Hip surgery becoming necessary for many children 'due to late diagnosis' amid lack of screening
Regarding the recent CHI report, a consultant said: 'If you subtract the unnecessary operations from the overall number, you are left with a lot of necessary operations. In many cases it is likely that they were necessary because of late diagnosis.' Picture: iStock
Questions are being raised as to why “worrying” gaps in care for children with hip dysplasia — first identified in 2017 and again in a Hiqa report last year — have not been addressed.
Healthcare workers were raising alarms about diagnosis, including through a HSE steering group in 2017, even before the latest crisis around surgeries under Children’s Health Ireland (CHI) hospitals.
By January 2023, concern was so high two medical bodies made a submission to the National Screening Advisory Committee (NSAC).
The National Child Health Public Health Programme and the National Clinical Programme for Paediatrics and Neonatology called for ultrasound screening for the condition for all babies instead of only those at high risk.
Hiqa was then asked by the NSAC to compare the benefits of selective and universal screening.
The NSAC reports directly to the health minister. Hiqa’s report team included people from the HSE and Department of Health.
The report advised against expanding screening, saying there is “significant uncertainty” over benefits.
However, it found existing systems are not a formal screening programme and not in line with HSE steering group recommendations. It said:
It is not known how many babies are born annually with hip dysplasia, it said, citing Irish studies showing a range of “between 400 and 1,800 babies”.
Funding was provided by 2017 for ultrasound programmes in maternity hospitals.
However, it is not mandatory to report patient numbers, diagnosis, or treatment.
One consultant familiar with hip dysplasia care warned: “So, essentially the steering group was there as spectators, helplessly trying to get information but not actually having the power to gather it and not having the power to act on it.”
The urgency was highlighted by the CHI hip surgery audit. The consultant said:
This is because “problems arise when the diagnosis is made late. The sooner you spot it, you can treat it in a harness or a brace. And the children respond very well and have excellent results”.
However, without a national register, the doctor said “we have no idea what the national rate of late diagnosis is. I would guess there are probably 80 to 100 babies per year who are presenting with late diagnosis”.
Sinn Féin health spokesman David Cullinane questioned long delays in implementing the recommendations or a national audit, saying “astonishingly the working group has now been disbanded”.
“The recent scandal into unnecessary hip procedures on children demonstrates the importance of the recommendations of the working group,” he said.
“It is worrying that these recommendations were not implemented and this has caused understandable concern for those involved in this valuable work.”
The HSE said the steering group was disbanded this year. Its role was to identify ways to find babies at risk.
“These pathways are now in place nationally,” a spokesman said.
Responsibility for this is now under the “relevant clinical and operational governance lines” under each regional executive officer in the new HSE health regions.
The Department of Health pointed to communication from the NSAC last month to the two bodies which raised concerns saying the best approach “would likely be the systematic application of the current selective screening programme”.
A spokeswoman said NSAC wrote to the health minister in March 2024 recommending against expanding screening.
“The NSAC Chair noted that the condition would be kept under review as new evidence emerges. This will be considered later this year,” she said.
Hiqa confirmed its advice was submitted to NSAC.
