Vital that Temple Street review examines systemic issues

It is unsurprising that the spinal surgery scandal at Children’s Health Ireland (CHI) at Temple Street was referenced in the speech of the IHCA President at the Association’s Annual Meeting on 30 September. Described by the Chief Executive of CHI as a “shocking litany of events”, the revelations have received substantial media coverage and political focus since they were made last month. The use of unauthorised implantable devices, among other issues, has raised grave questions about patient safety protections and clinical governance in the hospital. But it also has wider relevance.

In his speech at the IHCA meeting in Dublin, Prof Rob Landers said: “The battle many have to go through in healthcare is real. For hospital consultants, it’s a battle for theatre time, facilities and basic equipment. A battle with antiquated systems. A battle against the impacts of later patient presentations leading to increased complexity and often a battle to be heard.”

The IHCA has said justifiable concerns have been raised regarding the terms of reference of the external review commissioned to examine the issue.

The Scoliosis Advocacy Network and the Spina Bifida and Hydrocephalus Paediatric Advocacy Group   have called for the terms of reference to be widened and for patients to be directly involved.

There were also legitimate doubts about the independence of the reporting arrangements, according to the Association.

Prof Landers called on the Government to make the adjustments necessary to allay these concerns.

He noted it is “fundamental” the review is “systemic in nature”. He made the point that the review’s recommendations “will influence how all hospitals approach complex surgeries, innovation, risk evaluation, and resourcing into the future”.

Speaking at a business conference in Waterford the same day as the IHCA meeting, Taoiseach Leo Varadkar “guaranteed” that the review would be independent and that the final report would be published. 

It has also been confirmed that Mr Selvadurai Nayagam, who is heading the review, is meeting with advocacy groups and the families affected about their concerns.

At the meeting of the joint Oireachtas committee on health on 28 September, CHI Chief Executive Ms Eilish Hardiman welcomed the external review. She stated it was important that “any institutional or systemic issues that contributed to enabling these events to happen [are] found and addressed immediately”.

She also pointed out that the ongoing issues relating to access to surgery and “unacceptably” long waiting times are not the subject of the review.

However, Ms Hardiman noted “they are a subject of concern for us”.

It is appropriate that the shocking nature of the events in Temple Street are fully and independently investigated. It is also appropriate that the scope of the review is sufficiently wide to fully take into context and identify systemic problems that led to these events to ensure nothing similar can happen again across the Irish health service.