Spinal surgeries review must be systemic if medics are not to be deterred from complex cases

The issues concerning spinal surgeries at Children’s Health Ireland (CHI) at Temple Street could not be more serious. The matters under scrutiny have given rise to justifiable anguish for the children and families impacted. Children who may have undergone spinal surgery or are waiting to do so need clarity and reassurance.

The external review being commissioned is of the utmost importance, first and foremost for the patients concerned, but also for any patient, child or adult, who is on a waiting list to have surgery in Ireland.

Getting the full facts is imperative for them. It is imperative, too, for those working in Temple Street, other CHI hospitals, and the hospital consultant community as a whole.

Hospital consultants know that our profession is not just about having the skills to perform intricate procedures or the knowledge to diagnose complex medical conditions. It’s also about understanding the weight of the trust that patients place in our hands and the impact that our actions can have on their lives. Standards matter. Governance matters.

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Systemic evaluation of the environment and resource limitations within which complex medical and surgical decisions are arrived at, consented to and ultimately undertaken is key.

We operate within the system. Given that we have been pointing to the flaws in the system for years, then that system itself must also be expertly scrutinised

CHI was correct in commissioning this external review. However, the manner in which it did so illustrates once again the vagaries of the health system we battle with.

The cultural and governing environment in which healthcare professionals function is critical to patient outcomes. When we are dealing with serious, highly complex situations, it matters even more. Nuance can exist. Multiple skills may be required. Patients, often in despair and on whose behalf hospital consultants have been battling for months, often years, look to us for outcomes.

Suboptimal conditions

To do the job our patients need us to do, hospital consultants require the supports, structures and resources that enable them to do so safely, effectively and in a timely fashion. Many hospital consultants work in suboptimal conditions with inadequate resources and structures, yet are expected to perform to the very highest international standards. The new Children’s Hospital will clearly go a long way to addressing some of the structural deficits in paediatric care. But we need to think more deeply than that.

Healthcare must always function in an environment where rigorous regulation and governance applies. Given what we do, the consultant will be leading the entire team, necessitating – as it rightly should – audit of decision-making and performance. But we do not operate in isolation. We operate within the system. Given that we have been pointing to the flaws in the system for years, then that system itself must also be expertly scrutinised.

We see the consequences where this is not the case far too frequently. In Child and Adolescent Mental Health Services (CAMHS), the publication of the Mental Health Commission reports revealed the scale and severity of the deficits faced in this vital service day-to-day. CAMHS serves, or at least should serve, as a lifeline for our young citizens and their families living with the challenges induced by moderate to severe mental health disorders. However, the very fact that our benchmarks for staffing and bed levels are rooted in a 17-year-old mental-health policy exemplifies the lack of priority the system has given to addressing this issue for close on two decades.

[ Review of Temple Street spinal surgeries could take at least a year, says HSE chief ]

[ Spinal surgeries: ‘Things happened in Temple Street that should not have happened,’ says CHI chief executive ]

Now, scoliosis patients and their families who for decades have had to battle the system, find themselves having to do so again. The battle many have to go through in healthcare is real. For hospital consultants, it’s a battle for theatre time and basic equipment. A battle with antiquated systems. A battle against the impacts of later patient presentations. Often, a battle to be heard. In short, a systemic battle.

We must have our eyes wide open to the consequences of a system which inhibits or at worst deters our medical specialists from taking on complex cases and advanced medical care

That is why any external review must be systemic in nature, even more so given how events in this instance are continuing to unfold. Justifiable concerns have been raised regarding both the terms of reference and who the review is ultimately reporting to. It is not too late to allay these concerns. A systemic review, comprehensive in nature, with the authority to see any documentation and evidence available, is paramount. It cannot in effect be allowed to report to itself.

The Taoiseach and Health Minister need to take firm control and make the necessary adjustments to ensure this review does not fall over before it has even begun.

[ Crumlin spinal surgery review finds most children with spina bifida had repeat surgery ]

This is fundamental because how it unfolds, what it concludes and ultimately recommends will influence how all hospitals approach complex care, innovation, risk evaluation and resourcing into the future.

We must have our eyes wide open to the consequences of a system which inhibits, or at worst deters, our medical specialists from taking on complex cases and advanced medical care.

A disservice

Every day, patients in our hospitals benefit from medical innovations. The more complex the health solution, the more dependent the patient is on a consultant and hospital who are prepared to help.

It would be a disservice to these patients, their families and the healthcare professionals who care for them to undermine this.

Prof Rob Landers is a consultant histopathologist at University Hospital Waterford and President of the Irish Hospital Consultants Association (IHCA). The 35th Irish Hospital Consultants Association Conference will take place today at the Radisson Blu, St Helen’s, in Stillorgan, Dublin.