Orthopaedic services ‘inadequate’ and ‘chaotic’, say specialists

Services for children with orthopaedic conditions have been described as “inadequate” and “chaotic” by orthopaedic consultants.

Connor Green, consultant paediatric orthopaedic surgeon, told the Oireachtas health committee on Thursday that "everybody thinks this new [children's] hospital is going to save everything and it's not".

Mr Green was addressing the committee alongside Prof Damian McCormack, a consultant orthopaedic surgeon, Children's Health Ireland (CHI) and Health Service Executive representatives. CHI governs children's hospitals.

Mr Green said while the care of children with scoliosis in Ireland is inadequate, “the care of children with all other orthopaedic conditions is just as bad.

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“This is alarming when I tell you scoliosis only represents about 20 per cent of our practice,” he said.

“Therefore the real crisis is in everything else. As paediatric orthopaedic surgeons we see children with huge potential to contribute through their abilities to Ireland of the future. But these abilities are destroyed physically and psychologically by inadequate access to care.”

Mr Green, who carries out surgeries in Cappagh and Temple Street hospitals, said the issues of recruiting surgeons, building infrastructure and providing supports in the communities, were not going to be solved next year.

He said “unacceptably high wait times” were present before either the Covid-19 pandemic or the HSE cyberattack. And he added that “they have made it worse but they were there beforehand”.

“Nothing was in control before the pandemic. Nothing was in control before the cyberattack,” he said.

Mr Green added that because he and Prof McCormack were at the committee advocating, 50 children would not be seen. He said he did not know “how long I can continue doing this.

“If there was a major incident in Dublin today involving children we do not have one ICU bed for them to go to. We’ve no beds in Temple Street at the moment, we have no redundancy in the system.”

Prof McCormack said the system has “become more and more chaotic” over the last 20 years.

“Every little change now is the butterfly wing that is just creating more chaos. Everything is in flux, everything is chaotic,” he said.

Prof McCormack said three years ago over the summer, following his suggestion, he operated a theatre at Temple Street hospital on Saturdays to help cut the waiting list.

He said he worked for nothing but ensured the nurses were paid and about 10 children were operated on every Saturday. He said this happened for a second year but by the third year it couldn’t happen due to “too much bureaucracy”.

Prof McCormack said he had no problem working at weekends and that the infrastructure was there to allow this.

“The bureaucratic management structure at the moment is impossible,” he added.

He said it upsetted him when he heard of families doing charitable works to gain money to go abroad to private institutions for treatment, “some of it is excellent, some . . . completely bogus. There are tragic things going on in that regard and it kills me to see it.”

‘We should be embarrassed’

Prof McCormack said “we should be embarrassed” if any children have to go abroad for treatment and that “we should be better than that”.

Children's Health Ireland chief executive Eilish Hardiman apologised to patients and their families who have experienced increased waiting times and delays in accessing paediatric services

“Timely and increased access to our services is the single greatest operational challenge in CHI,” said Ms Hardiman.

“We are operating within old and constrained infrastructure and we have recently experienced extremely high levels of emergency departments and urgent care centre activity.”

She said at the end of last month, there were 2,876 children on the inpatient waiting list, 2,686 children on the day-case waiting list and 43,844 children on the outpatient waiting list.

Ms Hardiman said the annual target of 382 spinal treatments was “decimated” in 2020 due to Covid-19, with 60 less spinal treatments undertaken, a total of 322 procedures.

“We did make progress in early 2021 to recover some of this activity but the cyberattack in May 2021 severely impacted services in CHI,” she said.

“We anticipate that this year we will undertake a total of 335 spinal treatments in CHI.”

Ms Hardiman said there are 203 children on the waiting list for scoliosis-related procedures.