Report findings from pelvic surgery audit of very serious concern, says HSE

The HSE welcomes the publication today by Children’s Health Ireland (CHI) and the National Orthopaedic Hospital at Cappagh (NOHC) of the report of the External Medical Audit for Children’s Health Ireland on Indications for Pelvic Osteotomy in Children with Developmental Hip Dysplasia (DDH). We acknowledge and deeply regret the anxiety that the audit, and the time taken before publication, has caused to children and their families.

According to HSE CEO Bernard Gloster: “The variance found between surgical practice in relation to DDH between on the one hand CHI at Temple Street and NOHC, and on the other hand CHI at Crumlin, is of very serious concern. The proportion of pelvic osteotomies taking place at CHI at Temple Street and NOHC, despite not reaching the international criteria used in the audit, was so high that the audit report says further inquiry is mandated.

“There is little doubt that the findings of this audit raise significant concern. Focus on follow up and putting in place a mechanism to ensure this kind of variation can’t recur is central to our next steps, and we will be working with everyone to ensure that this can’t happen again.

“I welcome the establishment earlier this year of a cross-site pre-operative surgeons meeting for all cases listed for this surgery to ensure consistency in decisions on whether to proceed.

“The HSE will now oversee the implementation of the recommendations and the comprehensive response by way of follow up with the children that the recommendations outlined in this report are implemented in full. This will include the establishment of an expert panel or panels to respond to queries which may arise from patients and their families in relation to their individual procedures and whether they were necessary.

“A detailed plan has been developed to ensure that in the region of 1,800 children and young adults who have had this surgery at CHI at Temple Street and NOHC since 2010 are reviewed up to skeletal maturity. The audit report also advises that long-term follow up of all children who have pelvic osteotomy surgery should take place and the teams at CHI and NOHC are currently putting plans in place to enable that.

“The audit was commissioned by CHI and NOHC after concerns were raised with CHI by a whistle-blower about the thresholds being applied when making the decision to undertake surgery for children with Developmental Hip Dysplasia in both CHI at Temple Street and the NOHC. CHI commissioned this external UK-based expert, to review a random sample of cases of DDH surgery carried out between 2021 and 2023 across all three sites. I want to recognise the positive step taken by CHI and Cappagh in commissioning this audit in response to a protected disclosure. I also want to ensure we offer any support that is required by the new CEO of CHI Lucy Nugent in the major transformation project she has undertaken.”

CHI has established a dedicated contact number which will be supported by clinical staff and will support patients and families who are seeking further information about their care and the next steps.