All children waiting more than four months for spinal surgery at the end of last year should be offered treatment abroad if clinically appropriate, the Health Service Executive was directed by then minister for health Stephen Donnelly in January.
Mr Donnelly made the direction under health legislation after expressing disappointment with the HSE that the backlog for surgeries had not been reduced.
Children’s Health Ireland (CHI) and the Government have come under repeated criticism for delays in spinal surgery for children with scoliosis and spina bifida.
Asked about Mr Donnelly’s direction, CHI has said that “not all patients” waiting for spinal surgery for longer than four months “are clinically suitable to travel abroad for surgery”.
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Many families have said these children endure a reduced quality of life and intense pain and discomfort due to delayed procedures.
On January 21st, in one of his last letters before he stood down as minister, Mr Donnelly wrote to Ciaran Devane, chairman of the board of the HSE, issuing directions to the executive under Section 10 of the Health Act 2004.
Mr Donnelly said “significant additional funding” had been allocated to help address waiting lists through both additional staffing and increased capacity.
“I am pleased to see a record number of procedures were carried out this year, but the backlog of children awaiting inpatient spinal care has not yet been fully addressed,” he said.
According to Mr Donnelly, the number of children on the active list who were waiting more than four months for surgery had fallen “considerably” from 86 in January 2024 to 54 on December 31st last.
“While this figure is much improved since earlier in the year, we are not where we need to be. I am disappointed that the figure is not closer to 20, as was projected by the paediatric spinal services management unit in CHI,” he said.
Mr Donnelly said he brought a memo to government in October last outlining the work under way to reduce waiting lists further.
“At that time, I also advised Cabinet that I had asked CHI to ensure that after Christmas any child waiting longer than four months will, in consultation with their treating clinician, be offered surgery overseas, if clinically suitable,” he said.
“CHI has advised that the additional consultants being hired, coupled with additional investment already made, will ensure enough surgical capacity to meet the needs of the paediatric spinal service in future, once the current backlog is addressed.”
Mr Donnelly said, as a result, he was directing the HSE to ensure all children who were then waiting more than four months will be offered the care package in New York and London provided to other children and families to date.
“This offer should be made in consultation with [their] CHI consultant for each child. Please note that after this consultation, the family may avail of the offer regardless of the view of the CHI consultant,” Mr Donnelly said.
He added that the funding for this treatment should be allocated from the “considerable sums” allocated to the 2025 waiting list action plan.
According to the most recent figures from CHI, from February, there were 132 patients active on the waiting list for spinal surgery, of whom 43 are waiting longer than six months.
In 2017, Simon Harris, who was then minister for health, gave a commitment that no child would wait more than four months for spinal surgery, but this target was not achieved.
Asked if these patients had been scheduled for surgery abroad, a spokeswoman for CHI said “a number of families are considering surgery abroad in the future”.
“Spinal surgery and aftercare are complex, and our priority is the safety of patients. Not all patients who have been waiting for spinal surgery for longer than four months are clinically suitable to travel abroad for surgery,” the spokeswoman said.
“They may have complex care needs, they may not be physically able to travel on a long-haul flight, they may have socioeconomic factors to consider, their consultant in Ireland may recommend against it, or the team in the treating hospital abroad may recommend against it. For less-complex adolescent idiopathic scoliosis patients, using capacity in Ireland is the more appropriate pathway.”
