New Spinal Service Waiting List & Activity Report – Your Questions Answered

In line with the NTPF reporting structures, CHI’s monthly Spinal Service Waiting List & Activity Reports will now be published on the second Friday of each month.

Children's Health Ireland (CHI) has been working with the National Treatment Purchase Fund (NTPF) to develop CHI’s Spinal Surgery waiting list reports, and to align them with the NTPF’s reporting structure. This is the way in which all other waiting lists are compiled and reported across the health service.

The National Treatment Purchase Fund (NTPF) is an independent statutory body established by the Minister for Health, which collates and validates information on patients waiting for public hospital treatment. CHI’s Spinal Surgery monthly reports were previously compiled manually, but we are moving towards compiling these automatically, and in line with the NTPF’s protocols.

Children's Health Ireland has been working with the Paediatric Spinal Taskforce, set up by the Minister for Health, which includes representatives of patients, to improve and reform our service. This is one of those reforms.

Please be assured that while the way in which we are presenting this information will change, this will have no impact on where your child is on the waiting list for their surgery, or how patients are prioritised for their surgeries. Instead, it means that the way we present patient information will be greatly improved. It will allow us to better track patients and see any issues in real-time. It will help us to manage suspensions to ensure valid clinical reasons for delays. This helps us make sure patients get the care they need and aim to move them more smoothly towards their spinal surgery.

The NTPF breaks waiting lists down into four different categories to provide a clear and detailed understanding of the status of patients’ treatment.

Children's Health Ireland has been working with the NTPF to develop CHI’s Spinal Surgery waiting list reports, and to align them with the NTPF’s reporting structure. We are moving towards compiling and reporting automatically, and in the same way as all other waiting lists are compiled and reported across the health service.

- Active: A patient who is waiting for a scheduled date for admission in the future and does not have a “To Come In” (TCI) surgery date assigned.

- Pre-Admit: A patient who has been assigned a “To Come In” (TCI) surgery date.

- Planned Procedure: A patient placed on a waiting list for a planned procedure is a patient who had an initial episode of care and requires a further planned, timed or surveillance procedure in the future as part of their ongoing clinical care and/or treatment.

- Suspended: Patients with an offer of a TCI surgery date who, for clinical or personal reasons, are not ready to proceed with their care and/or treatment may be temporarily suspended on the waiting list on one occasion only. The suspension process is also recommended to support the management of patients being treated through NTPF or HSE-funded commissioning initiatives.

Patients who are confirmed to have their surgery in a hospital abroad through funded outsourcing will be moved from the “active” list to the “suspended” list, until their surgery has been completed.

Suspended patients have been temporarily removed from the active waiting list.

CHI’s Spinal Services Management Unit actively monitors the suspended waiting list on a weekly basis to ensure there are valid reasons for patients to remain in this category and to get them back on the active list as soon as possible.

As the NTPF outlines, there are only three reasons why a patient may be suspended from a wating list:

- Clinical Suspension: Clinical suspensions are informed by clinical decisions and usually due to the patient not being ready to have their surgery/treatment at this time. Patients are suspended from the “active” list, and then returned to the “active” list when they are ready for surgery.

- Non-Clinical Suspensions: A patient may wish to postpone their surgery for a period of time for their own reasons. (e.g. exams/school or primary carer obligations).

- Commissioning Initiatives: To support the management of patients who are having their surgery in another hospital in Ireland or abroad through funded outsourcing, the patient should be moved from the “active” list to the “suspended” list.

Waiting lists for surgeries will fluctuate throughout any given year. There are various reasons for this:

- New group of patients added to the “active” waiting list (August 2024): The Spinal Services Management Unit has been working to ensure accuracy and transparency in CHI’s spinal surgery waiting list reports. The team has deemed it appropriate to include an additional patient group to the spinal surgery waiting list. This group of 15 patients (added to either the “Active” or “Planned” waiting lists this month) are waiting for a non-surgical theatre procedure, which may be done under general anaesthetic in theatre. This group of patients were previously reported under “General Orthopaedic” waiting lists, as it is not a spinal surgery. For example, nine of these patients are waiting for “Spinal Injections”.

Therefore, in the CHI Spinal Service Waiting List & Activity Report August 2024 (published on Friday, 6th September), 15 patients have been added to either the “Active” or “Planned” waiting lists.

- Out-patients being added to the “active” waiting list: As well as carrying out surgeries, CHI’s Orthopaedic Consultants hold regular out-patient clinics to meet and treat new Orthopaedic patients. Some of the patients seen at these clinics need spinal surgery and are therefore added to the appropriate waiting list. We have carried out many out-patient clinics in 2024, we have also carried out additional Saturday clinics, which result in more (new) patients being added to spinal surgery waiting lists.

- Moving “suspended” cases back to “active” waiting list: CHI’s Spinal Services Management Unit actively monitors the “suspended” waiting list on a weekly basis to ensure there are valid reasons for patients to remain in this category and to get them back on the active list as soon as possible. When these patients are released from the “suspended” list, they are added to the “active list”.

Now that CHI has moved to the new format, aligned with the NTPF’s reporting structure, we are committed to developing our waiting list report format to include time bands. We understand that publishing waiting time bands is important to families.

The Children’s Health Ireland Orthopaedic teams across the city are working as one team. They use the same rules and procedures and work together on complex cases.

In February 2024, Children's Health Ireland (CHI) established a team called the Paediatric Spinal Services Management Unit. This team is led by Mr. David Moore, Consultant Orthopaedic Surgeon, and supported by the wider CHI Paediatric Orthopaedic and Multi-Disciplinary Teams.

The aim of CHI’s Paediatric Spinal Services Management Unit is to optimise access to care for children with spinal disorders and to build a world-class spinal surgery service, which treats children and young people in a patient-centred way.

Mr David Moore was recently interviewed on RTE Radio 1 about the progress and future plans for the Spinal Services Management Unit, which you can listen to here.