HSE audit finds no issues with Children’s Health Ireland's scoliosis and spina bifida funding

The HSE audit  reviewed funding for the Scoliosis and Spina Bifida Action Plan 2022, updated in 2023 with amended targets. File photo

A HSE audit of scoliosis and spina bifida funding for Children’s Health Ireland has found “no issues were identified” between plans for the money and how it was actually spent.

The audit was commissioned after Health Minister Stephen Donnelly raised concerns in July a tranche of €19m was spent "more broadly" than on care for the vulnerable children.

It reviewed funding for the Scoliosis and Spina Bifida Action Plan 2022, updated in 2023 with amended targets. 

The audit, published on Wednesday, compared reported spending to the agreed plans and found that “no issues were identified” by them.

“There is an expectation gap in the public domain regarding the purpose of the funding provided to CHI under the Agreed Plans,” the audit stated. “The perception that this funding would solely impact the Patient Group is inconsistent with some of the roles and their related intended purpose as funded under the Agreed Plans.” 

In one example, they found staff recruited to care for these children are also working with children who have other health conditions. The team’s analysis of the language in the action plans says this allowed for additional capacity in CHI hospitals.

They noted some categories — MRI scanner, additional operating theatre and critical care beds — were not described as needing to be ringfenced for scoliosis or spina bifida. 

“However, funding for outsourced surgeries to private hospitals (totalling €3m) was fully ringfenced for the treatment of scoliosis,” the audit found. 

Overall, funding of €34.78m was committed.

The audit team also analysed various kinds of surgeries for these children. A number of gaps compared to targets were identified.

Targets for ‘spinal fusion’ and ‘spinal other’ were broadly met, but cumulative targets for ‘non-complex’ cases were below levels set out in the action plans. The number of surgeries in this area was 197 (15%) below target.

The audit team raised this with the hospital. Targets were then revised in light of what CHI said was the high complexity of those patients.

For spina bifida targets, CHI reported 76 completed surgeries which was a shortfall of 39 (34%) below target. The National Orthopaedic Hospital Cappagh, which cares for these children with CHI, reported 92 completed surgeries meaning there was a shortfall of nine (9%) on the target.

Hospital management told the team this was linked to a consultant on extended leave and delays in the new operating theatre opening in their Temple St hospital. Spinal surgeon Connor Green has been on leave since controversy erupted last year over use of non-medical devices, springs, implanted in three children during surgery.

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Consultants interviewed by the audit team in September 2024 “highlighted definite improvement” linked to the funding.

However the audit also noted delays. These included an MRI installed in October 2023 not used until April this year. Additional beds were not all open until March this year.

The new operating theatre opened in October 2023 but did not become fully operational until April 2024.

CHI Interim CEO Fiona Murphy welcomed the review’s findings.

“We regret any delay in the delivery of the service and we strive every day to reduce waiting lists and waiting times for our patients and their families,” she said.

“Importantly, the review shows that a total of 989 surgeries were completed in Children’s Health Ireland under the spinal surgery plans 2022 and 2023; a marked increase in the numbers treated in previous years.”

Health Minister Stephen Donnelly said: "While the audit finds the funding was allocated and spent for the benefit of children, it concludes that CHI did not prioritise children with Scoliosis and Spina Bifida as was clearly intended by Government."