Billy Kelleher (Cork North Central, Fianna Fail)
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I thank the Ceann Comhairle for giving me the opportunity to raises this issue. I do not often come into this Chamber and play emotional cards but I met a group, the Scoliosis Advocacy Network, the members of which are campaigning on behalf of their children and other children.

I will put one or two case studies on the record. I have given the individuals pseudonyms to protect their identities. Mary was diagnosed at age ten in May 2013 with a 40° spinal curve at Mullingar General Hospital. She was referred to Our Lady's Children's Hospital Crumlin for urgent review by a specialist. She was obliged to wait 11 months before she could see a consultant. Her mother rang the hospital daily in order to secure this appointment. During this 11-month wait, Mary's curve deteriorated from 40° to 90°. She now required urgent surgery to halt the progress of her spinal curve. In fact, she now required two significantly invasive surgeries and would need some of her ribs removed. This was due to the long wait and the deterioration in her condition. She finally made to theatre 17 months after her diagnosis for her first surgery and her curve was well over 100°. One week later, she had her second surgery. Her body suffered severe trauma during these surgeries and she spent one month in hospital in Crumlin. During the 17-month wait, Mary had to give up sports, was in constant pain and unable to eat and her back became more deformed. Unfortunately, Mary now finds herself back on a waiting list for surgery to correct a failed fusion and there is no date in sight for this procedure. Once again, her condition is being allowed to deteriorate.

A second child, I call him Dónal, was diagnosed with scoliosis aged two and had a 35° double curve. He had two separate medical interventions over the years to prevent his spinal curve becoming worse. These did not work. In August 2015, Dónal was placed on the urgent surgery waiting list. Dónal's parents were told he needed surgery and the sooner the better. Dónal's curve was approximately 60° when he was placed on the surgery waiting list in August 2015. Dónal has been waiting 15 months for his urgent surgery, with no date in sight. His curve is now approximately 80°, with added rotational problems. Dónal is seven years old. He has reduced lung capacity due to his scoliosis. He has reduced endurance and is not growing as he should be. He has to go to bed after school most days. His mother told me yesterday that he can no longer retain his food due to the pressure on his stomach.

Another child to whom I give the pseudonym Ted was born with scoliosis. He has had a number of surgeries to date, with long wait times and cancellations along the way. He had vertical expandable prosthetic titanium rib, VEPTR, surgery to treat his scoliosis and, unfortunately, that failed. He waited many months with an unhooked rod before he could again gain access to the theatre. The rod dislodged from his shoulder blade and from his hip and it was months before that was even addressed. During this waiting period, Ted suffered pain on a daily basis. He needed strong pain medication to help him cope. Ted missed lots of time in school and needed home tuition. Ted has poor endurance and requires a wheelchair for days when he cannot be mobile as a result of the pain and the tiredness. Ted is six years old now and will require ongoing surgeries throughout his entire childhood. Due to the 100% complication rate with growing rods, this means that revision surgeries are guaranteed for Ted.

He will spend most of his childhood on a waiting list for surgery to treat his scoliosis.

I could continue speaking on this. I have five cases with me and I have analysed most of them. After listening to the parents I urge that something be done, dramatically and quickly. This simply cannot be allowed to continue for these five cases or for the other 203 cases currently on the waiting list.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I thank Deputy Kelleher for raising this matter. It is clear that the Deputy has been personally affected by his engagement with the parents. Those of us who enjoy good health and whose children enjoy good health sometimes take it for granted. Anybody listening to the Deputy could not help but be moved by the dreadful experiences those families have had. However, this is an opportunity to update the House on behalf of the Minister, Deputy Harris. He asked me to extend his apologies to the Deputy for not being present but he is unavoidably detained elsewhere.

Long waiting times for scoliosis surgery are not acceptable and the Department of Health has been working closely with the HSE to address service pressures, particularly in Our Lady's Children’s Hospital Crumlin, which is the largest provider of scoliosis surgery for children and young people. Additional funding of €1.042 million was allocated under the 2015 service plan to increase capacity at Crumlin, and further resources of €0.987 million have been allocated under the 2016 service plan for orthopaedics and trauma to address service needs in Crumlin which will have a positive effect on access for scoliosis patients. The complement of consultant orthopaedic surgeons at Crumlin has increased by 1.5 whole-time equivalents which will enhance the overall orthopaedic service, including spinal surgery.

