Paul Murphy challenges Blackrock use for children's spinal surgery
Paul Murphy questions why idiopathic scoliosis procedures for children are increasingly being carried out at Blackrock Clinic instead of CHI sites, citing rising case numbers and capacity concerns. He presses CHI officials on who pays surgeons, whether payments create incentives, and what governance changes have been implemented to prevent inappropriate surgeries.
Scope and numbers. Paul Murphy highlights parliamentary answers showing idiopathic scoliosis procedures in Blackrock rising from 39 in 2023, to 48 in 2024 and 67 by the end of November 25. He asks why these fusion procedures take place in Blackrock rather than CAPA and probes whether capacity, clinical safety or payment arrangements drive the choice of site.
Payments and incentives. CHI officials explain Blackrock cases are funded under the HSE access to care programme and surgeons operating there are paid by Blackrock, not directly by CHI. Murphy asks if that creates a material incentive for surgeons to favour private-site lists; CHI replies surgeons operate outside contracted HSE hours and asserts there is no monetary incentive to shift cases.
Governance and oversight. The exchange covers past concerns about unnecessary procedures and disciplinary processes. CHI confirms governance reforms, increased clinical audit activity, appointment of clinical specialty leads and steps to stand up CAPA capacity so more idiopathic scoliosis cases can be repatriated.
Next steps and implications. CHI says the long-term aim is to repatriate spinal surgery to CHI where clinically appropriate, while some surgeons may continue to use private lists for adolescent idiopathic cases if clinically justified. The debate underscores questions about transparency, waiting-list management, and the safeguards around paediatric surgical care.
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Thanks a lot and thanks for the presentations and the information. I just want to start on the issue of idiopathic scoliosis procedures taking place in Blackrock Clinic. So I have PQ answers from yourselves illustrating that there's quite a number of procedures taking place in Blackrock. In 2023 it was 39, 2024 it was 48 and by the end of November 25 it was 67. Why are these fusion procedures taking place in Blackrock as opposed to in CAPA? It's a capacity issue. Idiopathic scoliosis by its nature is normally an unknown cause commonly in otherwise normal healthy children and therefore they're suitable for surgery in a third party private hospital as opposed to the additional supports and more complex surgery requires. Our aim in the longer term is to repatriate all spinal surgery to CHI and CAPA. And if the procedure is done in Blackrock as opposed to in CAPA is there a difference in how much the surgeon will get paid? Our contract, our SLA as such is, sorry, the Blackrock patients are done under the UAM process which is under the HSE access to care programme. The surgeons don't get paid by the HSE or CHI, they are paid by Blackrock so we don't have access to what they are paid. We pay for the package as such. If they do it in CAPA it's included as part of their salary presumably, they're not getting an extra fee. If they do it in Blackrock... It's outside of their normal contractual hours, so it's additional work. And is it possible that they're getting 10,000 euros per procedure? I have no idea. And do the surgeons have an influence in whether the operations take place in Blackrock or CAPA? Each child is allocated based on clinical grounds, so the surgeons don't influence where the surgery is to take place except if it's clinically appropriate. So the surgeon will decide if it's clinically appropriate to go to Blackrock as an example, but after that, once the decision is, if the child can be treated in Blackrock, then it's chronological scheduling with the wider team, so nursing ops and the surgical team. So the surgeon says this child would be appropriate to do in Blackrock? Surgery along with anaesthesia and nursing, so it's a multidisciplinary decision. And the surgeons that do surgery in Blackrock is well outside their core clinical activity, so they all have a contractual commitment to provide 37 hours of clinical care or 30 hours of clinical care and seven non-clinical, so it's all outside of their clinical commitment. Surgeons aren't using their contracted HSE time to perform these operations? No. And would you accept that if, for example, they're getting 10,000 euros per procedure in Blackrock, that there is a material incentive for them to suggest that the child would be done in Blackrock as opposed to in CAPA? Knowing all the surgeons, to be honest, the drive for all the surgeons is to get quality care and to get our waiting lists under control, so I do not believe for a moment that there's any monetary incentive to do that surgery. And you're saying the reason it's not currently happening in CAPA is because there's not enough capacity? So there is capacity in CAPA. CAPA traditionally had done a lot of idiopathic scoliosis. That was stood down at a time when we were looking closer at governance. There was an additional need, I suppose, Blackrock Clinic has in-house anesthesia, in-house pediatricians. CAPA didn't have that at the time, so the clinical director in CAPA had to make sure that all the safety measures were in place to be able to provide spinal surgery in CAPA. So there was an appointment of two additional pediatricians recently in CAPA? Two additional pediatricians have been appointed so that that could be stood back up. So from now on there shouldn't be any idiopathic scoliosis procedures taking place in Blackrock and they should all happen in CAPA? So not all, particularly some of the Crumlin surgeons would feel that