Joan Collins (Dublin South Central, United Left)
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I tabled parliamentary questions on waiting times for scoliosis surgery at University Hospital Galway to which I received a reply on 2 February outlining that one patient was waiting three to six months - I know who that person is - that three people are waiting between six months and nine months - I know one of those three people - and five people are waiting are waiting for 12 months. That is a total of nine people. The general manager outlined in the reply that the waiting lists for spinal surgery is one the priorities of the Saolta University Health Care Group. He further outlined that a number of arrangements are being put in place to facilitate the level of complexity involved in relation to spinal surgery for patients with scoliosis and that the group is currently reviewing a number of resources in the context of bed availability, access to diagnostics, purchase of specialist spinal equipment and access to theatre. He stated that when the key elements required are in place, potential surgery dates for the cohort of patients can be identified and scheduled accordingly.

The patients who contacted me have not received any date whatsoever and they are still waiting. I will not name them although they said it would not be a problem if I wanted to name them. They live in Mayo and Roscommon. A surgeon dealing with one of the cases raised a serious situation in September. He said that the patient in question was one of approximately 40 under his direct care who require major, complex spinal surgery at the Galway University Hospitals. He said she had been placed on a waiting list for the surgery to take place and that the rods were taken out of her back in September due to infection and she is now waiting to have the rods replaced. Surgery is required when the curvature level reaches 50% and the curvature of the patient in question is 70%. The surgeon indicated that in the current context of the allocation to him, he does not envisage the operation taking place for the foreseeable future. He said it was the case up to approximately two to three years ago that he could perform that type of surgery at Merlin Park University Hospital and had been doing that regularly since 1996. However, as a result of the withdrawal of support services for this type of surgery, the only place capable of providing it on the western seaboard was in University Hospital Galway. With the management team he set about trying to structure a pathway that would allow that to happen, but it has not happened in a seamless, safe way to date. As a result, he could not advise the patient of a definite time or date for the operation to take place. It seems that operations were to go ahead in University Hospital Galway but the team has not been put in place to carry them out. It is not good enough for patients to wait so long for urgent surgery, in particular when one patient has a curvature of more than 70%.

Kathleen Lynch (Cork North Central, Labour)
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I thank Deputy Collins for raising this matter. All Members are dealing with at least one or two cases of people with scoliosis who are encountering difficulties. Waiting times for scoliosis surgery are unacceptably long. There has been an increase in the number of outpatient spinal review referrals, and a consequent increase in surgical demands. Hence, waiting times both for outpatients and for those awaiting surgery are indeed challenging. The Government is determined that this problem will be addressed. The HSE is examining all options to reduce scoliosis and other waiting lists as soon as possible. It must be pointed out that Galway University Hospitals do not carry out paediatric scoliosis surgery. That type of surgery may only be carried out at Crumlin, Temple Street, Tallaght and Cappagh hospitals and is predominantly managed at Our Lady's Children's Hospital, Crumlin. Approximately 5% of cases, predominantly those with neuromuscular disorders, will require post-operative access to a high dependency unit or paediatric intensive care unit. Surgery is provided through two full-day theatre sessions per week and ten specialist orthopaedic beds at Crumlin. Currently, there are two orthopaedic consultants jointly appointed between Crumlin and Tallaght hospitals to provide paediatric spinal surgery in Crumlin and paediatric, adolescent and adult spinal services at Tallaght hospital.

Saolta University Health Care Group has assured the Department of Health that the waiting list for spinal surgery is one of its main priorities. To facilitate the level of complexity involved in relation to spinal surgery for patients with scoliosis, access to inpatient beds, diagnostics, purchase of specialist spinal equipment and access to theatre for significant periods of time must be considered. When the key elements required are in place, potential surgery dates for this cohort of patients can be identified and scheduled accordingly. Funding has been allocated in the 2015 HSE service plan for the appointment of a consultant orthopaedic surgeon with a special interest in spinal surgery at Galway University Hospitals. Funding has also been allocated for the appointment of an orthopaedic surgeon, anaesthetist and support staff at Crumlin. This will maximise the use of available theatre sessions in the hospital. These allocations are part of a total of approximately €5 million available for the overall development of orthopaedic service infrastructure nationally in 2015. This funding will also allow for the development of a 24-7 spinal theatre and allocation of consultant anaesthetist and additional 5.5 nurse posts at the Mater hospital, the appointment of an orthopaedic surgeon to provide for up to 100 cases of degenerative spinal surgery a year to be undertaken in Tallaght hospital, the appointment of a consultant orthopaedic surgeon with a special interest in paediatrics in Cork, the opening of current closed and under-utilised capacity at Cappagh hospital, and the appointment of an additional orthopaedic consultant as part of improved services for paediatric spina bifida.

The Department will continue to work with the Health Service Executive to ensure service needs and waiting times in this area are addressed, having regard to the overall level of resources available to the HSE.

Joan Collins (Dublin South Central, United Left)
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Last year, when I tabled parliamentary questions on Our Lady's Children's Hospital, Crumlin, I was informed there was a service level arrangement in place, money would be provided and work was being done with the children's hospital group, etc. Nine people have been waiting for surgery in Galway University Hospital for between three months and more than one year. One patient has been waiting for surgery since July 2014, when an infection caused her to have an operation done to remove rods from her back. She has not been given a date for surgery, and we have been informed that the reason for the delay is the lack of beds for post-operative care. It is unacceptable that patients with curvature exceeding 70 degrees are waiting for surgery.

According to a reply I received from the Minister, a number of cases involving children were transferred to the Blackrock Clinic. While it goes against the grain for me to advocate private care, in emergencies such as these, the use of alternative facilities, including private hospitals, should be considered. I am aware that consideration is being given to having these patients treated in Cappagh Hospital. The two people to whom I referred are serious and urgent cases. I do not understand the reason an alternative has not been provided for them on the basis that their cases are emergencies.

Kathleen Lynch (Cork North Central, Labour)
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We have all seen children and adolescents who have a high level of curvature. This is a serious issue, and one cannot simply put something in place and then take it out, as we all accept. The provision of funding to recruit additional consultants and support staff is expected to allow for an additional 25 procedures to take place in Crumlin hospital this year. This will be in addition to the 58 cases currently treated per annum.

Joan Collins (Dublin South Central, United Left)
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There are 37 people waiting.

Kathleen Lynch (Cork North Central, Labour)
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I understand that. Despite the additional capacity to be provided this year, the number of surgeries at Crumlin hospital will still fall short of what is required to deal with demand. The Health Service Executive is working with Crumlin Hospital and the children's hospital group to explore all options to increase capacity for spinal surgery.

The Deputy and I both understand that a structure for emergency surgery cannot be easily put in place, even if cases involving persons with a curvature of 70 degrees cannot be delayed any longer. The issue is much more serious. The new consultant posts in Galway and Cork and the opening of beds in Cappagh Hospital will contribute to addressing the problem, as will the provision of additional support staff such as nurses and anaesthetists. Given the type of surgery involved, which takes a long time, the role of the anaesthetist is as important as that of the surgeon. We are not dismissing this issue and we know full well how important and urgent it is. I hope considerable improvements will be made in the next few months.