Children's Hospital Ireland and the Health Service Executive are altering existing plans to try to ensure that paediatric patients awaiting complex spinal surgery are treated urgently, according to HSE Chief Clinical Officer Dr Colm Henry.
Many have had their time on waiting lists extended after operations were paused at Temple Street Children's Hospital in Dublin a year ago when staff raised concerns about outcomes for patients and the clinical processes in place.
"We’re exploring all options including expanding capacity in Crumlin (Children’s Hospital) opening a fifth theatre in Temple Street Hospital, private capacity and - if necessary - using international orthopedic centres," Dr Henry told RTÉ's Prime Time.
He said that Selvadurai Nayagam - the UK consultant who has been tasked with conducting an external review of aspects of orthopaedic operations at Temple Street - will also advise on the configuration of future surgery plans ahead of the planned opening of the National Children’s Hospital on the campus of St James’s Hospital in Dublin.
Mr Nayagam is a consultant in orthopaedics and trauma, and Head of the Limb Reconstruction Unit at the Royal Liverpool University and Royal Liverpool Children's Hospitals.
Earlier, HSE Chief Executive Bernard Gloster said the external review could take up to one year.
Dr Henry said that Mr Nayagam had been engaged for a year so the review could "go as far and as deep as it needs to go".
The work would go on for a year "if needs be," he added.
The review will look at "complex and non-complex spinal surgery and any other domains, limb-reconstruction surgery or trauma surgery, to see if there are any causes for concern with any other patients, and that [element] will be expedited," Dr Henry said.
The review comes after the publication by Children's Health Ireland (CHI) of the internal and external reports into spinal surgery for patients with spina bifida at Temple Street Children's Hospital in Dublin, between October 2019 and October 2022.
The external review found that 75% of patients who underwent complex spinal surgery developed a wound infection requiring extra surgery.
It has still to be determined how Temple Street did not detect the use of unauthorised medical implants, Mr Gloster said.
Speaking in Kilkenny, he said it has to be established how the end-to-end processes within the hospital did not detect that particular problem.
It was a problem that came on top of the incidents that are already under review, Mr Gloster added.
He said the new investigation had to be allowed to explain how that happened.
Advocacy groups seek meeting with Taoiseach and minister
Two advocacy groups for many of those affected by the spinal surgery issues have written to Taoiseach Leo Varadkar and Minister for Health Stephen Donnelly seeking a meeting as soon as possible.
The letters have been sent on behalf of the Spina Bifida and Hydrocephalus Paediatric Advocacy Group and the Scoliosis Advocacy Network.
The groups want to discuss the matters of concern and what they say is a requirement for the new external review to have comprehensive terms of reference.
Consultant Selvadurai Nayagam, who is to conduct the review, is expected to travel to Ireland to meet Mr Donnelly later this month to discuss the review.
The minister said he would meet the families next week, if they wish.
Yesterday, Mr Donnelly said he had asked the HSE to widen the external review to other CHI hospitals and to the National Orthopaedic Hospital Cappagh (NOHC) in Dublin.
NOHC said the issues raised at Temple Street relate to complex spinal surgery - primarily in patients with spina bifida - and those with significant complex medical needs.
The hospital said that due to the complexity of these cases, these patients are not suitable for surgery at Cappagh.
It added that its paediatric clinical director had assured the hospital that the implants in question were not used in NOHC.
Co-leader of Spina Bifida and Hydrocephalus Paediatric Advocacy Group Úna Keightley said there are outstanding issues and "missing data" with the reports.
Speaking on RTÉ's Today with Claire Byrne, she said there is no mention of the non-medical grade devices in either of the reports.
Ms Keightley said: "That is very worrying. So how did that information come to light? We still don't know that."
She also said that when the UK's National Health Service carries out reports of this nature, one metric it focuses on is the social and psycological needs of parents and children.
"There is no mention of that in either of these reports," Ms Keightley added.
We need your consent to load this rte-player contentWe use rte-player to manage extra content that can set cookies on your device and collect data about your activity. Please review their details and accept them to load the content.Manage Preferences
Co-founder of the Scoliosis Advocacy Network Claire Cahill said that parents have lost "trust and faith" amid a "long-running national scandal" regarding the care and treatment of their children.
Speaking on RTÉ's Morning Ireland, Ms Cahill said: "I want to know my son is having a safe surgery in a hospital, in our public hospitals that we need to trust.
"So when I go into the theatre with my son, I place my son in the trust of the hospital and in the trust of CHI."
She said these recommendations, as well as better access to care and quality services for children, are what parents have been advocating for since 2015.
"We were not listened to," Ms Cahill added.
"The recommendations that I see, that are actually contained in the report and to be implemented, are not rocket science.
"There are many basic safety measures, such as the development of a formalised, informed consent chaired decision-making process, or the triage of wait lists."
She said the Scoliosis Advocacy Network would have spoken passionately about this and parents shared their thoughts.
Ms Cahill described "the trauma and upset" for families whose children have had to endure up to 33 trips to theatre for spinal surgery.
"It is no surprise to us what has come at this stage," she added.
The external report reviewed medical records for 16 children with spina bifida who underwent spinal surgery between October 2019 and the end of October 2022.
It found seven out of 16 patients, over 43%, had metalwork failure complications and nine out of 16 patients, over 56%, had metalwork removed.
Over 81% of patients required additional surgery due to a post-operative complication.
One child needed 33 subsequent visits to theatre.
Read more:
Surgical springs 'not ordered from retail outlet' - CHI
Temple Street parents say scope of review is too narrow
Taoiseach 'concerned' over spinal care at Temple Street
External review ordered into aspects of orthopaedic care at Temple Street
Meanwhile, the Oireachtas Health Committee is urgently seeking a meeting with Children's Health Ireland to discuss the controversy.
There are indications that the hearing will take place next week.
Committee chair and Sinn Féin TD Seán Crowe said: "Myself and members of the committee are deeply concerned at the revelations regarding spinal surgeries on a number of children at Temple Street and we feel it is important that these matters are examined in detail at a meeting in public session with Children's Health Ireland at the earliest opportunity.
"We are working to arrange that the meeting will take place next week."
The committee has 14 members, nine from the Dáil and five from the Seanad.
Additional reporting Fergal Bowers
