Martin Daly (Roscommon-Galway, Fianna Fail)

It is with significant regret that I have to speak today. I am a member of the medical profession. I am not an orthopaedic specialist but I am a doctor of nearly 40 years' standing. The Thomas audit of the management of developmental dysplasia of hips in children in CHI at Temple Street and Crumlin and the National Orthopaedic Hospital Cappagh is deeply disappointing and unsettling, most especially as it follows on from the use of non-medical grade springs in spinal surgery in CHI. My thoughts are primarily with the children whom Mr. Simon Thomas states clearly should not have been operated upon and with their families. The trust patients and families place in doctors is the bedrock of our profession. That trust has been ruptured by some surgeons in the hospitals at Temple Street and Cappagh and these must now explain their actions.

These were not marginal decisions. Another hospital in the same group of hospitals in the same small city - the hospital at Crumlin - followed a starkly different standard of practice and is vindicated in the Thomas audit. The Thomas audit into the management of DDH in children has brought clarity within the limitations of its terms of reference. However, it raises many new questions about governance, ethics, consent, clinical judgment and decision making. This is more than clinical misjudgment. It shows some surgeons strayed far from evidence-based practice and ignored internationally accepted protocols. While Mr. Thomas notes that, while some variance in DDH management could be expected, the variance of pelvic osteotomy rates across CHI at Temple Street, CHI at Crumlin and Cappagh hospital, which is in the order of 60% to 80%, is inexplicable. No plausible explanation was offered.

I acknowledge the Minister's swift response to the official audit report and welcome the appointment of two HSE board members to the board of CHI, the increased operational oversight of CHI by way of an enhanced service-level agreement, the cross-hospital interdepartmental peer review group for consideration of any further surgeries and the commitment by the Minister and the Taoiseach to establish an independent external review process. However, broader questions remain regarding CHI's culture and governance and its relationship with the HSE. This is especially urgent in light of reports alleging unethical and irregular referral practices by a consultant in an internal CHI report and the alleged toxic work environment for junior staff. The non-action by management in response to that report is simply incredible but our immediate concern must be the care of affected children and families. Proper follow-up must be carried out to skeletal maturity. This is standard best practice that was lacking at Temple Street and Cappagh. Every case back to 2010 must now be independently reviewed. This is a major undertaking but it is essential. We must ensure this does not further delay care for children awaiting surgery.

It is incumbent upon the Government and this House to tease out the systemic failures this DDH debacle has revealed. The key issues are managerial culture and governance, clinical culture and governance and the process of clinical decision making at Temple Street and Cappagh. In many hospitals, critical robust collegial peer review of cases is standard before any treatments are carried out. We need to understand why some surgeons deviated so sharply from accepted practice. Mr. Thomas suggests a small subgroup of surgeons carried out a significant number of pelvic osteotomy procedures and an unusual number of bilateral pelvic osteotomy procedures in particular. These must prompt professional reflection, remediation and accountability to the appropriate bodies. Informed consent must also be addressed. Mr. Thomas details what adequate consent looks like and highlights poor record keeping, underlining the urgent need for hospital digitalisation. The health committee should explore these matters to clarify the management culture and governance of CHI and Cappagh hospital and the practices of individual surgeons.

As I have said, it gives me no pleasure to make this statement but we are obliged to act. The failures highlighted in the report by Mr. Simon Thomas on the apparent governance vacuum at Temple Street and Cappagh hospitals serve no one well, not the children, not their families, not the medical profession, and certainly not the State. We must learn from those mistakes.

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