Jim Daly (Cork South West, Fine Gael)
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I thank the Acting Chairman for giving me the opportunity to raise this important issue and the Minister for coming into the House to take it. I have been writing to him and his predecessor for some time about it. I have been representing the views of parents who are constituents of mine in west Cork. I refer to Jessica O'Flynn who is 12 years old and Aoife Murray who is 17. These young girls are waiting operations on their spines. One of them has been waiting since January 2013, while the other, Jessica, has been waiting since October 2013.

I understand from Mr. Pat Kiely in Crumlin that under the current resource system, it will take up to two years to clear the current waiting list. Obviously, this cannot be allowed to continue. It is opportune, since the new service plan for the coming year is being drawn up by the HSE and we have just had the budget announced, to plead with the Minister to speak to the HSE to ensure the necessary resources are allocated to ensure the waiting list of spinal deformity cases is dealt with as a priority. It would be much appreciated.

The delay in treatment is leading to complications. I am not a medic, although I know the Minister is, but I understand from Mr. Kiely that in one of the cases mentioned the patient is starting to develop respiratory difficulties and that if we delay too long, the case may become a good deal more complicated. He went on to say he was optimistic that a single stage operation would correct the girl's deformity and that, once she had recovered from the surgery, her life would be quite different, as would her overall level of support and function.

These are real people, which is the reason I have named them. Real lives are being affected. It is more than a management issue, it is an issue for society. We must not neglect these children. As they are growing, the curvature of their spines must be dealt with. Therefore, I plead with the Minister to act. I look forward to his response.

Michael Creed (Cork North West, Fine Gael)
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I thank the Ceann Comhairle's office for facilitating this debate with the Minister for Health, Deputy Leo Varadkar.

I wish to take up a point made by Deputy Jim Daly about there being an optimistic note. He referred to the comment made by Mr. Kiely on the life-changing consequences of the surgery involved. I was at an under-16s football match last weekend when one of the star performers was a young man who three years ago was in exactly the same position as the two girls referred to. This life-changing surgery has enabled him to be a full and active participant in sport, etc.

I imagine Deputy Jim Daly will agree that this is not a plea to have these two individual patients plucked from the list and ask the Minister to look after our constituents. I understand there are approximately 120 on the waiting list. It is not the longest in the world, but it is a critical one. It is painful for parents to have to watch their children stoop because of scoliosis and wonder whether they will undergo surgery in time or whether there will be long-term consequences for the health and well-being of their children as a result of the delay.

The time is opportune because the HSE is preparing service plans for 2015. Deputy Jim Daly has alluded to the fact that Mr. Kiely has written to his colleagues in Cork and said he is prepared to travel to Cork if he can access theatre space and recuperation facilities, in particular, intensive care unit beds. That is one of the critical issues involved.

The waiting list is probably the consequence of the lack of investment for too long in paediatric medicine in the children's hospital. Obviously, we are making progress in this regard, but we need an interim solution. The 120 children involved, including the two young girls referred to by Deputy Jim Daly, Jessica O'Flynn and Aoife Murray, represent the manifestation of the problem in our constituencies. We are familiar with both cases, but I know of others in my constituency. I appeal, therefore, to the Minister. The surgery involved could substantially improve the lives of these young children for the better. They can participate fully in sport and all other activities following successful completion of the surgery. I, therefore, call on the Minister and the HSE in the context of its service plan for 2015 to try to ensure we will have a more efficient system for performing this critical surgery.

Leo Varadkar (Dublin West, Fine Gael)
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I thank the Deputies for raising this important matter and will take the opportunity to outline the Government's position. As a constituent of mine is on the same waiting list, I have some understanding of the matter as a local Deputy, as well as in my role as Minister.

Scoliosis in children and young people is predominantly managed at Our Lady's Children's Hospital, Crumlin. The hospital has an agreed capacity to carry out 58 full spinal cases per year as part of its annual service level agreement with the Health Service Executive. A total of 68 full spinal surgeries were carried out in 2013, ten more than the number for which funded had been provided. In total, 147 procedures were carried out in 2013. It included children who required repeat procedures and rod lengthening, as well as full spinal surgery.

