Seanad debates
Tuesday, 27 February 2024
Nithe i dtosach suíonna - Commencement Matters
Hospital Services
1:00 pm
Tom Clonan (Independent)
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I thank the Minister of State for coming here today. I was informed last night that it was she who would be here. I was very pleased to hear that, not only because she is my local representative, of course, but also because I know her to be a person of absolute intellectual and ethical integrity. I know that the Minister of State will understand the import of the matter I am going to raise here. We may be distracted by, let us say, matters in RTÉ or the cost overruns in the children's hospital, but in the context of the concerns I am raising, these are irrelevant. Here we are talking about young lives. I have raised here before the issue of more than 200 children on waiting lists for spinal surgery in Temple Street and Crumlin hospitals. This has happened on the watch of Children's Health Ireland and its senior executive team and CEO. While those children are being failed, it has also been brought to my attention that children on the urological waiting list are also being failed. When we fail children, adolescents and young adults consistently over time without a meaningful intervention, in my mind it becomes almost a form of institutional abuse.
I want to be specific on the issue of the urological surgical waiting list. In the international medical community, the recommended model of care for children, and young adolescents in particular, on the urological waiting list is called the transitional model of care. It has been in place in the National Health Service in the UK since 2002, for more than 20 years, and in the United States since about 2005. We do not have a transitional urology programme on the watch of CHI. For these children who need surgical interventions approximately every 18 months as they develop from children into young men and women, these interventions are not taking place in Ireland. While there should be an 18-month therapeutic window, the average waiting time for a child in Ireland - these are disabled children, many of whom have cerebral palsy, spina bifida or other conditions - to get a first consultation to be seen by a urologist is an average of 2.5 years followed by a further 2.5 years to get surgery. That is five years. What is happening during those five years? I am sorry to say, many girls need vaginal reconstruction, which is not happening. This has a knock-on effect on their psychosexual development, their sexual development and their fertility. Boys can suffer from erectile dysfunction or have penises that are permanently bent for want of a little surgical intervention on the way. This leads to erectile and ejaculatory dysfunction. These issues lead to an increased risk of cancer. In the case of colorectal cancer, a person who does not have these interventions has a one hundredfold greater chance of contracting colorectal cancer. For bladder cancer the increase is six hundredfold. These interventions are not happening. We have young disabled Irish men and women, children and teenagers who suffer from infertility and incontinence and whose kidney function is affected. They suffer from UTIs. Many of them are wet and have to wear incontinence pads. These are children trying to go through their little development milestones and their urological goals are not being met.
I have no confidence in the executive management team of CHI. When we consider that it is about to oversee the transition of services from Crumlin and Temple Street to the new hospital site, the Government has to intervene and put in place a team of people who are actually competent to do this.I would appreciate it if the Minister of State could communicate the sheer import of this to her colleagues at Cabinet. The questions “When did you know?” and “When you did know, what did you do about it?” will be asked.
Martin Conway (Fine Gael)
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I welcome Liam and Breda O’Connor from Clogheen, County Tipperary, who are guests of our colleague Senator Garret Ahearn. I hope they have a wonderful day in Leinster House. We are dealing with Commencement matters, where people raise issues of concern to them. My mother is from Cahir, so I Clogheen very well. I hope they have a wonderful day and I have no doubt that Senator Ahearn is looking after them.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank Senator Clonan for raising this important issue. Senator Clonan knows there is probably no issue closer to my heart than the experience of children in hospital in Ireland and I am glad to have the opportunity to provide the answer I have been given by the Department to the Senator.
First, in respect of the experience of the children, additional needs, whether they be medical, personal, intellectual or whatever they may be, makes growing up much more difficult. That and their dignity throughout the hospital process is paramount. If there are issues that can be resolved reasonably easily – forgive me, I am not a medical person and do not know – one would think the personal hygiene and care that can be made better by surgical intervention of particular importance is. It is an important issue. I understand the mental health and developmental issues that are aligned to the surgical issues as much as anything else. That is why it is so important that the Senator is raising this.
I am told by the Department that Children’s Health Ireland, CHI, has advised that there are 163 types of procedures carried out by its urology team in Crumlin, Temple Street and Tallaght hospitals. They have three full-time urology consultants working on the service supported by a multidisciplinary team, MDT. The onboarding of the third consultant has created additional capacity to allow consultants to attend all spina bifida MDT clinics in Temple Street. Urological procedures are also carried out by general surgical teams.
