THE NUMBER OF “non-complex” surgeries on children with scoliosis and spina bifida between 2022 and 2023 was almost 200 below target, despite improved funding for Children’s Health Ireland, an audit has found.

It also revealed that targets for reducing the waiting lists for children for spinal surgery are not being met, with 54 waiting longer than four months for an operation in September 2024 compared to the target of 20.

A new report by HSE auditors also found that more than €13 million of almost €35 million in funding approved to tackle the problem of long waiting lists for the treatment of children with scoliosis and spina bifida over a two-year period was not spent.

An internal audit by the HSE to review €34.78 million in approved funding to provide high volumes of treatments for patients with scoliosis and spina bifida in 2022 and 2023 found that just €20.2 million had been spent within the relevant period.

The funding was approved under agreed plans between the HSE and CHI – the group that runs the main children’s hospitals in Dublin.

The audit revealed that €13.42 million – 92% of the total underspend – related to additional staffing for CHI hospitals.

CHI management told the HSE auditors that they experienced recruitment challenges in trying to hire some categories of staff over both years.

The audit concluded that targets set for spinal fusion surgery and other forms of spinal treatments were “broadly met” over the two years.

However, the target for “non-complex” cases was 15% below the set target – a total of 197 cases.

Cappagh Kids, the children’s inpatient ward at the National Orthopaedic Hospital Cappagh claimed the shortfall in treatment was partly due to the complexity of cases which affected the number of patients receiving surgery.

The audit showed that 468 spinal fusion surgeries were performed over the two years – 15 ahead of target, although CHI at Temple Street performed 26 surgeries below its individual target due to bed capacity, unplanned surgeon leave and the delayed opening of an additional operating theatre.

Another 503 spinal surgeries of another type were carried out at CHI hospitals between 2022 and 2023 – just three below target.

The audit showed just 168 of other types of treatment for spina bifida were carried out over the two years – 48 below target – due to extended consultant leave and a delay in opening a new theatre at CHI at Temple Street.

The audit noted that the majority of the additional capacity provided under the agreed plans did not become operational until late 2023 or early 2024.

However, CHI medical staff told HSE auditors in September this year that they believed there had been “definite improvements” over the last number of months.

The audit also revealed that:

• An MRI machine installed in October 2023 did not become operational for a further six months
• All 24 additional beds were not fully opened until March 2024
• A new operating theatre which was opened in October 2023 did not become fully operational until April 2024

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It noted that the nature of some additional roles funded under the plans gave staff members a wider remit than just relating to the treatment of scoliosis and spina bifida.

However, the audit claimed there was “an expectation gap in the public domain” about the purpose of the funding to be provided to CHI under the agreed plans.

It said the perception that the funding would solely impact on children and young people with scoliosis and spina bifida was inconsistent with some of the roles being funded and their intended purpose.

HSE auditors also pointed out that while there was funding for additional capacity in CHI, some spend categories such as an additional operating theatre, did not make any reference to ringfencing or prioritising the additional capacity for patients with scoliosis and spina bifida.

However, it did find that €3 million in funding for outsourced surgery to private hospitals was fully ringfenced for the treatment of scoliosis.

At the same time, the auditors found that there was an underspend of €640,000 in outsourcing spinal surgery which the CHI explained was due to issues with availability in the private hospitals.

Overall, the audit found there were no issues with funding under various categories not being used for their intended purpose.

CHI confirmed that priority was given to patients with scoliosis and spina bifida for some of the funded initiatives including new operating theatres and MRI scanner as well as orthopaedic and critical care beds.