Mr. Connor Green:

I thank the Chair. We are both delighted to be here today at the request of the committee to answer questions around scoliosis at Children's Health Ireland, CHI. We are both dual North American fellowship trained paediatric orthopaedic surgeons, both of us practising at Children's University Hospital, which is Temple Street, and the National Orthopaedic Hospital, which is Cappagh Kids. We are both practising as consultant surgeons and neither of us is in an administrative position.

Scoliosis has diverse cohort of patients and it affects kids in very different ways. Most of these children do not require surgery. In regard to those who do, some very young children with very complex disease require surgery in order to survive beyond their 20s. It is a completely different group of children in their teenage years. The reason we operate on them in order to reduce their chances of breathing difficulties but not until their fifth or sixth decade of life. It is not a homogenous group and it is important that we understand that. I am happy to answer questions around that later on.

It is great that the committee understands the challenge of timely treatment in scoliosis, and it is great that it understand the anxiety and the suffering it is causing, not only families but medical professionals as well. We both genuinely thank the committee for the opportunity today to advocate for children.

In order to adequately advocate for my patients and colleagues, I need to leave the committee with a very clear message. The care of children with scoliosis in this country is absolutely inadequate. However, the care of children with other orthopaedic conditions is just as bad. This becomes alarming when I tell the committee that scoliosis only represents about 20% of what Professor McCormack and I do. Therefore, the real crisis is not in scoliosis; the real crisis is everything else.

As paediatric orthopaedic surgeons, we see children with a huge potential to contribute through their abilities to Ireland in the future. Unfortunately, these abilities are being destroyed physically and psychologically by inadequate access to care. For example, there are children with spina bifida who are amazing, intelligent and mature. While these children have been waiting for surgery, they have gone from walking independently to using wheelchairs full time. They have gone from participating in school to staying at home full time.

They have gone from wearing shoes to sitting at home with open sores. These are not isolated conditions; this is a group of children.

In regard to children with cerebral palsy, the majority should live independently in this country. Not only that, through their amazing abilities they should be able to contribute to Ireland of the future. Instead, these treatable foot and hip deformities these children have leave them not only not contributing, but they leave them at home and in pain and missing school.

It is not just children with additional needs. We have children without any other medical problems at all who have hip deformities and limb deformities, and these children are in pain and ashamed of their appearance. They are not going to school and they are not being educated. They will not get an opportunity to give Ireland the benefit of their abilities.

We have no universal screening for hip dysplasia while we have universal screening for other things. This is a silent condition and when it is left untreated it accounts for 40% of hip replacements in people under 50 years of age in this country. Therefore, we are not only making the surgery around people's lives more significant, we are increasing the economic burden to the State.

We need to create a sustainable paediatric orthopaedic service for the children of Ireland, and for us medical professionals. The solution cannot wait until the national hospital is delivered. Furthermore, the committee needs to understand that a building alone will not fix all of these problems and it will only lead to disappointment. A sustainable solution will involve infrastructure and staffing. I can tell the committee that you would not find better colleagues anywhere in the world than the group of colleagues I have in Temple Street and in Cappagh. This is across nursing, therapy and my medical peers. We hold ourselves to an exceptionally high standard. You must go abroad for international training for two years before you have an opportunity to be a paediatric anaesthetist or a paediatric orthopaedic surgeon. Therefore, the access to care is the barrier here. It is definitely not the quality of care that can be delivered in this country.

However, over the last five years, it is very clear to me that this is coming to an end. You are not going to find people who will drag their families away for international training. You are not going to see nursing staff stay that extra hour continually in the face of adversity and with staff shortages. All of this goodwill has dried up. If we do not act now, this elite standard of care in this country is definitely going to reduce itself to "yellow pack", because people will not go abroad to train. Furthermore, it is equally likely that the next generation will leave and not come back.

We are not asking for much. We are asking to be allowed to do our job. We are asking that when we come to work there is enough staff and that we will not have to fight every morning to get a bed for our patient, so we can come in and operate. As surgeons, we are asking that we have an operating room to go to. I know it sounds ridiculous, but I was appointed as surgeon with no operating room. My colleague has just been appointed with no operating room.

I really hope that the new hospital will live up to expectations, but care for these children cannot wait. I know a ridiculous and obscene amount of money has been spent on the new hospital, but we still need to resource children now.

In Temple Street, our clinical director has been fighting hard for one operating theatre to be delivered by the end of next year. Why is it not two? Why are we waiting until next year? The American Army can set up a hospital in desert overnight, so why can we not have two operating rooms sooner?

Anybody listening to the radio this week will understand that stand alone facilities are the only way to deliver care in this country. We cannot provide elective care on acute sites. It is fantastic to see that the HSE and the Government are supporting these elective care facilities and we are going out to tender for it. However, we already have one in orthopaedics. We have the National Orthopaedic Hospital where we have Cappagh Kids. In the last two weeks, when all elective activity was cancelled in the acute settings, we did 20 cases on children when nothing else was happening. We can do more on these elective sites, but we need to be resourced to do so. A plan was submitted to the HSE and a plan was submitted to the Houses for an expansion in Cappagh. It will raise the standard of care not only in children, but in adults as well.

We need to be resourced. I promise members we will retain colleagues. We need to give my colleagues a reason to stay. We need a national system to be proud of, and we need the ability to care for our patients.