Frank Feighan (Sligo-Leitrim, Fine Gael) | Oireachtas source

On behalf of the Minister for Health, I welcome the opportunity to address the Seanad on this important matter. At the outset, I acknowledge that waiting times for many hospital procedures and appointments are unacceptably long. I am acutely aware of the great distress that this causes patients and their families. I remain committed to working to reduce waiting times for patients and bring them in line with Sláintecare targets. It is of particular regret that children can experience long waiting times, especially for time-sensitive procedures such as scoliosis treatments. I remain acutely aware of the impact that this has on children and their families. The priority of the Minister for Health, and that of the Government, is to improve waiting times for all patients accessing hospital treatment. Reducing paediatric waiting lists for orthopaedic procedures remains a priority within that.

Through investment in 2019, Children's Health Ireland achieved the delivery of the target of 382 spinal treatments. Activity levels were significantly impacted in 2020 as a result of the Covid-19 pandemic. Despite these challenges Children's Health Ireland delivered 322 spinal treatments, of which 163 were spinal fusions. Overall scoliosis activity figures for 2020 were 16% lower than the previous year despite significant social distancing measures, and infection, prevention and control requirements. By the end of October 2021, 295 spinal surgeries had been carried out, which is a significant increase on the same period last year when 255 spinal surgeries had been carried out. This activity level was achieved despite the ongoing challenges of Covid-19, and the very serious and significant impact that the cyberattack had on the services of Children's Health Ireland in May.

The Department of Health, the HSE and Children's Health Ireland have worked to deliver improved paediatric orthopaedic services and enhanced access to scoliosis services. In 2018, Children's Health Ireland, previously the Children's Hospital Group, was provided with an additional €9 million in funding to address paediatric orthopaedic waiting lists, including the provision of scoliosis services. This funding is recurring and has been provided in the base HSE allocation each year since 2018 to fund orthopaedic services. The additional funding supported the recruitment of approximately 60 whole-time equivalents, WTEs, in 2018 and 2019 to enable the expansion of paediatric orthopaedic services. The posts relate to the multidisciplinary team at diagnosis, pre-assessment, during surgery in theatre and post-operatively. The posts include a number of grades and specialties, including consultants, registrars, radiographers, clinical nurse managers, staff nurses, physiotherapists, occupational therapists and associated administrative posts. The most recent appointment was an orthopaedic consultant with a special interest in neuromuscular conditions who started in the Temple Street in September.Only the post of consultant neurophysiologist remains vacant. A recruitment campaign commenced in October 2021 and, in the interim, there is a contract with a specialist service provider.

The orthopaedic implementation group was established in 2018, as was the scoliosis co-design group. Representatives of Children's Health Ireland, the orthopaedic spinal team and advocacy groups continue to meet as part of the co-design framework on a quarterly basis. The central aim of the group is to assist in the design of a contemporary values-based and patient-centred approach to service delivery in scoliosis services. Children's Health Ireland has advised the Department of Health that work with the advocacy groups is under way to strengthen disengagement and to develop more positive communication with the advocacy groups, including the Scoliosis Advocacy Network and patients' families. Scoliosis activity is just one element of the wider orthopaedic services provided by Children's Health Ireland, accounting for approximately 70% of orthopaedic activity and children with a range of needs rely on the orthopaedic services of Children's Health Ireland, for example, children with spina bifida, hip deformity and other orthopaedic needs. The complex needs of these children remain at the forefront of service provision.

Of the children who receive a diagnosis of scoliosis, not all are referred for surgery, with other treatment options in the form of orthotics or spinal bracing also used, as appropriate. All patients referred to the inpatient waiting list for surgery require a preoperative work-up prior to spinal surgery, including multi-diagnostic investigations and review by a multidisciplinary team. The plan of care which is implemented for each patient is tailored to best meet the patient's clinical requirements and the complexity of a child's total medical conditions dictate the level of planning and preoperative work and time needed.

Children's Health Ireland has developed a new fast-track pathway as part of the outpatient reduction plans and paediatric active clinical triage has been introduced for those waiting for the longest time, 12 months or more, on the paediatric outpatient list. This has reduced the number of long waiters from 987 to 403 since the start of October 2020.

All of these examples highlight the focused work being carried out to improve orthopaedic services for children and the Government remains committed to improving access to these services, particularly for the children awaiting time-sensitive procedures. I thank the Seanad for this opportunity to update the House on this service.