Scoliosis External clinical review

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Safeguarding and maintaining the highest possible levels of quality and child safety is the absolute priority for Children’s Health Ireland and is in the best interest of the children and young people we treat. In order to ensure we maintain good standards and safety and clinical outcomes in our service, and to continuously improve the clinical outcomes of our service, Children’s Health Ireland has commissioned an external clinical review of the complex spinal surgeries carried out in Temple Street on children with spina bifida over the past 3 years.

The external clinical review will involve expert clinicians in spinal surgery. They will examine CHI’s practices, procedures and patient outcomes in relation to complex spinal surgery in patients with spina bifida with a view to advising whether there are clinical outcomes and patient safety-related issues and recommendations to continuously improve our service.

Spina bifida is a complex condition which affects multiple systems in the body. Children born with spina bifida have extremely complex needs and those needing spinal surgery are the most complex. As can be seen internationally, these complex cases do unfortunately have a high rate of complications. This year, in order to improve access and address long waiting times for patients, Children’s Health Ireland increased the number of complex surgeries undertaken for children with spina bifida.

For comparison, less than five complex patients were operated on in CHI at Temple Street in 2021, compared with 11 complex patients to date in 2022. As we increased the number of surgeries undertaken over the summer, an increase in complications was noted by several clinical teams.

While this external clinical review is underway, CHI has made a decision to pause complex spinal surgery on those children with spina bifida who are having kyphectomy surgery as this is the most complex type of spinal surgery in this group of children.

It is estimated this clinical review will take approximately four months. There are less than five children currently waiting on this specific surgery and they will be offered a Multi-Disciplinary Team review to assess their needs (as is international best practice) and see if there are any new care needs or actions we can take to support them at this time. Parents and guardians of children affected have been informed and this direct patient contact will remain the priority of Children’s Health Ireland and our staff.

Orthopaedic Service
Update from Children’s Health Ireland 28 October 2022

Published on 28 October 2022:

Please see the latest Scoliosis Newsletter here

Significant progress has been made this year with regard to increasing the number of surgeries undertaken which is up by 152 (54%) on the same period last year.

• Long waiting times have also been reduced with 32% fewer children waiting greater than 12 months and 24% less waiting greater than 4 months.
• An increase in referrals, or new additions to the waiting list of 30% this year means that the impact of this increased activity is not visible when looking at total patients waiting.
• Winter seasonal illness has commenced with unprecedented numbers of attendances and children awaiting beds in the Emergency Departments. This is having an impact on all hospital services and in particular on inpatient and PICU bed capacity, this has slowed progress but our commitment to continuing to improve our services remains and developments are on-going to achieve this.
• The current timeline for the completion of the new additional theatre in CHI at Temple Street is the end of March 2023.
• The timeline for the additional theatre in Crumlin is early 2023.
• Recruitment is continuing to secure the nursing staff to support opening the additional 11 inpatient beds in Temple Street.
• Crumlin are also recruiting to secure nursing staff for an additional 13 beds with a schedule to open in Q1 2023.
• A new Clinical Nurse Specialist for spina bifida has commenced in post in CHI at Crumlin in recent weeks and can assist with queries and link across services.
• A new data manager for spina bifida has commenced in CHI at Temple Street in recent weeks.
• CHI at Temple Street is working to develop new close monitoring beds to support the complex care service.

Update from Children’s Health Ireland 28 September 2022

Children’s Health Ireland has a full spinal programme at Crumlin and Temple Street caring for and treating many children with complex needs. Our primary duty of care is to these children, young people and their families.

Due to unplanned leave by a leading member of the Orthopaedic team in CHI at Temple Street, we are working with the clinical team to best manage the impact on services. The decision to cancel or change any procedure or surgery is not taken lightly, and is made in conjunction with the clinical team and management. We are sorry if this results in any postponement of planned surgeries. There are many factors which need to be taken into consideration in planning complex elective surgery, including bed capacity and key staff availability.

