Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I thank the Chair for selecting this very important matter for discussion. I am disappointed that the senior Minister is not here but I welcome the Minister of State, Deputy Catherine Byrne.

In mid-November, the Fianna Fáil spokesperson on health, Deputy Kelleher, made two impassioned speeches in this House following a meeting with members of the Scoliosis Advocacy Network who are campaigning very actively on behalf of their children and other children. Deputy Kelleher read a number of case studies into the record of the House and I want to update the Minister of State on one of them. Mary, whose name has been changed to protect her identity, 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. During this 11-month wait, Mary's curve deteriorated from 40° to 90°. At that point, she required urgent surgery to halt the progress of her spinal curve. In fact, she required two significantly invasive surgeries and would need to have some of her ribs removed. This was due to the long wait and the deterioration in her condition. She finally made it to theatre 17 months after her diagnosis for her first surgery and her curve was well over 100° at that point. 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.

Last week the Kilkenny scoliosis advocacy group wrote to update me on Mary's case and explained the following:

The pin which had become dislodged months ago has now moved and become septic. This child should not have been left wait months and months for this surgery. The fact is that the only way our children can access surgery is when they are in fact in a health crisis. This is shameful and of course we will be highlighting it with Minister Simon Harris. Before I left Our Lady's Children's Hospital Crumlin with my son after his surgery, I was told if a rod breaks or dislodges its ok. Don't present to Our Lady's Children's Hospital but go to a GP. This advice is totally unacceptable but indicative of the service our children are receiving. There has been a normalisation and acceptance of poor care and after care by teams involved in our children's care.

I am not going to stand in the House today and play politics with this issue but I have promised these women face to face that I will continue to raise these issues on their behalf. I understand the Minister has visited many hospitals around the country since taking over a very difficult brief, and that he is taking on his Ministry with determination and vigour, which is encouraging. However, these women are acutely aware of the current situation facing those on scoliosis waiting lists and this is a very damming assessment.

I acknowledge that commitments have been made for new theatres in Crumlin but the crux of the issue is that the longer we wait for policies to be implemented, the more children will be subjected to severe, long-term and, in some cases, irreparable damage while they wait. July 2017 has been stated as a timeline for the recruitment of additional consultants and for various policies to be implemented but we must be able to speed up this process. I have also heard statements about the difficulties surrounding recruitment but we must implement a more imaginative approach to attracting staff, particularly theatre nurses, on a short-term basis for these specific cases. We could recruit paediatric theatre nurses and additional consultants for several months to ensure extra capacity in the theatres in Crumlin to address this issue.

I am interested in hearing the Minister of State's thoughts on this potential strategy and I would like to ask her what progress has been made in reducing waiting times since we raised these issues one month ago.

Catherine Byrne (Dublin South Central, Fine Gael)
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I thank Deputy Aylward for raising this matter. I am pleased to take this opportunity to update the House on scoliosis services. Long waiting times for scoliosis surgery are not acceptable, and the Department is working closely with the Health Service Executive, HSE, to address services 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 were allocated under the 2016 service plan for orthopaedics and trauma to address service needs in Crumlin. The HSE is actively working with the hospital to advance the development of orthopaedic services, including spinal surgery services, which will have a positive effect on access for scoliosis patients. All patients on the waiting list are clinically triaged by a consultant as to their acuity and surgeries are carried out in order of clinical priority and waiting time, in order to provide an equitable service.

The number of consultant orthopaedic surgeons at Crumlin has increased by 1.5 whole time equivalents. The construction of a new orthopaedic theatre in Crumlin has been completed. This new facility will provide capacity for additional scoliosis activity in 2017. However, the use of this theatre is dependent on the recruitment of additional theatre nurses. While the hospital continues to successfully recruit nursing staff, balancing this with attrition rates, maternity leave and sick leave continues to present a challenge. 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.

In order to improve access in the short term, the HSE winter initiative 2016-17 includes €2 million provided specifically for surgery for scoliosis patients. To date under this initiative, 54 patients have been treated, have received appointments for treatment or been removed from the waiting list through clinical validation. This includes nine additional patients who have had their surgery at Crumlin and eight who have been given treatment dates. In addition, 23 patients have had surgery, or are scheduled for surgery, at Blackrock Clinic. Crumlin is continuing to work through a capacity plan to schedule patients that do not meet the age and clinical criteria for surgery in another hospital.

In an effort to address inpatient and outpatient spinal orthopaedic waiting lists at Tallaght hospital, an additional half-time consultant was appointed in late 2014. In 2015, some €1 million was provided by the HSE to fund 100 degenerate spinal surgeries at Tallaght. An additional consultant is due to also start work at the hospital in July 2017.

The Department will continue to work with the HSE and the relevant hospitals to ensure improvements in access to spinal surgery. The Children's Hospital Group is engaging with the scoliosis advocacy groups on developing a partnership approach to the design and planning of services for children with scoliosis. This provides an opportunity for them to work with hospitals and consultants in the design and planning of paediatric scoliosis services.

Bobby Aylward (Carlow-Kilkenny, Fianna Fail)
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I thank the Minister of State for her response and I hope she will appreciate that I am not trying to be political in any way, shape or form on this particular issue but we must do everything we can in the coming weeks and months to shorten these waiting lists. These children and their families are enduring too much pain and suffering as a result of the current waiting times and I urge the Minister of State and top officials in the Department to approach this issue with all of their ability and innovative thinking.

We have to get creative. This is life-changing surgery and access to the surgery is the crux of this issue. We must get the theatres adequately staffed to increase the capacity and reduce the waiting times. The longer we leave these children, the worse they get. They start off with a 10^oor 20^odegree of curve. If they are treated at that stage, it will save money on major surgery later on. More money should be put into early diagnosis and treatment for these children before the situation becomes critical. In Mary's case, she was left for 12 months and her curve went from 40^oto 100^odegrees before the surgery was carried out. If that child had been seen when the curve was at 40^o, it would have saved a lot of money for the State and a lot of pain for the child. Many children are coming into the system and there is a waiting list, although I do not have the figure here. I got it from the advocacy group. I ask the Minister of State to do everything she can to take these children in early and have them seen to early so that the curves in their spines will not get too serious before they are treated.

Catherine Byrne (Dublin South Central, Fine Gael)
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Speaking personally, as a mother and a grandmother, no parent should be left waiting for surgery for such a long time. Unfortunately, as the Deputy knows, in the past matters were not as fluid as we would have liked them to be, but funding is now beginning to build up again and the Minister is doing his utmost to ensure that staff are provided. The HSE has tried to recruit people especially in specialties around paediatric orthopaedic services and theatre nurses. We are trying to face this challenge together. I am delighted that the Minister has engaged with the parents' advocacy group. I will relay the Deputy's wealth of understanding of this serious situation to him. Like any parent, I do not want to see any child suffer.

I hope we will be able to address this in the early new year. It is not that people have not tried but that people have not been there to facilitate the opening of the new theatre in Crumlin. As somebody who lives quite close to the hospital, I know the wonderful work done there on a daily basis for young and older children.