Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"recognises that:

— waiting lists for spinal surgery remain too long, despite an increase in the number of procedures carried out in recent years; and

— the Government is committed to improving the waiting time for children seeking care;

notes that:

— the Government allocated €19 million of current and capital funding to help tackle these waiting lists by creating additional capacity;

— the €19 million investment supported an increase in the number of spinal procedures undertaken by our healthcare workers in both 2022 and 2023;

— 509 spinal procedures were carried out in 2022, and in 2023 464 spinal procedures were carried out as compared to 380 in 2019; this represents a 34 per cent increase and a 22 per cent increase respectively compared to 2019;

— at the end of December 2023 there were 78 active patients waiting over four months, which is a 13 per cent reduction compared to the end of 2022; and there were 231 patients waiting for spinal procedures, excluding suspensions, which is a five per cent reduction compared to the end of 2022;

— this Government will continue to invest significant funding to help reduce the amount of time children are waiting for important hospital appointments and procedures;

— Scoliosis and Spina Bifida were identified as a priority area, one of three priority areas, in both the 2022 and 2023 Waiting List Action Plans; and

— Scoliosis and Spina Bifida services will remain as priority areas under the 2024 Waiting List Action Plan;

further notes that:

— the Minister for Health intends to convene a Taskforce and invited all patient groups to input into the Terms of Reference;

— a dedicated Paediatric Spinal Surgery Management Unit has been established in Children's Health Ireland, which is focusing on the management and delivery of spinal surgery, including increased activity and further reducing the waiting lists;

— a Clinical Speciality Lead for Spinal Surgery, a Nurse Manager, and Business Manager have all commenced in post;

— work is underway on a paediatric spinal care programme of work which involves actions to tackle the current waiting lists, the design and transition to a dedicated Paediatric Spinal Service, and outsourcing options for clinically suitable children; and

— this Government is committed to seeing the new Children's Hospital opened as soon as possible.".

I very much welcome the opportunity to speak on this important debate on children's orthopaedic services with a strong focus on spinal services. I want to talk about what is working and what is not working and what more must be done. I want to acknowledge the children, their mums and dads, brothers and sisters, families and friends. I have been meeting them for several years, both in government and in opposition. I have to say that I do not disagree with anything I have heard from the opening statements this evening.

What is happening is inhumane. We, the State, over many years have failed far too many of these children. I assure the House I am not standing up to say that everything is fine because it is not. I am not standing up to say that everything that could be done has been done because it has not. I want to cover what has been done, where the ongoing failings are as I see them and what I believe can and must be done to address those failings. All of us in this House are united in our absolute determination to ensure that every child who needs these services will get them when they need them, whether that service is complex surgery in a hospital, a piece of equipment they need in their homes, access to a physiotherapist or occupational therapist in their communities or whatever else in might be in their homes, communities or hospitals. We must ensure they can get it when they need it. We all know that for far too many children in Ireland, that is simply not the case, and has not been the case, when it comes to complex orthopaedic care. What has happened is that the Government has invested record amounts of money in children's spinal services. The amount of surgery for these children is now at a record level and is being delivered by a record number of healthcare professionals. However, it is also absolutely the case that the waiting lists are far too long. The time the children have to wait is far too long. That is the case, as colleagues have pointed out, not just in the surgical lists, which is what we focus on most, but also for the community-based care that these children need before operations, at times when they may not be suitable for operations and after operations.

In 2022, I committed €19 million specifically for children's orthopaedic care with a heavy focus on spinal care. That money was for Crumlin and Temple Street hospitals in the main and, to some extent, for Cappagh hospital. In 2022 and 2023, I specified paediatric spinal care as one of just three clinical specialties in the waiting list action plans for those years, and I am doing the same again this year. I am not for a moment suggesting we are where we need to be but nonetheless, some important progress has been made by our healthcare professionals. With that €19 million, they have hired over 200 additional healthcare professionals, mainly in Crumlin and Temple Street hospitals. Those extra professionals include nurses, consultants, anaesthetists, radiographers and others. We have now opened a fifth new operating theatre in Temple Street, again funded through the €19 million. We recently opened a second MRI facility in Crumlin, again funded through the €19 million. Extra hospital beds have been added to both Crumlin and Temple Street, again from that €19 million. The amazing Cappagh Kids programme has had investment to do more of what it needs to do.

