Ireland at ‘cliff edge’ over paediatric surgeon shortages

Ireland has the fewest paediatric orthopaedic surgeons per capita of any European Union country and now faces a "cliff edge", a leading expert has warned.

There are only eight such surgeons in the State, one for every 600,000 people, compared with one for every 100,000 or so people in Northern Ireland and 200,000 in Scotland. Royal Manchester Children's Hospital alone has twice that number, Prof Feargal Quinn of Our Lady's Children's Hospital, Crumlin told the 2017 Millin conference.

Blaming a significant lack of funding, Prof Quinn said Ireland should have 12 paediatric surgeons spread throughout the country, a position supported by other clinical experts who spoke. Newly hired general surgeons should be able to treat children, he argued, adding that there is a need for more treatment outside Dublin, as the yet-to-be-built 470-bed national children’s hospital is already oversubscribed.

“Entirely unacceptable”

Prof Simon Cross, a surgeon at University Hospital Waterford, said that his institution now does only half as many paediatric operations as it did two decades ago, and that hiring and holding on to paediatric surgeons and nurses have reached a "cliff edge".

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“Presumably, the emergencies are going to Dublin when perhaps they shouldn’t be going to Dublin. In fact I know they shouldn’t be going to Dublin, and the electives” – people who need scheduled rather than emergency operations – “are probably just sitting on ever-burgeoning waiting lists,” he told the Royal College of Surgeons in Ireland conference.

Describing a recent case of a 12-year-old with a distended abdomen, Prof Cross said that he had been happy to do the surgery but that, as the Waterford unit lacked the capacity to deal properly with postoperative complications, the patient was transferred to Crumlin. "We shouldn't be transferring these patients." He said University Hospital Waterford needed two general surgeons capable of handling paediatric cases, and twice as many paediatric intensive-care unit beds.

Paula Kelly, a surgeon at Temple Street Children's University Hospital, in Dublin, said that Ireland had a high birth rate and a high incidence of congenital abnormalities, and that acute staffing shortages were being keenly felt. She described the waiting list of more than two years for elective surgery in Dublin as entirely unacceptable.

“Pay remote surgeons extra”

A UK-based expert, Prof John Macfie, said that the crisis in provision of general surgery for children was not unique to Ireland and that a gradual move towards specialised surgery in centres of excellence, rather than general paediatric operations at district hospitals, had exacerbated the situation. He advocated following the United States, where surgeons a paid extra if they relocate to remote areas.

Minister for Health Simon Harris recently told the Fianna Fáil TD Fiona O’Loughlin that by the end of 2017 children will wait no longer than four months for scoliosis operations. “The HSE is actively implementing the action plan they developed . . . and are focused on maximising all available capacity, both internally and externally,” he said.

Extra nurses have been hired by Crumlin and Temple Street hospitals, and an additional consultant orthopaedic surgeon began work last month in Crumlin. So far this year 272 scoliosis operations have been carried out in Ireland. This compares with 220 in all of last year. “This represents a 24 per cent increase with 11 weeks of the year remaining,” the Minister said in a written parliamentary reply.