Health service - Lack of surgeons not acceptable

SPECIALIST medical services outside Dublin are so thinly spread that the retirement of one consultant can bring the system to a halt, forcing infants to go to the capital for surgery.

Yet another example of this unsatisfactory scenario has emerged following the retirement of the only surgeon in the south of the country with the skills to operate on babies born with certain birth defects.

As a result, from Cork and Kerry to Carlow and Kilkenny, newborn babies have to be taken to Dublin for operations on defects such as club foot or congenital hip dislocation. Since April, when the surgeon in question retired on health grounds, children needing other specialised orthopaedic surgery are also compelled to go to Dublin.

Clubfoot affects twice as many boys as girls and occurs more frequently than any other congenital malformation. About one baby in 300 is born with the condition, which is treatable.

Eight times more common in girls than boys, congenital hip dislocation occurs with an incidence of 1.5 per 1,000 births and is also treatable.

In an effort to bridge the gap, the Health Service Executive South made a temporary arrangement with surgeons at Our Lady’s Hospital for Sick Children in Crumlin. On their rest days, four orthopaedic paediatric surgeons travel to Cork to treat children who would otherwise have been seen by the retired specialist.

The problem, however, is that the Crumlin surgeons only provide outpatient clinics. Practically, they cannot perform operations in Cork because the necessary follow-up treatment is not available since they are in Cork for only a day at a time.

Clearly, this stop-gap service cannot be sustained indefinitely. More than 100 children a month are being treated at Crumlin, ranging from newborn babies up to the age of 14 or 15 and the number is expected to increase.

It would be unfair, perhaps, to take the HSE to task for a situation brought about by the unforeseen retirement of a consultant. But there is no evading the fact that the present system is so deeply flawed, and the service so thinly spread, that immense difficulties face those needing corrective surgery.

As a result, the parents of infants born with club foot, congenital hip dislocation or similar defects have to spend hours commuting to and from Dublin because surgery is not available across an entire region of the health service.

Given the intractable nature of the row between consultants and the Government over the State’s efforts to break the grip of highly paid specialists on the system, it could take a lot longer than a year to fill a gap created by the retirement of a skilled specialist.

At best, it can take between six months and a year to fill a vacancy in the consultancy field. In 2005 a consultant paediatrician who specialised in treating disabled children quit his post in Cork, moving to Dublin out of frustration over the lack of resources. He has yet to be replaced on a permanent basis.

And with consultants operating a ban on government efforts to recruit what they see as “cut-price” specialists, replacing an orthopaedic surgeon will be that much harder.

In this day and age, it is appalling that infants with birth defects are forced to travel from Caherciveen, Clonakilty, or Callan for surgery in Dublin. This situation is utterly unacceptable and will raise more angry questions about the HSE’s controversial policy of concentrating medical services at central facilities, forcing patients to travel long distances for vital treatment.