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Amanda Coughlan-Santry, Úna Keightley, Claire Cahill and Michelle Long addressing the media this afternoon. Jane Moore/
Children's spinal surgeries

Taoiseach not ruling out statutory review into CHI following meeting with patient groups

The Spina Bifida and Hydrocephalus Paediatric Advocacy Group and The Scoliosis Advocacy Network met Leo Varadkar this afternoon.

TAOISEACH LEO VARADKAR told advocacy groups for scoliosis and spina bifida patients that he “wouldn’t rule out” a statutory review of Children’s Health Ireland (CHI) during a meeting this afternoon. 

The Spina Bifida and Hydrocephalus Paediatric Advocacy Group and The Scoliosis Advocacy Network have called for a full statutory review into the HSE and CHI following the controversy surrounding children’s spinal surgeries at Temple Street hospital. 

The groups, who represent 16 of the 19 children who suffered surgery complications at Temple Street and their families, said they want “no part” of an external HSE review into CHI’s spinal surgery services unless the terms of reference are widened significantly

Amanda Coughlan-Santry, Úna Keightley, Claire Cahill and Michelle Long met with Leo Varadkar, Health Minister Stephen Donnelly and HSE chief executive Bernard Gloster this afternoon to discuss their concerns and to ensure that responsibility “for this particular national scandal” is taken by Government. 

In a statement issued after the meeting, the groups said they asked the Taoiseach about a statutory review and that he said he wouldn’t rule it out.

They said the Minister for Health and the Taoiseach both stated that the terms of reference for the HSE review “were not set in stone and that they could be re-drawn with us”. 

“Mr Gloster said CHI would have no part in the investigation. It is HSE-led.”

The groups are also calling for an independent taskforce to be established separate from the Department of Health and the HSE to take over the management of spinal surgical lists and complex surgical care for children with spina bifida, hydrocephalus and scoliosis “as a matter of priority”.

Following the meeting, the groups said Varadkar “did not rule this out and it is under consideration”. 

They said the Taoiseach, Health Minister and HSE CEO have committed to reviewing their request of giving and paying for children with spinal conditions to have second opinions out-of-state if the families wish to do so “as an effort to allay fears families’ have about their children’s medical care”. 

They said the Taoiseach committed to meeting both groups again in the coming weeks.

“All agreed to reflect and review on the above and return to the table once we have consulted with the families in regard to their wishes on how to proceed,” they said.

Meanwhile, the HPRA also revealed this afternoon that it was notified about the potential use of springs in surgeries in August and was now liaising with CHI about the situation. In a statement to The Journal, the health products watchdog said one report was made through its vigilance system by CHI.

This related to the “potential use of product not intended as a medical device and identified by the reported as a spring in early August 2023″, it outlined. 

“While the normal medical device vigilance system would not apply due to the nature of the product, the HPRA has been liaising with CHI to ascertain further details in relation to the procedure(s) involved, the setting of use and the nature of any resultant adverse outcomes.”

‘Healthcare catastrophe’

Speaking at a press conference ahead of the meeting this afternoon, the advocacy groups said they had lost all confidence in the HSE, CHI and the Minister for Health to be able to manage or achieve a resolution of this “emergency healthcare catastrophe”.

“Our children languish on waiting lists and deteriorate to the point that they become at risk to highly complex and dangerous procedures, complications and poor outcomes as a direct result of the length of time they waited for intervention. In other cases like my son there is simply no intervention at all,” Coughlan-Santry said.

In no other State in the EU would that be deemed to be in any way acceptable practice and nor should it be acceptable within Ireland.

“The Government has failed to adequately address this situation, despite our consistent calls for support and engagement.”

They added that they believe responsibility for this failure lay with the HSE and the Minister for Health.

HSE review

The HSE review, which was announced last week, is to be led by Liverpool-based consultant orthopaedic surgeon Selvadurai Nayagam.

Long told The Journal that the terms of the review must be redrafted with all parties involved in order for them to have any involvement in it. 

“We need to start again, because what’s in it is to review the Temple Street review. That’s no longer in any way adequate and we need that written down,” she said.

“There’s no point in telling us that the reviewer can, if he likes, extend the scope. The decision shouldn’t be with the reviewer, or with the HSE. It needs to lie with the patients and families with an equal voice in it.”

She said she believed the issues raised were “too big” for one person to examine.

“The timeframe suggested of a year is completely unacceptable to families. [The children] haven’t a year to wait for a report,” she said.

“We need a taskforce that’s a much wider group to look at all the issues: medical, governance, management, and of course, the horrific incident of metal parts that are not medical being put into children, and how the management of a hospital either knew and stood back or didn’t know and therefore, are not in control of their own organisation.”

Coughlan-Santry told The Journal it was essential that any review would not only be led by someone from outside Ireland, to ensure impartiality, but would also incorporate specific expertise on spina bifida.

Cahill said any review also needs to examine whether other medical grade products were being used correctly.

“I think it’s really important to state that all of our children as such have metal implants and devices inside their bodies and there has to be standards,” she said.

“We need to know even for EU-regulated products, that the instructions for use are being followed on them and that’s a really important point. When we see such huge grave oversights, we worry for our own children.”

Taoiseach ‘angry’ at surgery delays

Speaking ahead of the meeting, Varadkar said he is frustrated and angry at ongoing delays for children receiving spinal surgery.

“Really, the purpose of the meeting is to hear from them,” the Taoiseach said before the discussions.

“You know, clearly there are issues with the spinal service in CHI, there are issues in relation to the practice of one consultant, but there are also wider issues and I know they must be very frustrated and very angry at the delays that children have to endure to get treatment. I am too.

“Despite years and years of additional investment and increases in the number of operations performed, we haven’t really seen waiting lists improve very much.

“But, mainly, the purpose of meeting is for Mr Donnelly and I and the head of the HSE to really hear from them and that’s going to be an important meeting and one I am looking forward to.”

Crumlin review

It comes after a review into spinal surgeries at Crumlin hospital was published. Crumlin is part of the Children’s Health Ireland group along with Temple Street.

The Journal learned earlier this week that this review had been undertaken but had not been published by CHI. 

The Crumlin review included all patients with spina bifida and scoliosis who had spinal surgery at the hospital between 1 January 2020 and 31 December 2022.

It found that 96 surgeries were carried out on spina bifida patients, 79 of which were spinal surgeries involving 13 patients. 

It found that the majority of patients who underwent spinal surgery at the hospital suffered post-operative complications.

Of those, six had postoperative infections, two had urinary tract infections, one had a significant nutritional deficit, one had a leak of fluid from the spinal cord and one had a significant psychological distress. 

“Wound infection was the only significant complication in this cohort. This fell within published rates for Spina Bifida spinal surgery. This has informed recent changes to wound management,” the review states. 

None of the patients had metal work failure following their procedure in this time period or needed replacement of metal work during the review period.

There were 42 emergency surgeries performed, four of which were unplanned. 

Four of the 11 children returned to the operating theatre between one and nine times, while two returned between 10 and 20 times.

The average length of time that patients remained in hospital after their operation was 25 days. Six children remained in hospital for fewer than 14 days, while two were in hospital for between 14 and 25 days. One child remained in hospital for 151 days.