Martin Daly (Roscommon-Galway, Fianna Fail) | Oireachtas source

Ms Nugent's comprehensive statement notwithstanding, there is no sense in the statement of the gravity of what has happened to the children in terms of development dysplasia of the hips. There is no sense in it of the gravity of what has happened. It is scandalous. I am not an orthopaedic surgeon, nor do I pretend to be, but I am a member of the medical profession, a doctor of 40 years' standing. Before I came into this job I would have been minded to defend our profession, where it could be defended. However, the Thomas audit of the management of developmental dysplasia of hips in children in CHI Temple Street, CHI Crumlin and the National Orthopaedic Hospital in Cappagh is deeply disappointing and unsettling, most especially as it follows on from the use of non-medical grade springs in spinal surgery in CHI.

With the HIQA report on the use of non-medical grade springs, we do not have all the answers. By the way, no one person should be thrown under the bus for this, notwithstanding whether that person has a question to answer about his or her judgment, caseload or decision-making. This is not about one surgeon. This is a about a whole system failure. When we hear talk about moving CHI into the new €2.5 billion hospital, it is like having top-of-the-range hardware for a computer but the software is rotten. There is no other way of putting it.

I do not think Ms Nugent imparted a sense of the realisation of the anger, not just about what happened to the community of children who were involved. I accept that the spinal issue might be different but with the hip issue it is just inexplicable that in a small city, relatively speaking, in a small country, between three orthopaedic departments, there could be such stark divergence in decision-making. The Thomas report has vindicated one department but not the other two departments. International experience has shown that there will be some divergence, in the order of maybe 5% to 7%. I stand to be corrected by an orthopaedic specialist on this. However, when the divergence is in the order of 60%, 70%, 80% or 90%, there is something absolutely rotten in that department, notwithstanding the work done and the good cases that come through. There is a generation of children who have been operated on who should not have been. These operations were carried out on spurious evidence, without proper audit and without proper governance. I know Ms Nugent is new in the job. Ms Hardiman was there. It looks like under her regime, she was rewarded for substandard management of the hospital. I am saying this strongly because all of this happened under Ms Hardiman's watch.

I will keep my contribution to five minutes because I would like the witnesses to have five minutes to respond. The HIQA report states: "there were no overarching CHI-wide standardised governance structures and supporting policies and procedures in place for the introduction and use of medical devices." This is an astounding finding. In addition, HIQA found that what corporate and clinical governance procedures were in place at the CHI group were overly complex and difficult to understand for management and staff, both at site-specific hospitals and the overall CHI group. I have spoken to medical professionals in those hospitals and they vindicate HIQA's view.

With the changes from 2019 onwards there was a loss of experienced management staff at Temple Street, resulting in a breakdown of communication and governance pathways. The report states: "While there were a number of controls in place, these did not provide adequate safeguards at each stage of the end-to-end process for the introduction and use of springs." I will leave that because I am going to run out of time.

We have the HIQA report and we are waiting on the Nayagam report into the practice of one surgeon in relation to the use of non-medical grade springs. It is incredible that these springs came through a procurement process, had a quality code and arrived to a surgeon in the operating theatre, yet everyone is throwing that surgeon under the bus. Management has thrown that surgeon under the bus. He might have exhibited poor judgment. He might have been overworked. He might have had pressure put on him to fulfil waiting lists and to operate more. That was for him to resist but management has serious questions to answer on this. I do not believe the answers we have been given already. We will have to wait for the Nayagam report.

I have covered the hips' issue. A lot of the same governance issues arise. It would appear that there was a department that was dominated by one or two surgeons who decided what would be best for a child in 15, 16, 20 or 30 years and operated on children who should not have been operated on. These operations were based on spurious evidence and spurious data.

Much has been made about retaining the CHI board intact leading up to the opening of the new hospital. There is zero confidence in the CHI board and the management, notwithstanding the changes outlined by Ms Nugent. I am speaking as a medical professional who would be inclined to try to tease the nuances of this but there are no nuances.