. This applies to paediatric orthopaedics, as he rightly said. It is of particular concern to me when it comes to procedures that are time-sensitive, such as scoliosis and others mentioned by the Deputy. I remain acutely aware of the impact that delays are having on children and their families. We remain committed to improving access to these critical services and to ensuring that orthopaedic procedures can be accessed, in good time, and that the complex patient needs remain at the forefront of all service provision.

Since 2018, Children's Health Ireland, CHI, has been provided with an additional €9 million in funding to address paediatric orthopaedic waiting lists. One of my first official engagements as Minister was to meet with the orthopaedic team in Crumlin children's hospital and to see the great work that they do and the challenges that they face. This visit highlighted to me the improvements that need to be made, as well as the impact that timely orthopaedic intervention has on a child and their family.

The additional funding provided has supported the recruitment of a significant number of people. Approximately 60 whole-time equivalents, WTEs, were recruited in 2018 and 2019. Accessing capacity in order that children can undergo the procedures remains a key priority, especially for those children who require time-sensitive procedures. To this end, CHI has been working with the HSE to source additional capacity to reduce waiting times. For example, as the Deputy is aware, Cappagh Kids at the National Orthopaedic Hospital at Cappagh provides additional theatre capacity for non-complex, age-appropriate orthopaedic procedures. Not only do those children get seen, but it frees up much-needed space at central CHI sites for the more complex work. I will come back with more in my response.

Earlier this week, I visited Crumlin Children's Hospital. I met with the CEO of CHI and the full clinical team, and I heard, first-hand, the very exciting plans they have for the national children's hospital, which will be a game changer in increased surgical capacity, staff and beds. It will also provide protected beds for scheduled care, which is most important. The team also outlined some of what they need in the next number of years to deal with the here and now. One of the asks that they had concerned the €200 million access to care fund, most of which, as the Minister will be aware, is used to outsource to the National Treatment Purchase Fund, NTPF, and the private sector. They are saying that is not a solution for them. What they are looking for is €8 million or €9 million in revenue funding to recruit staff that they need to provide the additional services to staff the beds, which are also very important. The surgeon there told me that the issue of the provision of recovery beds is a problem. There are problems with the provision of ICU beds, but the lack of recovery beds is an impediment. I ask the Minister to give a commitment that this €8 million or €9 million of revenue funding will be provided.

To be clear, it is not either-or. It is not revenue funding or the access to care fund. They are for different purposes. The revenue funding is to build up the permanent capacity in the system so we never see waiting lists like this again. While we are doing that, the access to care fund is used to ensure that the people who are currently waiting are seen. Cappagh Kids and the National Orthopaedic Hospital at Cappagh have submitted several applications under the access to care fund. They are using it. They received just over €1.5 million this year and they have more proposals in. They have submitted a proposal for around €2.6 million for next year. The access to care fund is not just for private care; in fact, the majority of it goes to the HSE. Indeed, approximately two thirds of the NTPF money also gets spent in the HSE and one third in private provision.

On the important question asked by the Deputy, all of the applications under revenue funding, including those submitted by the National Orthopaedic Hospital at Cappagh and Cappagh Kids, are being looked at very seriously. Indeed, there is more than the €9 million funding provided. We have told the HSE that there is funding available for critical care, diagnostics and capital proposals. What we need to do is to ensure that those proposals are assessed quickly and are acted on. Other capital proposals have been submitted, for example by the Crumlin and Temple Street children's hospitals, that we are looking to push along. I will share the details of them at another time.

The CEO of CHI knows the difference between the access to care fund and ongoing revenue funding, as do I. I believe the Minister is to meet with the CEO and her team next week. The point the CEO was making, and asked me to relay back to the Minister, is that this particular fund is not the solution for them. It is not a sustainable solution. Yes, they can use some of it, but the CEO told me that €30 million to €40 million of that can be used for revenue funding. They would prefer it if they could get €8 million or €9 million of revenue funding. Whether it comes from that fund or from somewhere else is immaterial. They need to recruit the staff. Given all of the concerns that we have had on this particular issue, I think it should be done and the commitment should be given.

On the surgical theatre space, we heard again, earlier this week, from Mr. Connor Green, a consultant orthopaedic surgeon at Temple Street, that the cancellation of procedures causes real difficulty for families and children. We need to avoid that as much as possible. Surgical theatre capacity, staff, paediatric ICU beds are all part of the solution.

There is no lack of funding available under the access to care fund. If Eilísh Hardiman and the team are looking for money for short periods, which is what the access to care funding provides, there will be money left at the end of December. The HSE has not been able to spend all the money. That is not from want of desire to do so. Given all of the various issues that the HSE has been dealing with this year, it has made incredible progress. There is funding there. In Temple Street, for example, part of the permanent solution is the construction of a fifth operating theatre. CHI has put in a proposal for that. We are looking at that urgently as part of the capital plan for next year. I am very positively disposed to it. I have spoken directly with the CEO about it.

As the Deputy will be aware and as we have discussed previously, there are different requirements in different hospitals and children's hospitals.

Crumlin hospital needs an MRI machine. There are various issues. All of this is being looked at within the capital plan for next year. We allocated more money than the HSE drew down this year so the issue is not funding. The issue is making sure that these critically important projects are processed and put in place as quickly as possible.

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