Colm Burke (Fine Gael)
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I thank the Minister of State, Deputy Alex White, for coming in to take the matter. I ask him to outline the up-to-date position on the provision of urological services for children who have spina bifida and hydrocephalus and, in particular, if arrangements have been made for a consultant paediatric urologist to travel from the United Kingdom on a monthly basis to provide the necessary clinical support in Ireland. The issue arises from the fact that there is only one paediatric urologist in Crumlin hospital. Children attending Temple Street Hospital do not have the services of a urologist and this consultant attends only for children with spina bifida in extreme cases. The paediatric urologist consultant in Cork reviews children in the south west region and is not in a position to see any Temple Street patients in the interim.

All children with spina bifida have a continence issue as a result of the condition but are being denied an important service which can assist in improving their quality of life. Children with spina bifida are in a high risk category for irreversible kidney damage which, in time, can lead to end-stage renal failure and, possibly, death if not monitored on an ongoing basis. As I understand it, the job was advertised and one applicant was interested but subsequently decided not to take the post. It appears that it will be difficult to fill the post as it is a very specialist area and it was suggested that we would engage the services of a UK-based consultant who would attend here on a regular basis to provide the service to these children. It is an important issue which needs to be dealt with.

Alex White (Dublin South, Labour)
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I thank Senator Colm Burke for raising the matter. Ireland has the highest incidence of spina bifida in the western world so it is important that this issue be raised in the Chamber and highlighted.

Spina bifida is a very complex physical disability and children with the condition have multiple problems as a result. The majority of children and adults with spina bifida have hydrocephalus. Best practice is that there are multiple professionals involved on a spina bifida team. We know that on average 30 children per year are born in Ireland with open spina bifida, which is the most severe form. I am aware that early intervention by a specialist and local team is essential to optimise long-term functioning for these children and to prevent medical complications later in life. The Children's University Hospital, Temple Street, is the national tertiary care centre for spina bifida and hydrocephalus. All infants born in Ireland with spina bifida are transferred to Temple Street after birth for ongoing neonatal management. Children with spina bifida are seen by a multidisciplinary team at Temple Street which includes a consultant paediatrician with a special interest in spina bifida, a spina bifida nurse specialist and neurosurgery input. The model of care being developed by the HSE is to share care between the specialist team in Temple Street and local teams. While the best care should be provided nearest to the patient's home with guidance and support from the specialist team, it is acknowledged, as adverted to by Senator Colm Burke, that there are complex issues which are best managed by the specialist team.

The multidisciplinary spina bifida clinic was established in Temple Street in February 2011 but I am advised that there has been no dedicated urological input to date. A recruitment process was under way in 2009-10 through which the hospital hoped to recruit a consultant urologist but, unfortunately, no suitable candidate was found. A new recruitment process for the post is in train and is currently at interview stage. The HSE is hopeful that this new recruitment process will succeed in hiring a suitable candidate. While awaiting the appointment of a consultant urologist, spina bifida patients are being reviewed by a consultant surgeon. As an interim arrangement, those children requiring urgent urological input are prioritised clinically and seen in the UK under the treatment-abroad scheme. I am advised that all patients are being kept under regular review and are referred on a case-by-case basis to the UK for treatment pending the appointment of a permanent urologist. Arrangements are also being made to establish a regular clinic with a UK paediatric urologist to cover clinical priorities here.

The Government is acutely aware of the challenges faced by patients with spina bifida and their families in managing their condition and is committed to providing them with the best possible health service. The Government will continue to work with the HSE to ensure the best possible outcomes for these patients.

Colm Burke (Fine Gael)
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I thank the Minister of State for his response and I hope he is right that the position will be filled. My understanding is that it will be difficult to fill the position given that it is a very specialised post and the number of people specialising in the area is small. I note that the Minister of State said arrangements are also being made to establish a regular clinic here with a UK paediatric urologist. When is that likely to be in place? Even if the HSE is successful, as I sincerely hope it will be, in recruiting a paediatric urologist, he or she may not take up the position for nine to 12 months. That 12-month gap must be covered.

Alex White (Dublin South, Labour)
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The best outcome is a permanent appointment here. There is a focus on achieving that now through the interview process. It is hoped a person can be appointed from the process in train. I will have to revert to the Senator on the timing in respect of obtaining the services in the interim of a UK-based paediatric urologist to provide a clinic here.