Children’s Health Ireland has a limited number of critical care beds at CHI at Temple Street – priority has to be given to children/young people with life threatening illnesses to use these beds. Each Winter, our resources, staff, beds and theatres are under more pressure due to the number of patients presenting to our ED’s. Due to additional investment, we have a plan to increase capacity, that means more beds, MRI facilities and additional theatre capacity in CHI between now and early 2023.

Good progress has been made in reducing the orthopaedic waiting times for spinal surgeries to date, despite challenges in staffing and infrastructure. Children’s Health Ireland cares for over 1,000 children a day. We are accountable for every single child’s care and treatment who uses our services. Children’s Health Ireland will continue to communicate with our patients and families directly. We do not comment on individual cases in public. 

Please see the latest Scoliosis Newsletter here

Update on progression of wait lists and access to Orthopaedic Service

9 September 2022: In February 2022, Children’s Health Ireland welcomed the announcement of funding approved from the Department of Health to bring down waiting times for access to children’s services in Children’s Health Ireland, with Scoliosis and Spina Bifida a priority focus within the Paediatric Orthopaedic specialty.  The funding also supported a joint initiative with the National Orthopaedic Hospital Cappagh to substantially increase the clinically appropriate paediatric Orthopaedic Scoliosis and Spina Bifida work undertaken in Cappagh Hospital.

The Waiting List Scoliosis/Spina Bifida Action Plan and funding was formally agreed with the HSE and Department of Health in April of this year. This plan covered Paediatric Orthopaedic services in Crumlin, Temple Street, Cappagh and Blackrock Clinic.

As at end of August 2022, across these hospitals, 342 spinal procedures have been undertaken –  100 more surgeries when compared with 242 cases undertaken in the same period last year.

Progress has also been made with reducing the longest waiting times for scoliosis treatment:  

• Reduction in the number of patients waiting over four months from 99 to 72 (27 per cent reduction since January 2022)
• Reduction in patients waiting over 12 months for surgery from 34 to 21 (38 per cent reduction since January 2022)
• The total spinal waiting list has reduced from 224 to 212 in the same period.

*Data period up to 26th Aug 2022.

A post COVID-19 surge in referrals to hospitals was expected but numbers could not be predicted. In Crumlin and Temple Street there has been a 33 per cent increase in referral numbers for Spinal Fusions from 2019 to 2022 (164 to 218). Despite this increase in referrals and resulting increase in the numbers on the waiting list, more children are being treated and waiting times are coming down.

Dr Ike Okafor, Clinical Director, Children’s Health Ireland and Clinical Director for the Orthopaedic Service said: “Despite challenges, our staff and clinical teams have made significant progress with plans to improve the Orthopaedic service and continue to do so. 24 additional beds have been added to Crumlin and Temple Street, all of which will be in use by the end of this year. The addition of a 5th theatre when operational in Temple Street will make a significant difference to our theatre activity.

“We really want to acknowledge the phenomenal effort from our specialist teams. For example, in Temple Street last year, one complex spinal surgery was performed per month – we are now averaging one complex surgery per week. This increase in activity requires effort from all disciplines and areas in the hospital – including anaesthesia, critical care, radiology, pathology, nursing, Health and Social Care Professionals, administration and management and not least out highly specialised teams in the Orthopaedic service. We are acutely aware of how delays impact our patients and families and are extremely grateful for the investment and support from Department of Health and the HSE. This investment is making a difference by improving access to care and reducing wait times and we will continue to update on this progress.”

Breakdown of the funding received

• Funding approved in February/March 2022 total = €19.23m
• Funding included both one off funding for building work and equipment (€4.18m)
• And recurrent funding for additional staffing to run services (€15.05m). The funding is primarily for additional staff to undertake more operations to reduce waiting lists for all patients across services, with a particular focus on Scoliosis and Spina Bifida. This means extra theatre capacity, beds and MRI services in CHI

How the extra funding is being utilised across CHI sites since February 2022

Challenges

• Recruitment remains a challenge in some areas as we continue to recruit for the service. As with any Winter, activity can be unpredictable and there may be the need to postpone some elective surgery.
• Capacity will dictate this and we will continue to work with our advocacy groups, families and patients to ensure they are informed at every point.