NHS consultant report: Dublin hospitals conducted unnecessary operations on child patients

Nearly 80 percent of hip operations at a Children’s Health Ireland hospital were unnecessary according to a leaked expert report obtained by The Ditch.

At another Dublin hospital 60 percent of the same procedures were considered unnecessary. 

Last year a whistleblower was worried some of these operations at Cappagh and Temple Street hospitals were “purely for financial gain”.

Children’s Health Ireland commissioned an audit of operations at three hospitals to investigate these claims and a draft report – unpublished but seen by The Ditch – has confirmed the whistleblower’s allegation that two sites were conducting needless hip surgeries on children. 

The findings concern the treatment of infants and children with suspected developmental dysplasia of the hip, a condition where the ball and socket joint doesn’t form as it should. Though surgery, called an osteotomy, may be needed in some cases to prevent the joint deteriorating in later life, in many instances the condition corrects itself over time.

Cappagh, in response to a freedom of information request last year, confirmed 377 osteotomies had been performed at the hospital between 2022 and 2023. Of these, 143 had been funded by private medical insurance. 

Since the NHS consultant delivered his draft, one whistleblower has said, “Profit is a motivator that cannot be excluded” – given the privately funded procedures “cost around €1,600 each”.

One mother whose child was scheduled for surgery last year, which she subsequently cancelled, said the report confirms her initial fears. 

“How many children have been put through unnecessary surgery? All I want from this is that it doesn’t happen to another family,” said Corey Cannon from Dublin. 

‘I am worried that these operations are being performed purely for financial gain’

Last year, whistleblowers at Children’s Health Ireland – which manages Temple Street and Crumlin hospitals - raised serious concerns. 

One whistleblower claimed some hospitals were carrying out unnecessary hip operations, osteotomies, on patients. 

“The motivation to perform these operations is complex, but given the significant proportion that are funded privately, and the fee per procedure, I am worried that these operations are being performed purely for financial gain,” was how they put it to The Ditch last July. 

CHI began an audit but the expert first appointed to conduct it, an NHS consultant surgeon from England, resigned over a “lack of clarity” and “confusion” about their work.

The second NHS consultant who agreed to take the audit on has now delivered a draft report, reviewed by The Ditch, which confirms the fears of whistleblowers, at least one of whom made a protected disclosure. 

According to the report, two hospitals carried out unnecessary operations on children over a prolonged period. Related surgery at the two – the National Orthopaedic Hospital at Cappagh and Temple Street children’s hospital – is now suspended with no date set for its resumption.

The senior NHS consultant CHI commissioned looked at indicators normally required for these surgeries to go ahead. Their audit considered whether the threshold had been met in a sample number of cases from three Dublin children’s hospitals - Cappagh, Crumlin and Temple Street. The audit examined a sample of 10 cases from each surgeon at each hospital. 

According to the report, 98 per cent of the procedures carried out at Crumlin met the threshold. 

However, at Cappagh, 79 percent of the surgeries did not. At Temple Street, 60 percent did not. 

‘No operation on a child is a minor procedure’

Many of the children put through the surgeries at the latter two hospitals displayed no or relatively low indicators for developmental dysplasia of the hip (DDH), the condition that requires the procedure. 

Of the 63 pelvic osteotomies assessed in Crumlin, 62 “indicated” – they met what the external auditor considered to be a reasonable threshold for surgery. 

However of the 85 pelvic osteotomies assessed in Temple Street, just 34 indicated. In Cappagh the auditor considered 55 of the 70 surgeries unnecessary. 

The children operated on – using a “novel” procedure that lacks “longer-term follow up”, said the report – in Cappagh and Temple Street were aged between one and seven. 

The report's findings, says one whistleblower, confirms the serious allegations against both hospitals. “No operation on a child is a minor procedure,” they said. 

“This report shows what many have already suspected regarding the treatment of dysplasia in Temple Street and Cappagh – a significant number of osteotomy procedures are being carried out unnecessarily.

“Nowhere else in the world is hip dysplasia treated so aggressively. We are left with a conundrum: either the considered views of the consultant tasked to review these procedures are incorrect or Temple Street and Cappagh have been operating unnecessarily,” said the whistleblower. 

A gut feeling something wasn’t right

The consultant report criticised Cappagh and Temple Street for the justifications used for the surgeries. 

“Some surgeons have been performing significant numbers of pelvic osteotomies for children that are not indicated based on the consensus criteria that have been retrospectively applied for the purposes of this audit,” said the consultant.  

Two surgeons at Cappagh didn’t have the records and X-rays necessary for reviewing certain cases. 

The report recommended all 561 patients who went through pelvic osteotomies at Cappagh and Temple Street between 2021 and 2023 should be recalled. “Clinical and radiological assessment of these cases by independent and appropriately experienced paediatric orthopaedic surgeons is recommended,” read the report. 

Though the majority of surgeries performed at Crumlin were necessary, the auditor said record keeping at the hospital was “poor”. 

“In the event that complications were to arise it would not be possible, in some cases, to establish the risk/benefit analysis behind the decisions to operate or whether the families had been involved in an exploration of their attitudes to and tolerance of the risks,” they wrote. 

Corey Cannon’s daughter was three when she was scheduled for an osteotomy in April last year. She withdrew her child because she had a “gut feeling that something wasn’t right”.

“We were the lucky ones because we decided to step back but, initially at least, you put your trust in a private surgeon and when you start to question the medical advice you’re being given, where do you turn?

“The original article in The Ditch set alarm bells ringing for us, but it was still a case of, who do you turn to? Private surgeons in this country aren’t answerable to anyone. 

“It’s shocking standing in a room and getting the second opinion that, not only does your daughter not need surgery, but that her hips are normal.”

Children’s Health Ireland and the National Orthopaedic Hospital at Cappagh have been contacted for comment.