David Cullinane (Waterford, Sinn Fein)

The Minister will agree that the cornerstone of our health service is trust. I am not a clinician, and I do not think she is one. Although some are clinicians, most Deputies in this House are not, but we depend on clinicians to guide us when we develop specialist services, for example, and when we get sick. That came into very sharp focus during Covid when people tried to sow mistrust about clinical advice. I have always been of the view that if I get sick, I go to my GP, thank you very much, for medical advice. We put our faith in the medical fraternity. That is what we have to do. When that trust breaks down, however, it is very difficult and challenging. Trust in Children's Health Ireland is shattered, in particular its orthopaedic services. That is unfortunate, but how could it be any different when we look at numerous reports that have cited governance failures, management failures, clinical failures, ethical failures, conflicts of interest, failures relating to open disclosure, and many more failures right across the system? That creates real problems for Children's Health Ireland.

The Minister is new to her post. I have no doubt she is trying to respond to this in the best way she can, but it is not an issue that just dropped into our laps in recent weeks. In fact, I imagine there are parents and advocacy groups watching and listening to this debate that quite rightly say they also blew the whistle on many of these issues for many years. They feel betrayed because they met with what they would describe as a wall of silence - a brick wall. I know the Minister met some of the advocates and parents in recent weeks. I met them several times. They raised issues relating to governance failures, clinical failures, management failures, ethical failures and many other issues for years. I listened to them and raised some of their concerns in this House, as did my party leader and others, including Deputy Paul Murphy. Unfortunately, they were not supported, or at least they say very directly - we must be conscious of their experience - that they did not feel supported. I just make the point to the Minister that these are not new issues.

Unfortunately, there are various issues involved. Very recently, we had a report from HIQA on the use of non-medical grade springs. In its own right, that was a shocking report. It pointed to very serious clinical failures by a clinician. That person must take responsibility for their actions. The report also cited very clear process failures, management failures and other failures in Children's Health Ireland, which have wider implications beyond the use of non-medical grade springs. In speaking to the Minister, I referred a number of times to one line in the report that was most damning. It was that children were not protected from harm. If that was the only issue in Children's Health Ireland, as bad as it was, then we could deal with it, but, unfortunately, that was not the case.

As the Minister is aware, we also have a clinical review into surgeon A – I am not sure whether it is only one surgeon involved - who was at the heart of the issues in relation to the use of non-medical grade springs. That person's clinical practice is under review by Dr. Nayagam and perhaps others as well. Dr. Nayagam was looking at very unusual patterns of high rates of return to surgery, infections and other issues. We still have not received that report. We must wait until the report is completed, but I have no doubt that it is going to point to very similar issues and patterns in respect of clinical failures and governance and management.

Then we had the leaking of the audit into hip dysplasia and osteotomies carried out on children. That was published by The Ditch. It was not picked up or covered all that much, even though it was being raised in the Dáil and many of us saw it as a very serious issue. Of course, it was only a draft audit. What was in that audit and what was published, however, was very worrying. I assume it was a whistleblower who put it in the public domain. We have all commended the whistleblowers in Children’s Health Ireland who have come forward, and I have met some of them in recent years.

Very quickly after that audit was leaked and arrived on the website of The Ditch, 2,200 letters were sent out to families. Parents are very worried, anxious and angry for a range of understandable reasons. They are worried that an unnecessary operation or procedure could have been carried out on their child. That would be cruel, particularly when we consider the stories we have heard about children who have had to learn to walk again after these procedures and those who were put through surgeries that are painful and difficult for any child. I have two children. One is 18 and is now an adult, but I also have a 14-year-old. I can only imagine that if any of our children had a procedure that we felt was unnecessary, for whatever reason, we would be devastated. That devastation is very real for the parents involved.

Again, we do not know why. Parents ask me, not just about this issue but also in the context of all of these issues, how this was allowed to happen. How is it that the surgeons failed? I accept that not all of them failed. I want to put on record that there are many brilliant surgeons and staff in Children’s Health Ireland. I have said this publicly. My heart goes out to all of the great staff working in Children’s Health Ireland who do such a fantastic job. However, there are those who have failed and they have to take responsibility for that.

Others failed as well. The Minister talked about members of the board and about wanting to be careful and cautious. She said that the new CEO is accountable to a board and so on. Parents get very frustrated when they hear that because they feel, at a corporate level, Children’s Health Ireland has let them and their children down. I can accept and understand that.

I welcome the fact four board members have stood down, as has the chair. Other members of the board need either to be stood down or to stand down, and they need to be replaced as quickly as possible if we are to have confidence. Although I am not sure how accurate this is, I saw media reports which suggested that there may have been some discussion about the responsibilities of the board being subsumed into the HSE board. I am not sure whether that is legally possible, and I do not know all of the circumstances around it. What I would say is that every option has to be on the table to ensure there is good governance and good management.

I will put another point to the Minister, and I say this sincerely and genuinely. A task force was set up in Children’s Health Ireland. Many parents at the time told me they could not sign up to the task force because they did not have confidence in the same people in Children’s Health Ireland who had let them down so badly and who were responsible for all of those failures. Again, I can understand that from those parents. However, we have a situation now where an expert panel is going to be established to look at and evaluate each individual case. I welcome that because it is necessary. I want every child to have their case reviewed. However, it has to be at arm’s length from Children’s Health Ireland. The Minister has said that will be the case. Obviously, I will wait to see the terms of reference and the criteria involved when they are published.

We have to make sure that in everything we do now, families and children are put first, which, to be frank, they have not been to date. Families contacted me yesterday regarding the phone line. While some of them were grateful that at least there was a hotline, in reality, to use their words, they felt the people on the other end, through no fault of their own, could not provide them with answers and were using what the families thought were responses to frequently asked questions. They felt let down by that and this compounds the anger and frustration those families have. Let us put children and families first in everything we now do to establish the facts and make sure these children get the care they need.

I want to use my remaining time to deal with the other issue that came into the public domain regarding the potential manipulation of public waiting lists. Again, I have a high regard for consultants, who do a fantastic job. I am on record as supporting the Government in putting in place a public-only contract. It is a very important transition that we need to make to remove private healthcare from public hospitals. I very publicly welcomed that at the time because it was the responsible thing to do. I called for it and I want to see it in our public hospitals. However, I have been concerned for some time about the use of public money for insourcing in hospitals to deal with waiting lists. It is necessary and we know we need waiting list initiatives because waiting times are too high. However, I have been raising concerns about the potential for conflicts of interest, perverse incentives and, I would argue, issues of productivity within the public system.

We have to ask genuine questions about what work some consultants are doing from Monday to Friday when they are paid from Monday to Friday to carry out public procedures. We need to contrast that with the so-called blitzes and private clinics they are organising and running, while charging €200 for each client they see and making very handsome amounts of money. I know this is a contention and that the outcome of the investigation, internal as it was, has not been published. It was a mistake not only not to publish the result of that investigation but not to forward it as well. I refer to the investigation into the practice of a consultant.

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