The construction of a new orthopaedic theatre in Crumlin has been completed. This new facility will provide for additional scoliosis activity in 2017, but is dependent on the recruitment of additional theatre nurses. While the hospital continues to recruit nursing staff successfully, it must be said that balancing this with attrition rates, maternity leave and sick leave continues to present a challenge. However, the Children’s Hospital Group is exhausting every recruitment and retention avenue available to it, including international recruitment, and is proactively working on nurse recruitment to support the opening of the new theatre.

The HSE winter initiative 2016-17 includes €2 million provided specifically for scoliosis patients to provide for the surgeries required by year end by 15 paediatric cases on the Crumlin waiting list and to treat 39 adolescent-adult cases on the Tallaght Hospital waiting list. In an effort to address inpatient and outpatient spinal orthopaedic waiting lists at TaIlaght Hospital, an additional half-time consultant was appointed in late 2014. This appointment has assisted in managing emergency admissions and in running additional waiting list clinics. In 2015, €1 million was provided by the HSE to fund 100 degenerative spinal surgeries at Tallaght. An additional consultant is also due to start work at the hospital in July 2017 and it is expected that this appointment will assist in addressing the hospital’s capacity deficit in the long term.

The Minister, Deputy Harris, and I are aware that the long-term strategy for Tallaght Hospital is to provide spinal degenerative surgery, with a gradual transfer of the adolescent scoliosis surgery from Our Lady’s Children’s Hospital Crumlin, to the new children’s hospital. The Department will continue to work with the HSE and the relevant hospitals to ensure improvements in access to spinal surgery are achieved. The Minister recently met with a number of scoliosis advocacy groups to discuss their concerns, following which the Children’s Hospital Group has begun a process of engagement with the advocacy groups on developing a partnership approach to the design and planning of services for children with scoliosis. Those inputs will be important because we must listen carefully to the parents and the advocacy groups. This will provide an opportunity for them to work with the hospitals and consultants in the design and planning of paediatric scoliosis services.

Billy Kelleher (Cork North Central, Fianna Fail)
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I thank the Minister for her reply, but I genuinely believe that even the deadlines mentioned by her are not good enough for many of the children I have mentioned. The Minister talks about July for Tallaght Hospital and international recruitment of theatre nurses for the new theatre in Our Lady's Children's Hospital. Everybody knew this theatre was being built - it was happening before our eyes - yet the recruitment process has been very slow. The problem is that, as I speak and the Minister listens, children's lungs and hearts are being slowly crushed while they wait. Some children can no longer retain their food because their stomach is being squeezed. That is happening to the five children with whose parents I discussed this. I met some of the children. There are also 203 others on the waiting list. July 2017 is a long way into the future for a five year old child who needs surgery today.

I urge the Minister and the Minister of State to reflect on this. I am not holding anybody personally responsible. Nobody has a monopoly on humanity and we all want to help. However, the Minister must urgently revisit this matter. We all know the Children's Hospital Group is under pressure to deliver care within its budget while at the same time plan for the new children's hospital. These children cannot wait for the new children's hospital. We must provide the resources, be it through the National Treatment Purchase Fund, NTPF, or through some other method. These theatres must be functioning from 1 January next. Otherwise, children will be irreparably damaged. That simply is not good enough. These children have an entitlement to life like anybody else.

Marcella Corcoran Kennedy (Offaly, Fine Gael)
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I acknowledge that Deputy Kelleher is not being political or over-dramatic on this. He is simply reflecting the situation of certain families and the challenges that face them. He is absolutely correct, and we agree, that waiting times are not acceptable in this case, with children in the circumstances the Deputy outlined. Having the theatre built is one thing but recruiting the nurses to be in place to ensure the surgeries commence is proving challenging, not only in this case but in other hospitals across the country. The Deputy will be aware of that. Crumlin hospital has outsourced 15 patients to the private sector under the winter initiative funding. It has also outsourced nine patients to the private sector. Every effort is being made to schedule patients for their surgeries. Some of the patients require two-stage procedures, along with emergency and urgent patients. There is much happening in terms of trying to manage the spinal surgery at the hospital while continuing to manage the trauma and elective surgery as well.

I assure Deputy Kelleher that I will bring his concerns, which the Minister is aware of, to the Minister's attention again. The Minister has met with the advocacy groups and he is working to ensure that these surgeries are carried out as soon as possible. This matter will receive our full attention.