Ciarán Lynch (Cork South Central, Labour)
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In February I asked the Minister for Health and Children if she could confirm that children from the Health Service Executive south area must travel to Dublin or Limerick for orthopaedic surgery, the reason this was necessary and if she would make a statement on the matter. Cutting through the usual fillers that accompany HSE responses to parliamentary questions, the reply showed that 210 children, including infants born with birth defects, had to travel to Dublin last year and the year before for orthopaedic surgery as no relevant physician was available in Cork or Kerry.

Why is it that infants and young children in the south of the country in need of specialised orthopaedic surgery continue to have to travel to the capital for treatment since the sudden retirement of the only suitable surgeon in the region in 2007? The surgeon, who retired in April 2007 on health grounds, was the only surgeon in the region with the skills to operate on babies and children with congenital dislocation of the hip or with clubfoot. At that time, HSE south entered into what was described as a "temporary" arrangement with Our Lady's Hospital for Sick Children in Crumlin, whereby four of its orthopaedic paediatric surgeons would travel to Cork to treat children who would otherwise have been seen by the retired surgeon. That temporary arrangement involving regular visits to Cork by the four surgeons has been in place since 2007 to cover the absence of that surgeon. Those consultants hold just four clinics a month on an outpatient basis. The consultants are treating in excess of 100 children each per month, from newborn up to the age of 15.

In an article in tonight's Evening Echo by Edel O'Connell, Mr. David Moore, an orthopaedic surgeon at Crumlin hospital, is quoted as saying there was a serious dearth of paediatric orthopaedic consultants in the country. He stated:

I travel to Cork and provide two clinics every second month. Last week I saw 77 kids in Cork. There is a huge workload in the southern region and it badly needs its own centre. The HSE need[s] to provide assurances that if people train in paediatric orthopaedics jobs will be created for them. No matter what happens it will be at least two years before we would even have people trained to take up paediatric posts. The posts that are being advertised for Cork are not paediatric orthopaedic consultants.

It appears that the positions the HSE has indicated it will fill are not appropriately trained ones. It is completely unacceptable that young children have to travel to Dublin for surgery which could be provided in Cork given that theatres, step-down beds, nurses and anaesthetists are all in place. All that is missing is a surgeon and one has not been in place for two years. It is unacceptable that the service in Cork which collapsed in 2007 is still not up and running. The issue does not relate to a cutback or a service that we were promised. The service was working two years ago but the HSE failed to project manage it adequately. We now have a deficit of provision in the southern region because of mismanagement rather than financial constraints.

The current situation where children have to travel to Dublin for orthopaedic surgery cannot be allowed to continue. Does the Minister of State, Deputy Hoctor, envisage it continuing? I call on the HSE to put in place the necessary measures to rectify the situation. According to the HSE's response to my parliamentary question, posts are currently being considered. It indicated: "Every effort will be made to ensure that one of the appointments made will have a special interest in paediatric orthopaedic surgery." The fact of the matter is that there is no paediatric surgeon in this country trained in paediatrics. If this post is advertised tomorrow morning, it will take two years to train someone.

Will the Minister indicate when the posts will be filled and when training will commence for the orthopaedic surgeons that are appointed? Is it acceptable to her that 210 children are travelling from Cork to Dublin because a service is not in place? Moreover, the service did not run out of money nor was it cut for budgetary reasons; it was simply mismanaged. As a result, 210 children per year are still travelling from Cork to Dublin for necessary surgery.

Máire Hoctor (Tipperary North, Fianna Fail)
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I will reply to this Adjournment matter on behalf of my colleague, the Minister for Health and Children, Deputy Harney.

Orthopaedic services for the Cork area are provided from the Cork University Hospital group. The division of trauma and orthopaedics is made up of the orthopaedic department at Cork University Hospital and St. Mary's Orthopaedic Hospital. Cork University Hospital provides the only orthopaedic trauma service in Cork city and referrals are generally from the emergency departments of the city and county hospitals, as well as specialist referrals from other locations.

A number of vacancies currently exist for permanent consultant orthopaedic surgeons within the Cork University Hospital group. That is a consequence of retirements and resignations of former permanent post holders. To date, the HSE has recruited three locum consultants to assist with the delivery of the trauma service in Cork University Hospital and two temporary consultant orthopaedic surgeons to assist with the current backlog in the elective service in St. Mary's Orthopaedic Hospital.

The Public Appointments Service held interviews for the posts of permanent consultant orthopaedic surgeon on 19 December 2008 and I understand that two applicants have been offered posts through this process and one of the successful candidates took up his post this month. The HSE has placed a further advertisement for permanent posts and Cork University Hospital expects to fill a minimum of two further posts from this process.

There is no consultant paediatric orthopaedic surgeon in the division of trauma and orthopaedics on the staff of Cork University Hospital or St. Mary's Orthopaedic Hospital at present. That is as a consequence of the retirement of the consultant orthopaedic surgeon with a special interest in paediatric orthopaedic surgery. The HSE is anxious to make such an appointment as soon as possible. In the meantime, arrangements have been made whereby the current service at St. Mary's Orthopaedic Hospital is provided by visiting paediatric consultant surgeons from Our Lady's Children's Hospital, Crumlin, who provide a total of four clinics per month. Approximately 15% to 20% of children seen at this clinic are referred on for surgery, which is undertaken in Crumlin. In 2008, a total of 210 patients were referred to Crumlin for surgery from those clinics.

As part of the process to recruit a number of permanent consultant orthopaedic posts for Cork University Hospital and St. Mary's Orthopaedic Hospital, the southern hospitals group of the HSE is seeking to ensure that one of the appointments made will have a special interest in paediatric orthopaedic surgery. In the event of such an appointment being made, the need for the arrangements which I have described, involving consultants from Our Lady's Children's Hospital, Crumlin, will be reviewed.