Surgery is provided in two full day theatre sessions per week and there are ten specialist orthopaedic beds in Crumlin. There are two orthopaedic consultants, each with a half-time commitment to provide paediatric spinal surgery, providing this service in Crumlin. They have been jointly appointed between Crumlin and the paediatric adolescent adult spinal services at Tallaght. Approximately 5% of cases, predominantly those with neuromuscular disorders, will require high dependency unit or paediatric intensive care unit access after the operation. The average length of stay for a patient having spinal surgery is normally seven to ten days.

There has been an increase in the number of outpatient referrals for spinal review and a consequent increase in surgical demands. Hence, waiting times for outpatients and those awaiting scoliosis surgery are challenging. The latest available figures indicate that 1,389 patients are on the waiting list for spinal review, while 190 have been waiting for an outpatient appointment for more than one year. There are target waiting times for surgery, but there are 108 children waiting longer than 20 weeks for this service.

The HSE has prioritised a business case for additional capacity for this service. The Department of Health and the HSE are fully conscious of service needs. The resource requirements to address waiting times and service needs are being considered in the context of the 2015 service planning process which is under way. In parallel, the children's hospital group which comprises the hospitals in Crumlin, Temple Street and the paediatric service at Tallaght is working to identify a comprehensive plan for the utilisation of all orthopaedic resources in the two relevant hospitals, Tallaght and Crumlin. This would address needs in the areas of trauma, bone cancer and other orthopaedic requirements, as well as spinal services. The Department and I will work with the HSE to ensure service needs and waiting times in this area will be addressed having regard to the overall level of resources available to the HSE.

Jim Daly (Cork South West, Fine Gael)
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I thank the Minister for his response. Deputy Michael Creed and I have made the case. It is heartbreaking to have parents come to a constituency office in these circumstances. Clearly, they will do anything for their children, as any of us would do for ours. They are completely helpless. Talking to them about resources and such issues is irrelevant. We are talking about real people.

Their child has a deformity of the spine, which is curving and getting progressively worse. It is heartbreaking to listen to the parents, who feel so helpless. They are pleading with us as their representatives in this House. Those children do not have a voice here and we are their representatives. I hope we have brought forward the human side to this.

I endorse what Deputy Creed said. It is not a case of seeking to take one or two names from the list. There are 120 children involved, all of whom are cherished equally by the State. That waiting list should be attended to as a matter of priority and the necessary resources should be made available in the preparation of the HSE service plan, which is under way at present.

Michael Creed (Cork North West, Fine Gael)
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I thank the Minister for his response. It raises an important issue in the context of having sufficient manpower to deal with the issue. Given the outpatient surgical waiting lists and so forth, is the issue whether an adequate number of consultants are appointed in this area? Is that something that must be addressed in conjunction with the issue of access to theatre and post-theatre recovery and intensive care beds? Perhaps this could usefully be pursued by the Minister with the HSE in the context of its service plan for 2015.

The common denominator in respect of the cases mentioned is Mr. Kiely in Crumlin hospital. He has indicated a willingness to regionalise his service delivery. In other words, he has communicated with HSE South and his colleagues in Cork that he is prepared to deliver this service in Cork. Obviously, we are more familiar with demand in Cork for the service, but would this help? If there is a logjam in access to theatre facilities in Crumlin, could regionalisation of the service be a way of dealing with it? Mr. Kiely is prepared to travel, so it does not mean we must duplicate manpower. There are two issues here: regionalisation of the service and the adequacy of consultant manpower to deliver the service.

Leo Varadkar (Dublin West, Fine Gael)
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The timing of this debate is quite opportune. It is entirely a coincidence, but I am having a meeting with the chief executive officer of Crumlin hospital in the next couple of hours about orthopaedic surgery, because it is acknowledged to be a problem.

At present, 12 children have been waiting longer than a year for scoliosis surgery, which is really unacceptable. However, when we consider projected demand, we can see that it will be necessary to increase the number of cases carried out per year from approximately 58 to 120. It is easy enough to deal with 12 cases, perhaps, but there will be more going onto the list after them, so we must almost double capacity for scoliosis surgery in Crumlin. I do not know enough about how the surgery or after-care work to be able to state whether it could be regionalised. The risk of doing something in two centres rather than one is that there might not be specialised staff in both centres all the time. Perhaps it is or is not doable, but this is something I am aware of and about which I am concerned. We certainly cannot allow a situation to develop whereby children's scoliosis is getting progressively worse, to the extent that they are starting to develop respiratory and neurological problems. I understand that is happening.

Needless to say, I am personally concerned about this and I hope it can be addressed in the context of the service plan for next year.