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Challenges, crises & the pandemic ends: 2023 in health

The year in health brought us some familiar issues but some surprising developments too.

One of the most unexpected issues was around spinal surgery at Children’s Health Ireland at Temple Street University Hospital in Dublin.

In September, the HSE announced an external review of aspects of orthopaedic surgery at the hospital following what is said were several “serious spinal surgical incidents” there.

The concerns surrounded poor surgical outcomes, the use of a certain spinal technique and the use of unauthorised implantable devices.

The consultant at the centre is the issue is not currently performing surgeries.

When the HSE announced the review, it also published a 21-page report summarising the findings from two reports.

But after pressure from advocacy groups, both original reports were published in full.

The controversy has raised serious questions over who knew what and when and how unauthorised spinal springs could end up in an operating theatre and being used on young patients.

Michael and Bridget Carter, the parents of a 10-year-old girl told RTÉ News that they want answers about why she died after a series of operations at the hospital.

Dollceanna Carter, who died following numerous operations

Dollceanna Carter from Co Meath had spina bifida and scoliosis.

She first underwent spinal surgery at the hospital in May 2021 involving the surgery at the centre of the external review, had multiple further procedures and died on 29 September 2022.

In October, the family of a six-year-old, Luke Ryan, who had a spring implanted, were forced to go to the High Court to get Children’s Health Ireland to release his medical records.

Mr Justice Cregan ordered the Chief Executive of CHI, Eilish Hardiman to come to court to explain the delay. The records were needed to enable the family to get a second opinion as to whether the spring should be removed or repositioned.

Eilish Hardiman, Chief Executive of CHI, at the Health Committee

In November, the Health Information and Quality Authority (HIQA) published the terms of reference for its review into governance and oversight at Children’s Health Ireland and Temple Street Hospital.

That review will look at the use of the surgical implants and medical devices.

The report will be submitted to the Minister for Health when completed and published by HIQA.

New children’s hospital

The site of the new National Paediatric Hospital (Pic: NPHDB)

The new National Paediatric Hospital at the St James’s Hospital campus in Dublin was back in the news again when it emerged that the final completion date had drifted further, to October 2024.

The hospital is 93% complete.

The external façade is ready and most of the operating theatres, single bedrooms and critical care units are complete. The hospital will have the only elevated helicopter pad in the country.

After the building work is finished, it will also take a further six months or so for the hospital to be commissioned, or for the equipment and furnishings to be installed. So, the earliest opening date is likely to be the end of April 2025.

Disputes between the hospital’s board and builders BAM are ongoing (Pic: Rolling News)

The budget for the hospital was €1.4bn. The extra costs are blamed on inflation, Covid-19 and some changes to the design plans.

The final cost of the hospital is still not known, although the National Paediatric Hospital Development Board (NPHDB) has informed the Government of what it may be. This figure is not being released for commercial reasons, given the NPHDB continues to battle the builders, BAM, over extra claim costs.

Child and Adolescent Mental Health Services (CAHMS)

Dr Susan Finnerty warned that she could not guarantee children would get access to a safe, effective care

This year also saw a major independent review report into the national Child and Adolescent Mental Health Services.

The Inspector of Mental Health Services, Dr Susan Finnerty, said that she could not currently assure parents and guardians that their children have access to a safe, effective, and evidence-based mental health service. 

She pointed out that all children have a right to enjoy the highest attainable standard of physical and mental health under Article 24 of the United Nations Convention on the Rights of the Child, which was ratified by Ireland in 1992. 

Extra CAMHS staff were promised as part of Budget 2024.

Health budget 2025

Minister for Health Stephen Donnelly was embroiled in controversy over HSE funding

The HSE is expected to overspend its budget this year by around €1.5bn.

Recently, the Government approved a supplementary budget of just under €1bn to cover it.

That leaves a first charge of €500m on next year’s budget which will add to pressures on the health system.

The management of the HSE’s finances is now under the microscope again, especially as it broke some of its staff recruitment ceilings.

Bernard Gloster took up the post as CEO in early March.

He told the Oireachtas Health Committee that the funding for this year was inadequate and that next year will also see a budget overrun.

Bernard Gloster warned that the HSE is not properly funded for the year ahead

The HSE has introduced a major recruitment freeze to try to contain costs and this is leading to industrial unrest among some staff.

Some areas are excluded from the freeze, including consultants, doctors in training and graduate nurses and midwives.

The increase in the health budget for 2024 was significantly less than the amount the Department of Health had sought.

A big concern is the impact on services next year.

Health officials have said that existing levels of service can be maintained but there is little or no money to expand new programmes or introduce new ones.

David Cullinane warned of a ‘challenging winter’ for the health service (Pic: PA)

Sinn Féin’s health spokesperson has accused the Government of continuing to have a reckless and chaotic approach to funding the health service.

David Cullinane said that the service will still be short €500m.

“This will carry forward as the first charge in 2024. None of the €1bn provided is permanent funding so the underfunding for next year will be even greater, and all the while the recruitment embargo will continue as we approach a difficult and challenging winter,” he said.

Trolleys

The HSE has set a daily target for the numbers of patients on trolleys

The HSE has promised new performance targets for emergency departments.

On average each month, at 8am daily, there should be no more than 320 patients waiting for admission to a bed.

It also introduced a new system for freeing up beds occupied by patients whose clinical care has ended.

Under the plan, elderly patients who require a nursing home bed after their treatment will be offered the first available bed, even if it is not their first choice.

Both the Minister for Health, Stephen Donnelly, and the HSE chief defended the change, but Prof Des O’ Neil of the Irish Society of Physicians in Geriatric Medicine challenged the new policy, saying that it was ageist and questioning the access to rehabilitation.

Covid-19

The global Covid-19 emergency is over, the World Health Organisation declared

Thankfully no new strain of concern of Covid-19 emerged, making 2023 the first full year when the virus had quite a limited impact.

Also, the World Health Organisation declared an end to Covid-19 as a global health emergency.

Here at home, the Government has said that the inquiry into Ireland’s handling of the pandemic will be held next year.


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