Professor Damian McCormack:

Yes. Some are doing so with the agreement of their surgeon but unfortunately, we have a breakdown of trust in the system and therefore patients are going abroad for experimental treatments without the knowledge of their surgeon. This is a real symptom of a sick system, a system that is broken. Ireland, as a nation, should be proud of its health system and we should be embarrassed if a patient is going elsewhere for an operation. We are better than that. It would be a manifestation of a healthy system that no one ever needs to go abroad for anything.

The Deputy asked what the "everything else" is. To my mind there are three elements to this. There is the infrastructural issue, but we have brand new paediatric orthopaedic theatres in the north east. Alone that is not enough. Infrastructure is important, but we need additional staff. We need consultants, nurses and so on. We need sufficient numbers and that needs to be addressed. The third issue is that we need quality staff. One way to ruin any system is to put a bad doctor in, someone who is not confident or comfortable. It is not about bringing in, as has happened, locums from eastern Europe who claim they can do paediatric orthopaedics but who cannot. They last three or four years and they disappear. That has happened and it is not a solution.

We need quality training. I believe we need to train our own surgeons in paediatric orthopaedic surgery. It will take time to get good Irish leaving cert students through an appropriate medical school where they earn their degree and become high-quality surgeons and then incentivise them to do this work. The money is not sufficient incentivisation. It is not about money. We would not do this job for money. No amount of money would make us do this job. There is more. It is a social contract we make with society and with our patients.

There are three elements and if one of those elements is deficient, the whole thing is a waste of time. We can get into the detail of this another time but they need equal attention.