Dáil debates

Thursday, 28 June 2018

Ceisteanna - Questions - Priority Questions

Paediatric Services

10:40 am

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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2. To ask the Minister for Health the number of children on scoliosis waiting lists; the length of time they have been on the waiting lists; when the 2018 action plan for scoliosis will be published; and if he will make a statement on the matter. [27992/18]

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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The question is self-explanatory. It is not long since we all watched, with a combination of sadness and horror, children who were in extreme pain and their parents who had been battling with the system. Unfortunately, I believe they are still battling with the system and there are still long waiters. Those children are still in pain and their parents are still worried about them.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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I thank Deputy O'Reilly for the question and for the opportunity to update the House on the progress we are making on the scoliosis waiting list and, more importantly, what we will do next. The long-term strategy to develop sustainable scoliosis services has been prioritised by my Department and the HSE in the 2018 HSE national service plan. The Deputy is correct that the country was appalled by what it saw on RTÉ, and it should not have been necessary to see it on RTÉ to respond to it. It is clearly an issue that had been ongoing for many years. The country made progress on it from time to time but never fully got on top of it. That is why we have taken it very seriously. An additional €9 million has been provided to the HSE this year specifically to develop paediatric orthopaedic services, including further increasing access to scoliosis services. 

The Children's hospital group committed to a two-year service development plan to implement an orthopaedic service that provides timely access for outpatient and inpatient services. The HSE has confirmed that as part of this plan, the four-month target for all patients who are clinically deemed - the phrase "clinically deemed" is important - to require surgery will be maintained.

The Children's hospital group has advised that at the end of May, there were 166 active patients on the group's spinal waiting list, of whom 88 were waiting in excess of four months.  However, the hospital group advises that it is confident the four-month target will be met as activity levels are predicted to increase with the expected appointment this year of two new paediatric orthopaedic consultants. While it is not good that anybody is waiting a long time there are 88 now and there were 182 last September. We have made significant progress in reducing the number of people waiting and the length of time they are waiting.

The increased investment in the service in 2018 will stabilise and expand the current capacity. Consultants in the group clinically prioritise patients for surgery. Up to the end of May, 177 surgeries have taken place across the Children's hospital group.  The scheduling of spinal surgery for patients in this age group is frequently dependent on the timetabling of examinations and other school commitments, which is logical. As a result, activity is set to increase significantly during the summer months and I met the CEO of the Children's hospital group about this last week.

In addition, from April this year, additional theatre capacity for Temple Street Hospital is being facilitated in Cappagh National Orthopaedic Hospital. I received correspondence from the Scoliosis Awareness and Support Ireland advocacy group. It is holding an event at the hospital on Saturday to highlight the fact that Cappagh is open for business and that there is capacity to do more there.

Funding for two additional consultant posts for paediatric orthopaedics has been provided and it is expected the consultants will be appointed in the fourth quarter of this year. As an interim step, Our Lady's Children's Hospital, Crumlin commenced an outpatient department spinal review clinic in May. The aim of this clinic is to reduce the wait for the first outpatient appointment to six months by September. Importantly, we will be launching the scoliosis co-design plan in July. This plan is not written by me but by the clinicians, the hospital group and, crucially, the advocacy groups. All three advocacy groups have been part of that. I have recently written to the Scoliosis Advocacy Network to inform it of this publication date.

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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That is a lovely list of the things the Minister might be doing in the future, but he failed to mention the 88 children whose targets have been missed. He gave a commitment on the four-month target but it has been missed in 88 cases. Some of those children have been waiting in pain for more than three years. They are not able to live a full life. They are in agony. What is the status of the scoliosis plan? It was due to be published but there is no sign of it. I appreciate that things may happen in the future but commitments were given in the immediate aftermath of the "Prime Time Investigates" programme and they have been broken. The families have been let down time and again. Some of the 88 children have been waiting for more than three years. That is unacceptable. Those children received an apology from the Minister and others in the immediate aftermath of the programme. It is not good enough just to say "sorry". They need to know when they will get their surgery. They also need an acknowledgement that the targets are being missed in a substantial number of cases. The parents in the Scoliosis Advocacy Network and in the other groups want honesty from the Minister and the HSE about when they can realistically expect to get treatment.

10:50 am

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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The Deputy is right. If I was just saying I was sorry or listing a number of things we will do in the future that would not be enough but that is not a fair representation of what I have said or done. There will be 447 spinal procedures carried out in 2018, compared with 371 in 2017 and 224 in 2016. The figures do not lie and we are dramatically increasing the number of scoliosis operations being carried out in this country. We are not done and we are not there yet but we are significantly increasing it by any measure or metric.

In addition we have funded two new consultant posts. They are with the consultant appointments committee and they will be appointed this year. I acknowledge the Deputy has been advocating for extra capacity for some time and this will provide it through additional theatre sessions in Crumlin. The Deputy rightly asked where the plan is and that is a fair point. The plan is co-designed. It is written by the advocacy groups with the clinicians. These are surgeons who the Deputy and I and any parent with a child with scoliosis would know who are carrying out the operations. It is an excellent plan, chaired by Brian O'Mahony who has done great work. It will be published in July and I am happy to brief the Deputy in this regard as well. The advocacy groups have received correspondence telling them the date of the publication, which I believe might be 12 July.

Cappagh is now doing more and we have had the extra outpatient appointments in Crumlin on Saturdays. We have more to do but we genuinely are making a lot of progress.

Photo of Louise O'ReillyLouise O'Reilly (Dublin Fingal, Sinn Fein)
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We welcome the plan if and when it is published. Some parents have contacted us - we have raised this with the Minister previously - to the effect that the waiting lists are being managed in an aggressive way and parents are receiving letters asking them if their child still requires surgery. Can the Minister please request that this practice ceases? These children will not get better on their own. There is no prospect of them not needing surgery. They are getting these letters, they are given an impossibly short timeframe in which to respond and then they are being taken off the waiting list. I sincerely hope that is not contributing to the reduction in the waiting list numbers because if it is, that is a shame on the Department and the HSE. That is happening. Can the Minister issue an instruction to his officials to tell them to desist from that practice or if they must write to the parents, to give them sufficient time to respond. Parents are panicking about getting the post or responding in time. They are busy people with sick children and they do not need this extra hassle. Their kids will not get better on their own and the doctors know that.

Photo of Simon HarrisSimon Harris (Wicklow, Fine Gael)
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When the Deputy highlighted this issue with me in the Dáil last week, or perhaps it was her party leader, I asked the National Treatment Purchase Fund, NTPF, to ensure that all the proper protocols and procedures are being followed. I have no evidence to suggest they are not but in light of the Deputy raising it I have asked to make sure that is the case and I will correspond with her on that. The reason the waiting lists are reducing is logical enough - we are carrying out a lot more procedures. I have spoken directly to the clinicians. They are eminent medical professionals who work extremely hard on this and I know the Deputy accepts this too. They are satisfied that progress is being made. We have more to do. The scoliosis co-design plan is an exciting and important step forward. It has had the direct input of children, including young children, in how they want their services to be designed. It will be published next month and I look forward to the arrival of the two extra consultant posts which we promised, which we will deliver and which we have funded. They will start working in the Irish health service later this year. That will mark another step forward in building sustainable services in order that we never return to the place we were in last year and in years gone by. I do not want to see us ever go back there as a country and we will do everything that we can to make sure that never happens.