Minister for Health Jennifer Carroll MacNeill notes the publication of the Developmental Dysplasia of the Hip Audit by Children’s Health Ireland (CHI) and National Orthopaedic Hospital, Cappagh (NOHC)
- Foilsithe: 23 Bealtaine 2025
- An t-eolas is déanaí: 23 Bealtaine 2025
The final report of the audit was received by the Minister yesterday and will be published by Children’s Health Ireland (CHI) and National Orthopaedic Hospital, Cappagh (NOHC) today (Friday 23 May) at lunchtime.
"I know that parents and young people themselves will have many questions when they read the report and that the findings of this Report will lead to worry and uncertainty for them.
"In responding to this Report, I am thinking first and foremost of the impact a surgery has on a child. I am also deeply aware of the worry that parents will face today and this is something that is sitting with me all the time.
"My immediate priority is to ensure that there is clinical follow-up and care for patients who have undergone pelvic osteotomy surgery. This follow-up will be in accordance with best practice and the recommendations of the Report."
Minister for Health Jennifer Carroll MacNeill
Patients and families will receive letters in the coming days from CHI and NOHC about the arrangements/next steps that will apply to them and their child, and how they can get further information or support.
There will be an information line available, open today (Friday 23 May) 8pm, open Saturday and Sunday from 9am to 5pm and open Monday - Friday from 8am to 8pm for parents with queries. The numbers are Freephone 1800 807 050 or call 00 353 12408706 from outside Ireland. It will be staffed by specialist Developmental Dysplasia of the Hip (DDH) nurses from Crumlin and will enable parents to talk about the process over the next few days.
"I immediately accepted the recommendations of the Report and ensured that others did too. Further to this, I have moved immediately to strengthen governance and oversight structures at CHI and NOHC. This will be done via the appointment of two members of the Health Service Executive (HSE) Board to the Board of CHI, a strengthening of the Service Level Agreement (SLA) between CHI and the HSE to strengthen operational oversight with increased involvement and support from the Dublin Midlands Region Regional Executive Officer (REO) and senior management, while further arrangements are being considered. This is designed to support the new CEO, Lucy Nugent, in CHI and enable her to continue with the transformation programme she has started.
"I have also asked the HSE CEO, Bernard Gloster, to consider the implications of the audit for the NOHC and its oversight of paediatric surgery conducted at the hospital. The CEO has agreed to respond to this request within the next week."
Minister for Health Jennifer Carroll MacNeill
In terms of the clinical pathways for patients involved, the Minister has been informed that:
- Clinical follow up to skeletal maturity in CHI Crumlin is already underway for 447 patients, many of whom (200) are almost at skeletal maturity and will likely need just one appointment.
- Clinical follow up for CHI Temple Street and NOHC patients - these children have been identified and categorised by age; a significant proportion here (392) are also close to skeletal maturity. It is planned that a multi-disciplinary team, including physiotherapists and nurse specialists and overseen by a consultant surgeon, will be involved in this clinical review.
- Transition of care for patients who require follow up by adult services will be agreed. A new Model of Care for all children who have undergone/will undergo pelvic osteotomies will be implemented, generally involving review at 5, 8, 12 years post-op.
- A cross-site pre-op surgical meeting is already in place since early March 2025, so that all children are being discussed at this meeting before they are listed for surgery by any of the services concerned. An expert reference group (with international expert input) is developing the criteria against which future Multi-Disciplinary team (MDT) assessments will be made; this is expected to be in place within the next two months.
- A retrospective determination of the indication for osteotomy surgery. It is acknowledged that some patients and parents may request retrospective review of their case to determine the indications for surgery (i.e. was it needed or in line with standards). A separate process, involving external experts, will be required for this purpose which would only take place at the request and consent of patients/guardians. Details of which will determined when the panel is in place and CHI and NOCH will communicate directly with families.
Upon receipt of the report, the Minister met with the CEO of the HSE and her department team, including the National Patient Safety Office (NPSO).
The Minister fully accepts the recommendations in the Report.
In responding to the recommendations, the Minister will immediately:
- appoint two members of HSE Board to also be members of the Board of CHI, with appropriate measures to avoid any conflict of interest, and while further arrangements are being considered
- ensure increased operational oversight, via the Service Level Agreement (SLA) in place between HSE and CHI, including increased involvement and support from the Dublin Midlands region REO and senior management
- ask the HSE to consider the implications of the audit for the NOHC and its oversight of paediatric surgery conducted at the hospital. The CEO of the HSE has agreed to respond to this request within the next week
The Minister has asked the Government Chief Whip, Minister Mary Butler, for time to be allocated for a full discussion on the Report in the Dáil next week.
Notes
The report by its nature is quite clinical and technical. It does make a number of clear findings and recommendations:
- it found that the majority of the procedures (pelvic osteotomies), looked at in the audit sample, carried out in CHI Temple Street (60%) and the National Orthopaedic Hospital Cappagh (79%) did not meet the clinical indication on the agreed standard applied for the audit. The majority of procedures looked at in Crumlin (98%) did meet the indication
- the report further states that while there is worldwide variability between surgeons, the variance identified in this cannot be accounted for by measurement error or observer variability alone
- the report makes recommendations for follow up with children who have had this procedure, as well as recommendations for ongoing practice
- the report has been accepted by CHI, Cappagh, the HSE and the Minister