In the past year, CHI has undertaken work to reduce the number of patients on the waiting lists for hypospadias – forgive me if I pronounced it incorrectly – surgery repairs. A significant number of single-stage and multistage procedures have been converted from inpatient admissions to day care procedures, which makes a big difference. This change in patient care has allowed an increase in the number of those procedures happening throughout the system. Additionally, the HSE has recently approved a fourth urology consultant post, which will allow for the creation of a separate urology call rota from general surgery once the new children’s hospital has opened. I agree with the Senator’s sentiment in respect of cost. When you are the parent of a child in hospital for a very long period, you know exactly how important it is and the care that will be provided to children there will be incredibly important.
On waiting lists, it is important to set this on the record today so that we can compare it with figures in the future. The national treatment purchase fund waiting list figures for January 2024 show there are 1,135 patients on the outpatient urology waiting list in CHI. Of those, 55% are waiting six months or less and 87% are waiting 12 months or less. I am told the waiting list has decreased by 6% when compared with the same period last year.
Regarding inpatient and day case procedures, the January 2024 figures show there are 476 patients waiting for a urology procedure at CHI. Of those, 40% are waiting six months or less and 74% are waiting 12 months or less. The inpatient and day case waiting list has increased by 23% when compared with the same period last year and there has been a decrease of 5% so far this year. Forgive me as I am not sure exactly how that works. The figures also show a decrease of 5% since December 2023 in the numbers waiting outside the 12-week target.
I am informed that the Minister accepts that acute hospital waiting lists are too long and that many patients are waiting unacceptably long time. He is aware of the impact that can have on children and families, so he has adopted a multi-annual approach through a series of waiting list action plans. Those 2023 plans built on the foundational work in previous plans. We are seeing significant reductions in some waiting lists but not all waiting lists. In some waiting lists, there are considerable improvements. From my own constituency, I know that some waiting lists have improved considerably. The overall waiting list reduction was achieved in 2023 despite 8% more patients being added to our waiting lists than was projected last year. Obviously, there is significant additional work to be done in 2024.
Perhaps the Senator has more details that I can pass to the Minister.
Tom Clonan (Independent)
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I appreciate the sincerity of the Minister of State’s response. I know she and I are on the same page when it comes to our concern with children and citizens with additional needs.I have deep concerns about the surgical qualifications of these people carrying out urological procedures. Many are general paediatric surgeons with no specialisation in urology which is not consistent with international best practice. Some of them are not on the urological surgery register. We should not have surgeons intervening in that way.
We are in breach, on Children's Health Ireland's watch, of Article 25 of the UN Convention on the Rights of Persons with Disabilities which provides that disabled citizens have a right to enjoy good health, development and so on. I have written to the Chair of the Joint Committee on Disability Matters. I want Bernard Gloster, CEO of the HSE; the chief clinical officer, Colm Henry; and the CEO of CHI to come in and explain themselves because this is not one list; it is another list. It is evidence of a lack of proper governance, oversight and management. At this very sensitive moment, when we are transferring all the care and closing down two hospitals and going into a new environment, there is a serious risk that children will suffer needlessly life-limiting and life-altering outcomes that are avoidable. We need a different management team in place.
Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Perhaps I will not comment on the capacity of the surgeons or indeed the current management team. I will say that in my experience, the longer I am a public representative and engage with the hospital system, the more I know about the value of management processes in delivering for patients, for example in the reduction of some waiting lists. Although some hospitals do not seem to have difficulties with emergency departments, others have very considerable difficulties. The different management processes in healthcare management are extremely important. I know from speaking to constituents that if you are the parent of a child with multidisciplinary teams, by necessity the management of all that is extremely difficult for parents. Something that could easily be adopted by hospital management is to always think of things from the patients' perspective and the patients' experience rather than from the perspective of the convenience of the hospital. This is a mindset shift that could be made by hospitals in Ireland and adopted by the State more broadly. It involves really thinking about things from the perspective of the patient and their convenience, the difficulties they go through and how appointments are scheduled. I have always thought particularly of parents coming with children from very long distances and the inconvenience of having an appointment on a Tuesday and a Thursday when perhaps they could easily be brought together. These are management questions and the Senator is right to highlight management issues. We can always do better in this. The management of waiting lists is something we will pay particular regard to.
Martin Conway (Fine Gael)
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I thank the Minister of State and I thank Senator Clonan for his constant advocacy on these extremely important issues.
Before the next Commencement Matter, I welcome our guests in the Distinguished Visitors' Gallery from the Irish Wheelchair Association. They are very welcome to Leinster House today. They are guests of Senator Hackett. I hope they have a very enjoyable and informative day.