Pádraig Rice (Cork South-Central, Social Democrats) | Oireachtas source

I thank Sinn Féin for bringing forward this motion, which provides Members with another opportunity to raise our concerns about the yet-to-be published audit into hip surgeries at CHI as well as the long-standing failures in the organisation.

I first raised the issue of hip surgeries with the Taoiseach on 1 March yet almost two months later we still have no more information. Were it not for the reports in The Ditch we would still be in the dark about the latest scandal at Children’s Health Ireland. Last July The Ditch reported CHI was conducting an audit into hip surgeries at three hospitals following a whistleblower’s claims unnecessary surgeries were being carried out on children. The report said the audit was due to be completed in the autumn of last year, but as we enter the summer parents are still anxiously awaiting its publication. Last month The Ditch published a leaked draft of the audit that measured each case against the indicators normally required for surgeries to go ahead. In total 147 children’s cases under the care of 14 surgeons were audited between 2021 and 2023. According to The Ditch, a staggering 79% of cases in Cappagh did not meet the required threshold for surgery. In Temple Street it was 60% while in Crumlin it was just 2%.

Since these findings were published last month a number of parents have contacted me to express their deep concerns about their children’s surgeries. A parent said she received a letter from CHI stating Crumlin, Temple Street and Cappagh may have been using different criteria to determine whether surgery was required. Given the audit results leaked last month that would certainly appear to be the case. It also echoes the findings of the recent HIQA report into the use of unauthorised springs that found procedures were not standardised across CHI sites. Again and again we see the same issues in CHI, but nothing seems to change. Another parent whose child’s case has already been raised on the floor of the House was in touch with me recently. His daughter was a patient in Temple Street in 2016 and the parents were told she required hip surgery despite the lack of symptoms. The surgery they were told she would need involved sawing into her hip bone and reshaping the socket to hold the ball in the joint more securely. Fortunately, this girl’s parents sought a second opinion north of the Border and the second consultant found there was no need for the surgery. This is a really horrifying case. This girl narrowly missed an unnecessary surgery and I wonder how many children were not so lucky. Another parent contacted me recently to say they were shocked at the findings. They described the day of the surgery as a day they would never forget and that their child would never forget. To think that many may not have needed the surgery makes me sick to my stomach. They spoke also about how they put their faith in professionals.

On the scope of this review, the Social Democrats fully support the motion’s call to conduct a more extensive review of surgical practices at CHI. The scope of the current review is too narrow and must be widened. How many parents, over the years, understandably accepted the advice of surgeons or simply were not in a position to seek a second opinion?

The motion before us also refers to profit, which was initially reported as a possible motive in the The Ditch articles. This is a rather alarming claim and it needs urgent clarification. There is no mention of it in the leaked report. We must know if the potential presence of this motive was assessed in the review and if not, then why not.

I wish to raise another set of allegations that have been levelled at CHI. I am sure the Minister has seen the reports in the Mail on Sunday regarding CHI’s IT failures. Just two weeks ago it reported surgeons had commenced operations on children without the help of vital X-rays to guide them on a number of occasions. According to the whistleblower, IT workers had to be summoned into theatre midway through operations on children and in one instance a pregnant woman. On one occasion in Temple Street, a whistleblower stated they witnessed what appeared to be a child’s intestine during a live operation while trying to resolve a medical-grade PC issue to enable the surgeon to see the child’s X-ray. That operation should not have commenced without the visible X-ray on the medical-grade PC. Last Sunday another report stated children’s chemotherapy procedures are being cancelled in Crumlin because of a totally inadequate IT system. According to the whistleblower Crumlin’s chemotherapy department is entirely reliant on Wi-Fi, with no wired connection on site. This has been called a dangerous oversight for a critical department. The whistleblower alleges chemotherapy appointments were routinely being cancelled because the Wi-Fi system is plagued with disconnections. This, they say, has resulted in numerous occasions where quality-controlled and safe doses of high-risk chemotherapy medication could not be administered to children. To add insult to injury, it was reported it would cost only about €12,500 to ensure the hospital had a more reliable, glitch-free system. That is a barely a drop in the ocean in the context of the overall health budget. I accept this is another reason the new children’s hospital is so urgently needed, but we have to deal with the IT issues in the meantime. It is unsafe and entirely avoidable. I thank the brave whistleblowers who have come forward to expose the mounting problems in CHI. There is an ever-increasing evidence base the culture in CHI is a major factor in the failure of patient care and the poor levels of accountability. A 2023 report by experts from Boston Children's Hospital stated CHI "... needed to create a culture where all members of the care team are encouraged and comfortable sharing safety questions and concerns". Nothing to date would suggest there has been any change in the culture. CHI may claim there has been but report after report suggest otherwise. Lessons never seem to be learned.

It seems to be system-wide failure after system-wide failure. I wonder where the accountability lies. The Minister mentioned the possibility of changing the legislation that underpins the board. Will we see those changes? Is it possible to amend the legislation? Can the structure around governance be changed? Can that be looked at in a more holistic manner? This month's report from HIQA is just more proof that a culture that supports the asking of questions does not exist in CHI. It is time for a major overhaul. In this instance, continuity is not what is called for. If anything, continuity is the very thing that is causing the instability.

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