Children in long waits and cancellations for NHS spinal surgeries

Chris Adams said up to one in four surgeries at NHS Lothian are canceled with staffing being the main reason.

Mr Adams also claims some children are not being put on waiting lists as early as they should.

NHS Lothian disputes some of Mr Adams’ claims but said “significant pressure” has affected waiting times.

READ MORE: Almost 7000 patients in Scotland have been waiting for NHS surgery for over two years – compared to 1400 in England

Mr Adams is a consultant with the Scottish National Spinal Service (SNSS) and the Edinburgh Royal Hospital for Children and Young People (RHCYP).

The lead clinician, one of Scotland’s three pediatric spine surgeons, said he speaks on behalf of spine patients and their families.

Christopher Adams (Image: BBC)

The surgeon’s claims appear in a new BBC Disclosure inquiry into Scotland’s NHS, which reveals:

• Some children are waiting up to three times longer for spine surgery than before the pandemic, and some are even waiting longer than a year.
• At least 51 out of 190 possible planned spinal surgeries at RHCYP were canceled at short notice in 2022, with the main reason being the nursing shortage.
• Some children with “complex” needs face further evaluation and delay before being placed on waiting lists.
• Discrepancies between NHS Lothian data and reports from frontline medics on the number of canceled surgeries.

Mr Adams revealed that in the last year he had a patient whose spinal surgery was canceled six times, four of them due to staff shortages.

The surgeon said the main reason for canceling the surgeries was “a lack of capacity for a bed by nurses” after the procedure.

He said: “It makes you sad, makes you very angry. It is the fact that this patient is not treated and is deteriorating.

“It’s the parents or carers, that’s where the absolute need is because they have nowhere to go.

“And the hardship, when you’ve seen enough families cry – I’m done with that.”

Mr Adams said the wait for surgery was usually between four and six months before the pandemic, but now it can be a year.

According to BBC Scotland, some of Mr Adams’ colleagues within NHS Lothian have raised concerns about the number of surgeries that have been canceled due to staff shortages.

Nathan Kelly had two spinal surgeries postponed at Edinburgh’s Sick Kids Hospital in December last year, which his mother Ann said was due to staff shortages.

Ann, from Denny near Falkirk, said the experience was “incredibly exhausting” for everyone as one of the cancellations came on the morning of the scheduled surgery.

“It was such a big disappointment, we had planned everything around it. I had cried for weeks before that, I knew he needed surgery but I was worried.”

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Nathan, who has cerebral palsy and was first told he would need spinal surgery in early 2020, was given another appointment for the surgery in December but it was rescheduled five days earlier.

“You can’t blame the surgeons or the nurses, they’re doing such a great job and they’re going full throttle, but it can’t be right that pediatric surgeries can be canceled like that,” Ann said.

“We’re trying to protect him as best we can but when the second one got canceled he just said when are they going to fix me mom?”

Nathan underwent spinal surgery on February 3rd. He is still suffering from severe pain and has a hip problem that could only be fixed after the operation.

Mr Adams told the disclosure that spinal surgery candidates with disabilities and other complex needs would need to undergo further evaluation before being placed on waiting lists for their surgery.

He said these additional assessments have introduced a delay that could mean “there is a greater risk of death, paralysis and other complications.”

There are currently 88 children on the official RHCYP waiting list, but the BBC understands at least 11 other children deemed suitable for surgery by Mr Adams are not on that list, identified as ‘NOWL’ (Not On Waiting List) is categorized.

He added: “It’s almost certain that we made a good call at this clinic that the patient is actually allowed to have the surgery they want – I don’t quite understand as a clinician why this patient should have to wait any longer. ”

Mr Adams said he believed “the rules and the system are playing the waiting list”.

dr NHS Lothian Medical Director Tracey Gillies apologized to families affected by delays.

She said, “We have been open and honest about the significant pressures that exist throughout our healthcare system and its negative impact.”

Ms Gillies said it was “absolutely correct” that some patients were not immediately listed for surgery.

She added: “This occurs when the patient cannot have surgery until further diagnostics are complete and a final decision can be made on whether to proceed with surgery.

“Once the decision to have surgery is made, the patient is placed on the waiting list.”

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NHS Lothian said only three patients were classified as NOWL and that the average wait time for surgery was 25 weeks at the end of December.

It said it had investigated previous claims of delays on Mr Adams’ waiting list and these had been “unfounded”.

Scarlett Sharp has been on an NHS waiting list for surgery to treat the curvature of her spine since September last year.

The 12-year-old, from Motherwell, has moved up the priority list as the problem has worsened, with the condition known as scoliosis rising sharply since it was first identified last June.

“I was pretty shocked when I saw the first X-ray,” explains Scarlett.

“When I walked into the room and saw the X-ray, my jaw was on the floor and on the other X-rays it had gotten stronger, so I’m worried it might grow a little more before the surgery and get worse over time.”

Dawn Sharp with daughter Scarlett, 12 (Image: BBC)

Scarlett can find school challenging due to the pain in her back and mum Dawn, 38, is dying for the procedure to continue.

She said: “As far as we know it’s being brought forward to around May.

“It’s almost a full year if they predict May she has the same problem [and] it keeps getting worse. But nothing has progressed in terms of fixing it.”

BBC Disclosure also identified issues over how NHS Lothian reports delayed surgeries.

The Board initially told BBC Scotland that just one operation across all RHCYP pediatric specialties was canceled in April 2022 due to lack of capacity.

READ MORE: New taskforce for nurses and midwives amid staffing crisis

However, the BBC Scotland documents suggest otherwise. NHS Lothian has since confirmed there have been three cancellations this month.

Mr Adams said it was not clear whether the public data on cancellations reflected some patients having canceled their surgeries multiple times.

The BBC Disclosure team said they had asked every mainland health agency to film access to facilities and all declined.

Chief medical officers from four health authorities, including NHS Lothian and Greater Glasgow and Clyde, have been refused permission by their employers to take part in the documentary.

Health Secretary Humza Yousaf told BBC Disclosure that the Scottish Government will listen to concerns from medics speaking on the programme, adding: “I guarantee they should have no impact.”