Spinal surgeries for children not meeting demand
The increase in spinal surgeries for children is ‘not sufficient’ to reduce waiting times, despite major investment, internal Department of Health documents reveal.
The Irish Daily Mail has obtained briefing documents prepared for Health Minister Jennifer Carroll MacNeill in late September, which show that though surgical activity across Children’s Health Ireland (CHI) has risen, the system remains under severe pressure, with key waiting time targets set to be missed.
Concerns over long delays in paediatric spinal care have been a politically charged issue for years.
In 2017, then health minister Simon Harris pledged that no child would wait more than four months for spinal surgery by the end of that year. However, despite the promise, long waiting times continue to persist for children in need of spinal surgery.
Simon Harris. Pic: Fran Veale
In July 2025, nine-year-old Harvey Morrison Sherratt died after a prolonged battle in which his parents raised concerns about delays in accessing specialist care. The briefing documents note that the average waiting time for surgery in Crumlin and Temple Street hospitals is five months.
Officials warned Ms Mac Neill that although throughput has improved, the level of impact on waiting times ‘is clearly not sufficient in the context of the level of investment in this service’.
The documents point to a range of persistent challenges that continue to inhibit performance. These include limited theatre capacity, bed pressures, the complexity of many cases, recruitment difficulties across key posts, and inconsistencies in referral pathways. Just 39% of inpatient spinal cases were treated within the Sláintecare nine -month target, down from 43% a year earlier.
While 14% of children had been waiting over 12 months for surgery. By September, 242 children were on waiting lists for spinal surgery.
Jennifer Carroll MacNeill. Pic: Sam Boal/Collins photos
Of these, 129 were deemed ‘ready for surgery’ and awaiting a date, 60 were listed for planned follow-up procedures, 34 were suspended due to clinical or personal reasons, and 19 had a scheduled date.
The documents outline that the Spinal Surgery Operational Plan set an ambitious target of 540 procedures for 2025, representing a planned 5% increase on the 2024 total of 513 surgeries.
By the end of August, 342 procedures had been completed, amounting to 91% of the year-to-date target of 375. Officials noted this reflects an improvement compared with performance earlier in the year, when activity was trending at 86% of target. However, the gains in activity are not translating into meaningful reductions in the number of children waiting.
The weekly Spinal Tracker Report submitted by CHI on September 22 projects that if the annual target is met, there will still be 127 children on the active waiting list by year’s end. That would represent an 18% increase on the 108 who were waiting at the start of the year.
The documents show that officials still predicted projected growth in long waits.
Of the 127 children expected to remain on the list at year’s end, 69 are forecast to be waiting longer than four months. That figure would be 28% higher than at the beginning of 2025, when the number stood at 54.
The internal briefing notes suggest that while the progress in increasing surgical activity is welcome, it is not keeping pace with demand, nor is it easing pressures on timely access to care. Outpatient pressures have eased slightly, with new outpatient spinal waiting list numbers falling to 395 in August 2025, compared with 725 in August 2024. However, one third of those on the list still have no appointment date issued, and officials stress that delays at outpatient stage feed into inpatient waiting times later.
The memo also cites operational pressures arising from the increased reliance on additional sites such as Cappagh, Blackrock, and the National Orthopaedic Hospital Group, where much of the overspill spinal activity is being delivered.
While this has helped expand capacity, officials caution that fragmentation of services can introduce added inefficiencies and challenges. Recruitment remains a prominent issue.
The August data shows that while 38.5 whole-time equivalent staff posts are filled across spinal services, a further 13.25 posts remain vacant. Despite the concerns, the Department insists that it continues to work closely with the HSE and CHI to drive performance and broaden capacity. A senior official noted that the next quarter will be crucial, with pressure mounting to close the gap between projected and required activity while curbing the upward trend in waiting numbers.
Additional initiatives, including enhanced clinical pathways, recruitment efforts, and expansion of postoperative support capacity, are under review. However, the documents make clear that without sustained increases in throughput and a broader rebalancing of the system, substantial numbers of children will continue to face long waits for life-altering spinal surgery.
A CHI spokeswoman said that ‘recent commentary has not always reflected the reality of CHI’s spinal service or the improvements that have been made’. She said progress has been achieved and work is ongoing ‘to ensure safe, timely, and effective care’.
A Department of Health spokesman said Ms MacNeill ‘has held regular meetings with the HSE and CHI board and executive, most recently on November 20 where she made it clear that everything possible must be done to reduce the amount of time children are waiting’. The spokesman said several initiatives are underway, including ‘a ringfenced theatre, additional outpatient clinics, and national and international outsourcing to maximise capacity’.
He added: ‘This has supported the completion of 488 spinal procedures this year to end of November 2025, compared to 473 for the same period last year. Over the same timeframe, a total of 502 procedures were added to the waiting list.
Every effort is being made to reduce waiting times in the context of this rising demand. ‘As of end November 2025, 47% of patients on the CHI active waiting list were within the Sláintecare targets. This is an improvement against the same time last year when 44% of patients were within the Sláintecare targets.’
