Marie Sherlock (Dublin Central, Labour)

I welcome that we are having statements on this this evening. Although I, for one, would much rather we were talking about all the many other issues in the health service, such as the huge inequalities we see, particularly in the primary care system, we are back again talking about CHI this evening.

When we look at the revelations at the weekend on top of the report last week, we are seeing anxiety levels among parents go through the roof in terms of their questions about trust and confidence in the individual hospitals that make up CHI. From talking to doctors and nurses in CHI, I am struck by how morale is on the floor. This drip feed of revelations is so damaging to the excellent work that so many of them are providing day in, day out.

If I counted correctly, we have had four externally-commissioned reviews over only three years in CHI, each looking at a specific aspect of care in CHI. Of course, three are published and we are waiting for the Nayagam report. Two have, I suppose, what I might call systemic recommendations - both the Boston hospital review and HIQA's. Obviously, the Mr. Simon Thomas report was more confined to pelvic osteotomies but between Boston hospital and HIQA, we have had 59 recommendations, if I counted them correctly. Many of these recommendations arise from the same conclusion that there were systemic cultural, clinical and management failures and point to the same fundamental reforms. Of course, some of these recommendations date back to 2023 and we are still not in any way clear that those reforms are fully under way.

When we looked on Sunday at the internal inquiry in CHI and its stunning revelations, on top of the appalling allegations that children were not cared for in a timely manner and that there was a possible abuse of the National Treatment Purchase Fund, NTPF, it is incredible that it seems the Department of Health, the Minister herself and the HSE appear to have been kept in the dark. It is a reflection of the level of dysfunction at the top of CHI that that was not communicated to the Minister and the Ministers of State, in particular because of this semi-permanent state of crisis that CHI finds itself in. I very much welcome the moves the Minister made over the weekend. I welcome the appointment of the HSE board members and the enhanced operational oversight by the HSE.

We have also been looking at the reports of the legal advice the Minister's predecessor received last year with regard to that substantive and fundamental change of governance at the top of CHI. To be clear, we in the Labour Party will not be found wanting if legislation is brought to this House in terms of ultimately bringing the board of CHI under the full operational oversight of the HSE because to have a situation, as we have had over recent weeks, where the HSE is effectively accounting for the failures of an organisation which it does not have full operational control over and oversight of is simply daft. It is telling that the HSE had to come in particularly in terms of the briefing on Friday on the set-up of the external review and that it is the HSE, as opposed to CHI, that is very much, along with the Department of Health, leading on this.

I want to make clear, I suppose, from many of my conversations on the ground that I understand the new CEO of CHI is somebody who people speak very highly of. That is very welcome but I am not sure that, in itself, enough anymore in terms of the governance of CHI.

On the Simon Thomas report, I have a number of questions. Why is the review only going back to 2010? As I understand it, it is because those children born in that year are currently ageing out of the paediatric children's hospital services, but there are children older than that, aged 17, 18 and slightly older, whose parents have also raised concerns with me about whether those children were caught up in the unnecessary pelvic osteotomy procedures. If I heard correctly, the CEO of the HSE, whom I have great time for, stated on Sunday that it was believed there was a situation with the clinical audits and that there was some reference made to 2010 but I understand from talking to other surgeons that the practice of clinical audits goes way back and is a key part of all surgical training so that it not having been embedded into the oversight procedures within CHI is, in itself, stark.

While the offer from the HSE with regard to the external review is confined to patients who have undergone pelvic osteotomies, and the protected disclosure, of course, related specifically to that, I have to ask the Minister whether she is confident that there were not other procedures conducted by those same surgeons that may have also been deemed unnecessary or perhaps did not meet the internationals standards for clinical indication because there is an air of distrust now with regard to all the procedures that have been undergone.

The review that was published on Friday related to children aged seven and under who had the pelvic osteotomy operations but I had a family contact me whose daughter was 13 years of age and underwent a similar procedure. At the time, the family felt the decision was quite rushed but, nonetheless, they were in the hands of the surgeons. I suppose my ask is that in terms of the opening up of the external review, it would be opened up to those children older than seven years of age.

One of my final questions relates to the change with regard to this new single peer-led review of a team of all surgical decision-making. Is that only for pelvic osteotomies or for all surgical procedures within CHI? That is a critical question.

Some weeks ago, I raised the issue of the status of current activity within CHI. Have surgeons been referred to the Medical Council? While these reviews are ongoing, has activity been temporarily suspended or reduced? I understand that is not the case. There is also a situation where we know that there are approximately 220 children currently awaiting orthopaedic procedures. Those families are obviously deeply worried that there will be any sort of reduction in activity and we need to provide assurances to them.

On the steps being taken now and the letters being set out, the question has to be asked that with all that has gone on, how could CHI be so tone deaf as to insert in its letter that only one parent attends? Perhaps the Minister might be clarify that because the parents who have contacted me stated that they feel broken and that their confidence has been shattered because of the uncertainty of whether they have put their child through an unnecessary procedure.

I will refer to a woman who contacted my colleague Deputy Mark Wall today. Her three children had undergone pelvic osteotomy. She secured a review with the surgeon two weeks ago. An X-ray was taken and this was followed up by a meeting with the consultant. She asked the questions and the surgeon told her that he had done her children a favour for their future. She is not sure who to believe any more. Who precisely will provide the follow-up care for every child who has undergone pelvic osteotomy that has now been committed to? Will it be the surgeon who undertook the procedure or somebody different?

I am conscious I have only a few seconds left but there are now serious questions about the NTPF. I refer to the allegations made on Sunday. We would like that report to be published as soon as possible. There are serious questions about the NTPF and an audit of its processes needs to be undertaken.

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