Dr. Colm Henry:

Having spoken to Mr. Thomas on a number of occasions, I recall he described the surgery, which I am sure the Cathaoirleach is aware is essentially preventative, as surgery in which the clinician's purpose is to prevent hip dysplasia developing in adolescence or later in life. His findings in the audit did not just indicate that there was a low threshold for surgery, or what he characterised as being at the extreme end of variation, but also that he could find no evidence in the audit samples of the kinds of discussions you would expect to take place between a surgeon and family to explain the pros and cons and relative risks. That is not to say they did not take place but he did not find evidence of what would be quite complicated but necessary discussions with families explaining why preventive surgical intervention might be used. Even the best practice centres that comply completely with the standards he has laid down will not be expected to get the decision right 100% of the time, because they are trying to prevent something from happening later. Therefore, his characterisation was that he did not see evidence in the audited sample that the kinds of discussions in question took place.