Commission of investigation recommended into spinal care

A Government backed scoping report into the treatment of children with scoliosis and spina bifida at Children's Health Ireland (CHI) has recommended a commission of investigation rather than a public tribunal.

The report recommends that the commission examine four areas including waiting lists, spinal surgery, hip dysplasia and a group of children who were not transferred from Our Lady’s Hospital Crumlin to Temple Street after 2008.

It says a commission would primarily carry out its work in private, which it says would be more appropriate given that the issues concerning the medical treatment of children.

It also says this approach may encourage broader participation from families and children who may otherwise be reluctant to take part in the process if it was conducted in public.

The report says a commission would provide a more flexible and less adversarial framework and would be more efficient in terms of time and resources.

However, the Spina Bifida and Hydrocephalus Paediatric Advocacy Group says that families of these children are no longer willing to allow the treatment of their children to be dealt with behind closed doors.

Co-lead Amanda Coughlan said that "we explicably explained to the Minister for Health and the Tánaiste in November last year that the children and families’ voices were central to this process and families were no longer willing to have what happened to their children dealt with behind closed doors".

The report recommends a specific module allowing children and families who were waiting for spinal surgery or assessment between January 2019 and December 2025 to give evidence about the impact of delays and the management of waiting lists.

It also recommends an examination of CHI management’s response to delays and waiting lists during that period. That would include how funding allocated under the Scoliosis and Spina Bifida Action Plan was spent, particularly whether it was used to reduce waiting times.

The Spina Bifida and Hydrocephalus Paediatric Advocacy Group says this timeline is far too narrow and focuses on the administrative response and not the clinical care and poor outcomes of the children.

'Inquiry was always meant to be patient centred'

Ms Coughlan said: "This inquiry was always meant to be patient centred and child focused and not to look into the individual cases and clinical outcomes of children is devastating to the families involved."

The circumstances surrounding five urology clinics held between December 2020 and March 2021 would also be examined, including whether they complied with applicable National Treatment Purchase Fund rules.

The proposed commission would also investigate whether CHI management was aware of the use, or intended use, of non-CE marked springs in spinal surgeries carried out at Temple Street by a consultant between 2020 and 2022.

A further module would examine the threshold for surgical intervention in cases of developmental dysplasia of the hip at Temple Street and Cappagh between January 2019 and March 2025.

It would consider whether that threshold was appropriate and justified and, if not, why.

It would also examine whether CHI and/or Cappagh management were aware of any deviation from the appropriate threshold and what action was taken.

That part of the investigation would not begin until the outcome of an external expert panel review is known.

The fourth proposed module concerns children who were not transferred to Temple Street from Crumlin from 2008 onwards - referred to in the report as the "Crumlin Orphans".

The commission would examine whether those children received a lower standard of care than children treated by the spina bifida multidisciplinary teams at Temple Street, and if so, why.

It would also examine the experiences of those children and their families, whether hospital and health service management were aware of the issues, and what response was provided.

Ms Coughlan says there was no sitting urologist in Temple Street from 2009 to 2016 and she says those children were also receiving substandard care and should be included in any investigation.

The report also recommends avoiding unnecessary duplication with existing investigations, reviews and statutory processes.

However, where significant questions of public interest remain unanswered, it says a statutory inquiry could build on previous work, examine issues from a broader perspective and increase transparency and public confidence.

The report notes that the terms of reference could potentially be expanded following publication of the Nayagam Review if further outstanding issues emerge.

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Minister for Health, Jennifer Carroll MacNeill, has said she is satisfied that a commission of investigation recommended by senior counsel Remy Farrell is a better way to proceed than a public enquiry.

Speaking in Cork, she said there would be provision for patients' stories to be heard in public, if they wished.

"That [commission of investigation] is a model that we've used very successfully in the past, and one that gives the flexibility, and the balance of privacy for people to have a choice, really, about the degree to which they want their story, or their child's story, to be made public or otherwise.

"That is the overwhelming reason that he has recommended a commission in this way, but it does replicate, as I said, exactly what we announced a number of months ago in respect of an investigation, a commission of investigation, into the paedophile, Michael Shine, and his victims. "

She said a commission of investigation would allow for the issues to be examined to be more defined.

"One of the challenges we've had with establishing investigations is that they can be too open ended in terms of times or issues.

"And we've heard, in the Dáil, we've heard before, a need for the issues to be very defined, the time period to be defined, and that helps a commission of any kind, to get to the work much more quickly, and to produce a report.

"We do want something that's going to come quickly. This is about giving answers to people who deserve answers, and we, at the same time, have to continue to improve the management of spinal services and scoliosis generally," the minister said.