they will do their surgery, their complex surgery in Crumlin and then their adolescent idiopathic surgery in Blackrock if appropriate, but not to go into a third site. So what we're trying to do is optimise capacity, use our less complex surgery, so our non-spinal surgery to move out to CAPA to utilise that capacity so that we can do our complex spinal surgery in the one site. And I suppose just in addition to that, Deputy, with the support of the HSE and the department we have been able to get more equipment for an additional theatre in Crumlin to be converted into a spinal theatre and the caseload in that theatre are moving out to CAPA. And so you're not paying the surgeons for the procedures in Blackrock, but presumably ultimately the public is paying, Blackrock aren't paying them for their own money? Exactly, it's HSE funded. Okay. And I get another PQ which suggested that something like I think 60 cases or so were done of different, not necessarily idiopathic scoliosis, but were done in the matter private over a course of five years or something from the CHI. Which just confused me in the sense of I don't know, does matter private normally do children's operations? No, Deputy, it would depend on the time frame. Maybe that's a historic arrangement, I'm not familiar with it. So an answer back from Trina McDonald, 12th March 2026, CHI can advise that between January 2021 and January 2026 a total of 60 procedures for patients on the CHI inpatient and day case waiting list were carried out in the matter private hospitals. So they wouldn't have been all spines? No, yeah, I'm not suggesting they were. Yeah, so there would be a number of initiatives for orthopaedics, the likes of the matter private would have done spinal and non-general orthopaedic cases in the past under the NTPF. Just to go back to all of this, all the procedures that are happening, for example, for idiopathic scoliosis procedures are happening outside of HSE contracted time. So I understand some surgeons would operate two theatre lists in Blackrock. How is that happening within the time that one has in a week? How do they have enough time to do it? Sorry, when you say two theatre lists, do you mean two lists at the same time? Two lists in a week in Blackrock Clinic, in addition presumably to their contracted HSE hours? The work plan for each surgeon is two days of operating, ideally, with access. So if a surgeon is doing, so we have one every Wednesday as a spinal list in Blackrock, so they will do one spinal case in Blackrock, that will be in addition to their two days in CHI. Just in relation to the surgeon who is referred to the medical council in relation to the insertion of medical or non-medical grade springs, springs that have nothing to do with medicine whatsoever, is also involved in the unnecessary hip dysplasia operations. Just a caution, members, we are in a position to find those facts against individuals, so just a caution, members. No problem. Is that surgeon still being paid? Deputy Murphy, I do not wish to appear evasive, but I am very conscious that there is an ongoing HHR process and I do not wish to jeopardise that. I mean, it is a simple enough question, whether they are still being paid. They are still being paid. Thank you very much. And basically they will continue to get paid up until a point if the medical council was defined against them? With respect, I do not wish to comment further. Let's say a hypothetical situation of a receptionist who works in CHI and steals from CHI. I presume someone like that would be fired and would not be paid any more, is that a fair assumption? They would be taken through a disciplinary process. The end of that disciplinary process, presumably, if it was serious disciplinary issues would result in someone being fired and they wouldn't get paid any more? Correct. You see a problem in the fact that a surgeon can have very serious allegations against them and yet continue to get paid for a long period of time? As with all members of staff who are going through a disciplinary process, there is a process to be followed according to their contract. And are his legal fees being paid by the CHI? No. Definitely not. In relation to the other surgeons who were found to have done unnecessary hip dysplasia surgeries in the first look at that, all of those other surgeons, with one other exception as far as I understand, are still operating on children, including doing some hip dysplasia operations? Correct. All cases of hip dysplasia go through the cross-site multidisciplinary team, there is an agreed criteria for the threshold for surgery. Just an overarching question of, the basic issue here is that if there had been oversight between a comparison of Crumlin and Temple Street, something would have been flagged that there is some reason we are doing a lot more surgeries here than we are here. That governance issue, has that been addressed into the future where there is someone looking at these? Yes. We have made significant progress in our governance structures. We look at the RCSI clinical governance framework, which looks at ensuring that you have M&Ms, MDTs, clinical audit research, our clinical audit activity, for example, has increased from 86 audits in 2014 to 100 last year. We are very focused on ensuring that we provide safe care. We now have made changes in our structures. We also have clinical specialty leads now in place, that was one of the recommendations from the HICU report, that is moving from a traditional department head role to one of managerial leadership with certain responsibilities. We are the first hospital in the country to have all of our clinical specialty leads in place. So, yes, I am confident that governance has been improved in CHI.
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