Delays to spinal surgeries despite state-of-the art theatre

A state-of-the-art children’s orthopaedic surgery theatre is not reaching its potential to dramatically reduce 15-month waiting times for major spinal operations because the HSE cannot get the personnel to adequately staff it.

According to the latest available figures, 12 children have been waiting between 15 and 18 months for spinal surgery and five have been waiting for more than 18 months.

Leading orthopaedic surgeon Pat Kiely confirmed the new theatre in Crumlin Children’s Hospital is being used for all spinal cases at the moment.

“We have a navigation system and imaging system which is state of the art. Even as recently as last week, using that really helped us in an extreme situation,” he said.

“However, the whole theatre complex is certainly not staffed to the level that we would like. There are multiple operating theatres that are not open for as much time as they could be if they were staffed. The net effect is that we would love to be doing spinal surgery five days a week, which is what we would need to do to get on top of the backlog and really start to solve this problem.”

He said a recruitment drive needs to be ramped up to get all the operating theatres performing at a more regular level.

“We won’t solve the waiting list problem otherwise,” he said. “You don’t save a penny by not solving it because we end up spending a fortune sending them to the UK or elsewhere, not to mention that if they deteriorate, then the surgery becomes more extensive and the end result might not be as good, the risks are higher and it is not fair to the families and the kids and the medical staff trying to treat them.”

He said what he would like to see is a young person getting an operation within three to four months.

“That would be cost effective,” he said. “Waiting costs the services more. The kid is growing. Growth is not your friend. In a lot of them, growth is what has led to the deformity in the first place or is magnifying the problem that has started. Therefore a delay can make a huge difference.”

Mr Kiely gave the example of a child he treated last week. She was nine when she was listed for surgery. For a variety of reasons, she could not get treatment. She is now 13 and the spinal curvature has gone from 50 degrees to 125 degrees.

“We are asking ourselves to look after these kids in a potentially much more hazardous situation. If our remit is to reduce risk and be cost- effective and save money and provide the best care we can and provide equal treatment for the kids and the young people on this island to the adults, then this does not add up. It is not equal or fair. You question where political or public service priorities lie sometimes. We show cases to our colleagues in France or Germany or wherever, they look at each other and say how can this be happening, this is the dark ages what you are dealing with. You feel like you are inundated with this tidal wave of need. Trying to select who we try to defer hoping that things won’t get worse but they do for some of them.”

The Children’s Hospital Group said there were 133 spinal fusions treatments for scoliosis conducted in 2016 for children under 16 and young adolescents between 16 and 18, of which 44 were outsourced to the independent sector or UK under the HSE’s Winter Initiative funding.

“There is a shortage of nurses in specialist areas across the Irish healthcare system, such as theatre and critical care, which has required the hospitals to undertake an international recruitment campaign, that is ongoing since 2015,” it said. “The Children’s Hospital Group is currently working with the HSE on the international recruitment drive for nurses.”


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