Ms Eilísh Hardiman:

I thank the members of the committee for inviting us to attend this morning. I am joined by Ms Paula Kelly, who is a consultant paediatric orthopaedic surgeon at Children's Health Ireland at Crumlin, as well as being a clinical speciality lead for orthopaedics across CHI. Mr. Liam Woods, national director of acute operations, HSE, and Ms Helen Byrne, assistant national director of acute operations, HSE, are also in attendance. I also acknowledge our colleagues, Mr. Connor Green and Professor Damian McCormack, for their advocacy and support, for working with us to try to resolve this issue and for their honesty in the previous session.

We are here to brief the committee on scoliosis services and to outline the progress made in 2018 and 2019 to stabilise this service, which has been eroded in the past 18 months, primarily due to the impact of Covid-19 and the cyberattack. Most importantly, I will outline what we are proposing to do about this situation.

We are extremely aware that behind every number is a patient, a family and a team in CHI that wants to provide treatment. I reiterate, on behalf of CHI, my apologies to all patients and their families who have experienced increased waiting times and delays in accessing paediatric services. We do not, in any way, underestimate the impact that this has on them, and our intention is to correct this situation as soon as we can. As the committee will appreciate, we are not in a position to discuss individual cases in the public domain.

Timely and increased access to our services is the single greatest operational challenge in CHI. We are operating within old and constrained infrastructures, and we have recently experienced extremely high levels of accident and emergency department and urgent care activity. We have a plan in the form of the new national children’s hospital. It will be amazing and will address many of our current challenges, but we cannot wait for two and half years to improve access to our services. What we must do is to support paediatric orthopaedic services to operate more than in their pre-pandemic levels to address the backlog caused by what has happened in the last 18 months. The committee's focus today is on scoliosis. We must point out that there are other children with time-sensitive orthopaedic and other conditions that we equally need to prioritise. We are trying our best to manage all these service demands.

To contextualise the situation, at the end of October, CHI had 2,876 children on inpatient waiting lists, 2,686 children on day case waiting lists and 43,844 children on an outpatient waiting list. As part of CHI paediatric orthopaedic services, the most complex scoliosis cases are treated in Crumlin and Temple Street hospitals, with the less complex cases being dealt with in the national orthopaedic hospital at Cappagh, known as Cappagh Kids. Scoliosis treatment accounts for 17% of orthopaedic inpatient activity in CHI.

Through investment in 2019, CHI stabilised the service and achieved delivery of a target of 382 spinal treatments. This was the projected annual number of treatments required to practically manage timely access within our current infrastructure. This annual target of 382 spinal treatments was decimated in 2020 due to the impact of Covid-19, with 60 fewer spinal treatments undertaken. A total of 322 procedures were undertaken. We made progress in early 2021 to recover some of this activity, but the cyberattack in May really impacted services in CHI. We anticipate that this year we will undertake a total of 335 spinal treatments in CHI.

To address the impacts of Covid-19 and the cyberattack on performance, we have developed specific proposals for HSE funding approval to increase capacity at Crumlin and Temple Street hospitals and to expand the paediatric services at Cappagh hospital. That means more operating theatre capacity, additional beds, new MRIs and additional staff. As of today, 203 patients are on the waiting list for scoliosis-related procedures in CHI. These include active, pre-admittance planned procedures but in keeping with national waiting list standards, it excludes suspensions for clinical and other reasons. The vast majority of these patients need their surgery to take place in Crumlin or Temple Street hospitals, with Cappagh hospital offering the opportunity to undertake less complex elective procedures.

With this new investment, we will deliver sufficient additional orthopaedic activity to substantially eliminate long waiting lists for scoliosis treatments on a sustainable basis. In activity terms, this means increasing our annual funded target for spinal procedures from 382 to 430 in July 2022, which is an additional 48 spinal procedures in 2022. Plus 438 in 2023, which is an additional 56 spinal procedures. This will improve the waiting times and we are committed to the following. By the end of 2022, all scoliosis inpatient waits will be below six months unless clinically indicated, and by July 2023, all scoliosis inpatient waiting lists will be below four months unless clinically indicated. These targets are subject to securing the required investment and no uncontrollable events like a pandemic. The private sector capacity might be able to help accelerate these targets but we do not expect this to materialise due to the constraints in securing specialist paediatric staffing.

To conclude, waiting times for scoliosis services have deteriorated in 2020 and 2021 primarily due to Covid and the cyberattack. This is unacceptable. Again, we apologise for the distress and strain that any lack of timely access causes to children, adolescents and their families. We appreciate that families want to know when their child will have surgery. This is also impacting on our dedicated and professional staff who are working diligently through challenging and difficult times.

We have demonstrated that we can improve services when investments are made in CHI. Despite the infrastructure and serious challenges faced on a daily basis, we remain committed to improving services. I can assure the committee, patients and families that on securing the required investments everyone in CHI is fully committed to making timely access to our services better for children needing treatment for scoliosis. I am happy to take any questions.