Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael) | Oireachtas source

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"recognises that:

— Children's Health Ireland (CHI) was made aware through the protected disclosure process of a concern relating to the threshold criteria being used for surgical intervention in relation to development dysplasia of the hip (DDH) September 2023;

— the concern related to different indications for DDH surgery between CHI Temple Street, the National Orthopaedic Hospital Cappagh (NOHC) and CHI Crumlin, with a lower threshold for surgery at Temple Street and NOHC for children, this resulted in different practices across the sites in CHI and NOHC;

— the Department of Health was notified by the Health Services Executive on 9th May, 2024 that a clinical audit was to be conducted in CHI and the NOHC;

— the clinical audit is being conducted by an external international expert on surgery for children with developmental dysplasia of the hip performed during the 2021-2023 period across CHI and the NOHC;

— the Minister for Health is awaiting the final report of the audit, which is expected in the coming weeks, before any conclusions can be drawn on this matter, further details will be shared once the process concludes, respecting confidentiality and due process;

— patients and their families will have understandable concerns, and CHI and NOHC have issued letters to families to provide reassurance and information about the audit pending its completion;

— as a patient safety precaution, a single cross-site pre-operative decision-making process for any planned DDH surgery in CHI and NOHC has been implemented, all cases are being reviewed before any decision for surgery is made by clinicians from CHI Crumlin, Temple Street and NOHC;

— an action plan is currently being drafted, this plan includes identification of groups of patients not included in the audit sample but who may be affected by any findings of the audit.

— plans are also being put in place for patient follow-up as required in line with good practice and will consider any recommendations with regard to clinical follow up from the final report; and

— a communications plan is also being developed to support the publication of the final report and further communications to patients and families.".

I welcome the opportunity to address in this House the issues raised by the Deputies tabling the motion. However, I wish we could have this debate following the publication of the report. The reason the report has not been published is that it has not been finished and it has not been given to me. It is not a question of Government acting in silence. There is a clinical audit being done and it has not been completed. There is due process involved with its completion. That has not finished and therefore it is not finished. It has not been given to me. I cannot publish it. I have committed to publishing it.

On the remarks of the previous Deputy alluding to a silence or a cover up, it is factually wrong, and I have to say that. However, I wish we could just debate the issues and that will be better enabled when the report is published. I am very happy to do that when the report is published. As the report is not published, the motion is constructed based on reports in a media outlet that I cannot verify or stand over and that may be correct or may not be correct. Nobody on that side of the House knows the answer to that either. They do not know whether the facts they have asserted in this House are accurate. They may be and we will see that when the report is published but it is possible they are not or there are other things going on.

Given the seriousness of the issues, which everybody would agree with, I need to be careful that we handle that in an appropriate way going forward. I am very happy to have this debate based on the report when it is published because it is so serious and so important. I have to move an amendment to the motion because it contains details I cannot stand over factually. I do not want to do that but I do not have any alternative to that. That is a procedural point but, for example, were it to be the case that Deputies said the Government voted against their important motion on spinal issues, that would not be correct. It would not be procedurally or ethically correct. This is a debate we should have but I would like to have it when the report is complete and published. I would welcome that opportunity again.

As I said, I will insist on the report being published in full, save for the personal details. I am also very conscious that it is an audit in respect of a portion of time. I am very aware that it may be important to do something further but again I would like to reserve my own judgment on that until I have had the opportunity to see the report. I hope that is a fair reflection of the procedural element we are looking at this evening.

We have had a number of hours of debate on these very important issues, which I welcome. By far, the most important contribution to this issue over many years has been that of my Fine Gael colleague, Deputy Brian Brennan. I support other Deputies when they said it was a very significant contribution. I will not forget it and I do not think anybody here will forget it but it speaks to the complete humanity of the experience of families impacted in this way, the complete humanity of the decisions given to families or the complete humanity that is caught up in the diagnoses and treatment options. I have a child who had an emergency surgery in Crumlin that was completely appropriate and done on a Sunday morning at 10 o'clock, having been diagnosed at 7 o'clock. It was completely appropriate. In the previous debate, we talked about three categories and this was the correct response.

As Deputy Brennan expressed here this evening, to have a situation of being given a diagnosis, and Deputies described in letters that have come in to them, that was a wrong diagnosis, a treatment option that was incorrect, a treatment option that was unnecessary or a treatment option that was excessive on the bodies of small children for any reason, nobody here could possibly stand over it. It is so important that we get the correct information from this audit, reflect on the report that has been completed and make our next decisions together about what is next and what is appropriate. All of this is driven by genuine horror from us all, epitomised by Deputy Brennan's contribution of this own personal experience of this and we absolutely share this.

I will 100% debate this report with the Deputies once I receive it but I have not received it. It is not as though it is in my handbag, nor is the Nayagam report. I have not received them but when I receive them, in the same way as the HIQA report, we must debate these things. We will debate them again. We will also debate the different structural and recruitment challenges and all of the different challenges we all face together in trying to improve these different services which I, as Minister, am very clearly responsible for.

I recognise that the sequence of this is not where one would want it to be. We have a clinical audit and the clinical audit was public since last June or July. Of course, it is necessarily selective and anonymised because it is a clinical audit. Obviously, the best way for this to happen would be that the audit would be received, people would be contacted, there would be a natural sequence to these things and that it would be appropriate because I agree that families receiving letters in the post saying they might be impacted by something is just so worrying. When you go to get your post, you get your bills and something from Revenue but to get a letter like that about a surgery that your child had five or six years ago is so worrying. Those letters were sent in response to the fact that this issue came into the public domain - and I always respect the work of journalists, of course - prematurely, or earlier than I could control because the report has been completed or given to me. As a response to that, letters were sent to parents whose families were in this process where surgeries had occurred.

The clinical audit was to assess whether the indications and threshold used to select patients with DDH for pelvic procedures were in keeping with international standards of practice over a three year period between 2021 and 2023. The clinical audit was completed on a random and anonymised sample of patients aged one to seven years who had those procedures from 2021 to 2023 in both CHI and Cappagh hospitals. The purpose of the audit, and this is really important, is to assess whether the indications and threshold used to select patients were in keeping with international standards. Let us see what that report says.

The audit process is now in the final stages and, as I said, it will be published. I am told the audit process is at an advanced stage. Feedback on the draft report has been received by the expert who is authoring it and that is being reviewed.

In the meantime - and this is important - as a patient safety precaution, as I know some Deputies are aware, a single cross-site pre-operative decision-making process for any planned DDH surgery in CHI and in Cappagh has been implemented. All the cases are being reviewed before any decision for surgery is made by clinicians from CHI Crumlin, Temple Street and Cappagh. That MDT process, that multidisciplinary process, commenced in the first week of March 2025. An action plan is being drafted, and that plan includes the identification of groups of patients who may not in fact be included in the audit samples but who may be impacted.

I ask Deputies to allow me to come back to them once I have received the report and had the opportunity to understand what it means and what it looks like. I am very happy, for example, to immediately meet the health spokespeople and work through how we might best address that. I know they have been contacted by many people, as I have. I know that those people are worried and do not know whether they were included in the audit or were outside the period. I know that they do not know what has happened or how best to address it. However, I am here to try to do that with the Deputies and I ask them to do it with me. It would be so wrong of me to come in here and speak about a report I have not received. I think the Members opposite would rightly criticise me for that. Can we do this again once I have received both that report and the Nayagam report?

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