Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)

I thank the Deputy for raising this very serious issue. I have spoken to families and I see the concern and hurt. It is important this is raised in the House.

A clinical audit has been conducted by an external international expert on surgery for children with developmental dysplasia of the hip across CHI and the National Orthopaedic Hospital Cappagh, NOHC. The clinical audit involved a random anonymised sample of patients aged one to seven years of age who had pelvic osteotomy procedures for development dysplasia, DDH, from 2021 to 2023 in CHI and the NOHC. The purpose of this audit is to assess whether the indications and threshold used to select patients with DDH for pelvic osteotomy procedures were in keeping with international standards of practice. The audit process is at an advanced stage. CHI and NOHC are committed to sharing the findings of the audit once it is completed.

An action plan is currently being drafted in advance of the final audit report. This plan includes identification of groups of patients not included in the audit sample but who may be affected by any findings of the audit. A communications plan is being developed to support the publication of the final report and further communications to patients and families. As a patient safety precaution, a single cross-site pre-operative decision-making process for any planned DDH surgery in CHI and NOHC has been implemented. All cases are being reviewed before any decision for surgery is made by clinicians from CHI Crumlin, Temple Street and NOHC. This multidisciplinary team, MDT, commenced the first week of March 2025. In addition, CHI is establishing an expert reference group, including international experts, to develop the standards and criteria for the MDT decision-making process for CHI.

An early recommendation from the audit is that, in line with best practice, patients who have DDH surgery should have clinical follow-up at skeletal maturity. This is at about age 14 or 15, when bones have fully grown and developed. Clinical advice is that this follow-up is part of normal post-operative care. Plans are being put in place for patient follow-up in line with good practice and will consider any recommendations on clinical follow-up from the final report. CHI and NOHC have issued letters to all patients and families who have had this procedure since 2010 to provide reassurance and information about the audit and to ensure all potential cases have been included. The total number of letters sent to date is 2,259. The majority, 1,757, have been from CHI, while 502 have been from Cappagh. The number of patients and families involved is subject to ongoing refinements due to clinical review.

The HSE funds certain treatments in other EU member states and, as the Deputy knows, we have a similar scheme for the UK or Switzerland, when this treatment is not available in Ireland. As surgery for children with developmental dysplasia of the hip is available in Ireland, financial supports for treatment outside of the State are not available. However, I assure the Deputy that currently all cases for DDH are being reviewed by a single cross-site pre-operative decision-making process before any decision for surgery is made by clinicians from CHI at Crumlin, CHI at Temple Street and NOHC.

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