Like many such cases, the report into the incorrect use of medical devices in scoliosis operations in the Children’s Health Ireland hospital at Temple Street finds a string of errors and inadequacies were involved. The report by the Health Information and Quality Authority (Hiqa) provides an admirably forensic examination of what happened.
At the heart of the issue is the decision of a surgeon – not named in the report – to use an unapproved metal spring implant in operations on three children as part of their spinal surgery. Hiqa found this to be “a well-intentioned but ill-considered effort.” But it states clearly that the use of these devices was “wrong” – the product used did not have the relevant approvals and, because of the material used, carries longer-term risks. As Taoiseach Micheál Martin said, that this happened is “beyond comprehension.”
Internal controls in CHI Temple Street should have picked this up but did not. This reflects in part inadequacies in the new CHI structure put in place in 2019 as part of the merger of children’s hospitals services in Dublin. Remarkably, there was no framework for the governance and approval of medical devices and clear gaps in accountability and control. “Long-standing issues with communications and dynamics” within the orthopaedic team compounded this. At every level, the checks and balances failed.
It is a story of bureaucratic and clinical failure. The resignation of the CHI chairman, Dr Jim Browne, was probably inevitable. Other departures may follow. Accountability is important. But it does not fix things – and there are questions here not only for CHI but also for the HSE and Department of Health, which go beyond the need to implement the specific recommendations made by Hiqa. How were these chronic structural failures allowed to develop?
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There is also a wider context. There has been a series of controversies about the provision of spinal surgery for children. Notably, former health minister Stephen Donnelly questioned the use of funds he provided to reduce spinal surgery queues for children.
Under the voluntary hospital structure, the CHI board will be responsible for overseeing the work of the new children’s hospital. The State will, of course, pay the bills. The Government needs to be sure that the board contains people with the correct skills – and this is an issue, with many feeling such appointments are more trouble than they are worth. And it needs to ensure that the Department and the HSE have appropriate oversight and are themselves accountable.
The Hiqa report points to striking failures, in other words, and these appear symptomatic of wider problems. There were challenges in getting the children’s hospital built, but there will be, too, in ensuring it operates effectively.
