Children's hospitals forced to cancel surgeries for patients who are in 'increasing pain'

THERE IS CONCERN about the impact of bed shortages at the three children’s hospitals in Dublin, which were forced to cancel surgeries over the last week. 

Children’s Health Ireland, which runs Crumlin, Tallaght and Temple Street children’s hospitals, last week said there has been a “very high number” of attendances to its Emergency Departments and Urgent Care Centre (UCC). 

This has resulted in the cancellation of some non-urgent in-patient and day-case procedures. Parents were contacted over the course of the week to inform them that their children’s procedures would have to be rescheduled. 

Figures from HSE Daily Operations last week highlight the shortage of paediatric ICU beds:

On Thursday, Temple Street Hospital had just four general beds available; Crumlin Children’s Hospital had three general beds; and the children’s hospital in Tallaght had just two general beds available.

There were seven children on trolleys across the three children’s hospitals in Dublin on Friday. 

Children’s Health Ireland said around 40% of in-patients across its hospitals have Respiratory Syncytial Virus (RSV), a virus that presents with cold-like symptoms.

The Health Protection and Surveillance Centre (HPSC) has been reporting a rise in cases of RSV in recent weeks, with 33 confirmed cases – mostly among children aged 0-4 years -  recorded last week.

CHI has said many other children who have been admitted to hospitals have the winter vomiting bug and other viral illnesses. It said cancelling elective procedures is “necessary in providing care safely at this time for patients needing urgent or essential treatment and for our staff to manage”.

Speaking to The Journal, CEO of Spina Bifida Hydrocephalus Ireland (SBHI), Gerry Maguire, said he has been receiving calls from parents “in tears” because their children’s surgeries have been cancelled.

“Children are having to use wheelchairs – even though they are very good at walking – because the pain is so intense they just can’t do it anymore,” he said.

“And then with scoliosis, the spine is curving all the time and it starts crushing internal organs. You can only imagine the pain of that for a child. We as a country are allowing this to happen.”

Maguire said a support worker this week told him about a child who was waiting so long for his procedure that he required halo-gravity traction, a long process of gradually stretching the spine. 

“He ended up in hospital for four months when it only should have been a couple of weeks,” he said. “Four months for a child who is already trying to come to terms with a serious disability is cruel beyond words.”

He said he has written to Minister for Health Stephen Donnelly and Minister of State with responsibility for disability Anne Rabbitte about the issue.

“The excuse of Covid and cyber attacks cuts no ice with me and it doesn’t do anything for parents either,” he said.

Anna Gunning, CEO of the charity Children in Hospital Ireland, told The Journal that she is concerned about the impact of cancelled procedures on children and their families.

“Children and young people’s health cannot wait and it is really shocking to hear how some young people are regressing because of lack of much needed treatment,” she said.

“We understand the enormous pressure which the paediatric hospitals are under at the moment with the increase in the winter viruses and subsequent bed shortages and overcrowding in ED departments.

But for those families who are watching and supporting a child in increasing pain and having surgery dates postponed, it is really frustrating. Trying to explain that situation to a child in such distress is heart-breaking as expected treatment dates come and go.

“We urge the HSE and the government to make available the necessary budget to ease this situation through the provision of additional operating theatres and the required staffing and support services to ensure that these young patients do not continue to suffer.”

On Thursday, an Oireachtas committee heard from consultant paediatric orthopaedic surgeon Connor Green that some children’s future potential is being “destroyed” physically and psychologically by inadequate access to care.

He told the committee that scoliosis represents about 20% of his practice, and the failures in the system also affect children with spina bifida, cerebral palsy, hip deformities and limb deformities.

He said the children waiting for procedures are in so much pain and so ashamed of their appearance that they miss more school than they attend and spend their childhood on waiting lists. There are currently 43,844 children on the outpatient waiting list.

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Green said hospitals struggle to get the skilled nursing staff they need because they are not “remunerated and educated and supported appropriately”.

“We need to resource our ICU staffing better, we need to ring-fence an intensive care bed before elective surgery, and we need to support our intensivists and recruit more of them in order to look after patients afterwards,” he said.

CEO of CHI Eilish Hardiman has apologised for the distress caused to patients, especially those who have waited a long time for appointments. She said hospitals are under “extreme pressure” and hope to restore non-urgent services as soon as possible. 

Speaking to RTÉ’s Today with Claire Byrne on Friday, she said over the month of October there were almost 20,000 attendances at Emergency Departments at children’s hospitals.

This compared to 11,700 attendances over the same period in 2019. 

“So we have seen a massive increase and those children are in hospitals, in beds, requiring airflow because of respiratory conditions and in our ICU,” she said.

“That is naturally going to mean that our electives are going to be compressed. We have a capacity issue and we have to try to invest to expand the existing facilities and address it with staffing as well.”

Hardiman said CHI has been advocating through the government’s Access to Care Fund to access up to €9 million for staffing, additional theatres and equipment.

She said some progress had been made with previous investment but some of that has now been lost due to delays caused by the pandemic and the HSE cyber-attack.

“We don’t have the capacity to deal with the backlog,” she said. “So we need to do something pretty quickly.”

Has your child been impacted by long waiting lists for a procedure or had their operation cancelled recently? You can share your story with us by emailing michelle@thejournal.ie.