What has happened is that we have seen a very significant and important increase in the numbers of surgeries taking place in Cappagh, Crumlin and Temple Street hospitals compared to previous years because of these extra doctors, nurses and other healthcare professionals and because we now have the fifth theatre. In 2022, there was an increase of approximately one third in the number of spinal surgeries compared with the pre-Covid-19 figures. That is an important increase. It is not enough but it is an important increase. However, the reality is that far too many children are waiting. There was a very modest decrease last year in the total number waiting. It fell by 5%, which was not remotely enough. It is a very modest decrease. The number of patients waiting for more than four months is currently 78 and last year that number fell by approximately 13%. Again, that is not what is needed because it was only a modest fall but it was a fall nonetheless. Everything we are focused on doing now is about accelerating the reduction in the waiting lists and the amount of time that children have to wait.

I want to take a moment to acknowledge the significant work that the surgeons, nursing staff and other healthcare workers have done to increase the number of surgeries over the past two years. We all know we need far more but I have met those healthcare workers, as I know Deputy Cullinane and many others have. Good and dedicated surgeons, nursing staff and health and social care professionals are working harder to try to provide the care that is needed.

While the progress we have made in respect of the increase in the number of surgeries and the modest fall in waiting lists matters, it is nowhere close to enough in terms of what needs to happen. In 2022, when I allocated the €19 million, the forecast I got from Children's Health Ireland, CHI, was that it would bring the waiting list for those waiting more than four months down to zero and would do so quite quickly. It was on that basis that we allocated the money. As we all know, that has not happened. I have listened carefully to concerns that patients and families have raised with me. I have consulted clinicians about the allocation of that €19 million. I know that a portion of that money has been used to increase the numbers of surgeries. It is evident that is the case. However, concerns have been raised that all of the money may not have been allocated to orthopaedic and spinal surgery, at least not in the way that I and the Government intended and that all of us in this House would want to have seen. On that basis, I have asked the HSE to send its internal audit teams into CHI. I want a full account of the entire €19 million mapped against the intended purpose for that money.

Despite the record number of surgeries, what we have seen over the past two years is a record number of new referrals onto the list, which is more significant than many of us would have thought. For example, just last year, the number of children referred onto the spinal lists was over 40% higher than in 2019. That is a comparison between the levels in 2023 and 2019 and it is a very big increase. The increase has meant that while many more surgeries are happening and more children are being operated on, the waiting list has not fallen to zero and, in fact, the waiting list for those waiting longer than four months only fell by 13%.

There are several additional measures that I have directed my Department, the HSE and CHI to undertake. A dedicated spinal surgery management unit has now been established, focusing on the management of the service, increasing volume, ensuring patient safety and reducing waiting lists and waiting times. It is a cross-city unit between the various hospitals. We have a clinical lead. A very experienced orthopaedic surgeon has agreed to lead the service. We have a nurse manager and other supports in place to help this team. I have met the clinical lead to discuss the service and see where we need to go. After listening carefully to the orthopaedic surgeons, my direction to my Department and to the HSE is that we are now transitioning to a dedicated spinal service in this country. As the surgeons have pointed out to me, that is best practice in Stockholm and other places around the world. What do we mean by that? We mean a dedicated theatre or theatres. In those theatres, there will be dedicated nursing staff, anaesthetists and other theatre staff dedicated to the spinal service. It also means dedicated recovery beds, dedicated ward beds and dedicated ward staff who are specialists in spinal care. It is something we have not had. It is something that the consultants have told me in their view is international best practice and will ultimately provide the service we all want. I am allocating further funding this year to the clinical lead to progress that.

I also intend to convene the stakeholder task force referenced by Deputy Cullinane. I met some of the patient advocacy groups yesterday to discuss what they want to see, and the terms of reference they want, including independent chairs and other things. It was a constructive meeting and I am grateful for the time of those advocacy groups.

I acknowledge that the co-design group did not work. Unfortunately, it turned into something like a talking shop. None of us have any interest in that happening. We are going to have a very clear timeline and a funded programme of work. This task force will meet regularly to ensure that programme of work happens.

With the indulgence of the Ceann Comhairle, I will make a few final points. We have two important reviews under way: a HIQA review into the use of the springs, which we are all aware of, and the review of the international independent expert, Mr. Nayagam. From these, we are going to get recommendations on patient safety, spinal management, international best practice and what does and does not work. We will be acting on those recommendations.

I thank Deputy Cullinane and his Sinn Féin colleagues for tabling the motion. I acknowledge everyone present. This is an important debate. We are all absolutely determined to end the failure of these children and provide them with the care they need. Towards the end of this debate, the Minister of State, Deputy Butler, will be closing for the Government. I will be meeting the HSE board and the chief executive, and one of the things I will be bringing to them this evening is the feedback from around the House on the debate we are having.

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