Mr. Connor Green:

I will deal with it on the two different sites separately - Temple Street and the National Orthopaedic Hospital at Cappagh - because they are two different cohorts of patients.

In Temple Street, if we are specifically looking at scoliosis, the biggest rate-limiting step is the intensive care unit. We have an eight-bed intensive care unit where, on a daily basis, six beds out of the eight are only staffed by nursing staff. The reason for that is they cannot get the skilled nursing staff to do it because these nurses are not being remunerated, educated and supported appropriately. I do not know who would want to do that job. I will go into more detail on that afterwards due to the limited time. We need to resource our ICU staffing better. We need to ring-fence an intensive care bed for elective surgery and we need to support our intensivists to recruit more of them in order to look after the patients afterwards. The first thing I do on a Monday morning every time I come to the operating room is go up and look around the ICU.

We need two more theatres, at a minimum, just to get us through the next couple of years in Temple Street. I have a half-day operating once a week. That is all I have got at present. I cannot do a spine in a half-day. It is impossible. That time is nearly involved with anaesthetics. Therefore, we need more operating space in Temple Street. There is space to build two.

In Cappagh, there is a €17.5 million plan which will give us ten extra high dependency unit, HDU, beds and 16 extra ground-floor beds with increased paediatric and adult services. The rate limiting step in paediatrics in Cappagh at present is the high dependency units. In addition, we need staffing for our rehabilitation service. We are trying to set up a four-bed unit which would decompress the main hospital and allow patients to go to Cappagh for their recovery. That would also give us two additional operating theatres in Cappagh which would allow us to operate two paediatric orthopaedic lists a day instead of the current one, on a Monday to Thursday. We currently have 18 potential beds in Cappagh but we need to recruit the nursing staff and the support services to support them. Specifically, the support services we need to recruit are around physiotherapy and specialist nursing. We need a psychologist urgently.

Deputy Cullinane spoke of mental health issues. The suicide rate when you transition from paediatric care to adult care in spina bifida is astronomical. It is well published that the depression rate in these children is terrible.