Pádraig Rice (Cork South-Central, Social Democrats)

It is really hard to know where to start when it comes to CHI. The report that was published is shocking, disturbing and deeply upsetting for families across the country. It confirms what we have known and what we have said in the House for some time, that unnecessary surgeries took place on children. We know what happened and now we need to know why that happened.

I have a list of questions as long as my arm that need to be answered. As a new TD, I do not believe this format of long statements and posing questions without getting direct answers works. I ask the Ceann Comhairle to think about that in the context of the functioning of the House. It would be far more beneficial for us and for the families affected if we could pose our questions and get direct answers from the Minister, and have that time for the back and forth direct engagement. There are lots of serious questions that have been raised over the last hour or so and we have not had a chance to hear any answers from the Minister. I ask this in terms of the functioning of the House so that we do our job better for the families and get direct answers to our questions.

I have ten questions I would like the Minister, Deputy Carroll MacNeill, to answer in her reply. How long will the external review take? Does the Minister know how far back this issue goes? We know that letters have been dated back to 2010 but does this go back further? Are we looking at something that goes back to the early 2000s? Reference was made to a published academic paper but what is that paper based on? Is it based on surgeries that happened before that? We need to know how deep this issue runs. Will there be further investigation to determine how this scandal arose and persisted for so long without anyone in CHI or Cappagh hospital being aware of it? Will the Minister conduct a review of clinical directors? Could children under the care of CHI surgeons in other hospitals be affected? We know that they worked in other hospitals such University Hospital Galway. Crucially, and as referenced by others, has financial incentive been completely ruled out as a motivating factor here? Have any doctors been placed on leave? Are any doctors contesting the findings of this report? Are there any legal proceedings against CHI as result of the scandal? Does the Minister trust CHI to take on the running of the national children's hospital? These are just ten of the many questions that I, others and parents have. They are questions we would like to get answers to. As we go through this report and delve through it, there will be more questions that need answers.

To that end, in my capacity as the chair of the Oireachtas Joint Committee on Health, I have invited CHI to come before the committee. I and the other members would expect that to happen quickly and not be delayed. Hopefully, we will have that engagement with it sooner rather than later because we need to get answers to these questions.

The report raises really serious concerns around the novel procedure and the serious failings around informed consent and lack of clinical follow up, which was another key issue. What we need to see now is that independent panel established quickly. It is key that there would be independence there for families. They are quite worried about the lack of independence. This needs to be put in place. The report, which I read through more than once, trying to get my head around it, highlights many issues: poor record keeping; the different criteria applying in different hospitals, which is deeply worrying; the lack of oversight; and indications of children having complications. There are many issues that need to be addressed urgently.

I suggest to the Minister that in future with these kinds of issues, and particularly those of a real technical and medical nature like this, it would be worthwhile publishing at the same time an easy-to-understand guide for families and having a version that people could understand. In reading through this report, I struggled to understand this as someone who is not a medic. It would be worthwhile having something that is easier to understand for families and parents issued at the same time.

I commend the whistleblower on raising these concerns, and also the parents and families who have been raising the issues. Some of them feel they have not been heard. Over many years they have been raising concerns around CHI and its processes and have felt stonewalled and unheard. That culture needs to change. We know there are serious issues with culture. The HIQA report talks about the issues around culture, governance, the lack of communication, and the lack of oversight. There are many issues that need to be addressed.

These are not the only serious concerns that CHI needs to address. There is also the use of unauthorised springs, and more recently the reports at the weekend around the National Treatment Purchase Fund. I would like to see that published. I would like to know whether there has been a referral to An Garda Síochána. I would like to know also whether there has been a referral to the Medical Council and what actions have taken place on foot of that. The report is deeply disturbing about patients being cherry picked and put on private lists in order to make more money. The lack of oversight there and the lack of awareness by the HSE and the Department of Health in that regard is deeply worrying. With the National Treatment Purchase Fund, we are talking about very large sums of money around €240 million. We must ensure this money is being spent correctly. These reports are deeply worrying.

This morning my party's deputy leader raised the Social Democrat's deep concerns about the situation of clinical directors. These are consultants who have been given the task of supervising their colleagues, and who receive an additional allowance for that work. This was introduced in 2008 to ensure consultants were adhering to their contracts. In 2017 "Prime Time Investigates" revealed that consultants were gaming the system in many ways. At the time, the Social Democrats raised serious concerns about the role of clinical directors. The latest revelation at CHI shows that clinical oversight is still issue. We want to know how these processes were happening under the noses of highly-paid clinical directors. We would like to see that system reviewed. I would like to know the number of clinical directors employed with the health service, where they are based, the number of consultants they are overseeing, and the reporting arrangements in place.

A lot of this comes back to clinical governance and that needs to be looked at.

I welcome the Minister's interventions over the weekend, particularly the swift action she took on the appointments to the board. That work needs to be commended. From the Social Democrats' perspective, we want answers, not heads. We need to know what happened at CHI. We also have fundamental questions about the purpose of CHI, whether it is needed and what the plan for it is going forward. This is an HSE-funded but not HSE-controlled organisation and there are serious issues there. There are issues about building in these additional layers that we might not need in our health service and whether the HSE can directly manage these hospitals. The national children's hospital is a €2.2-billion hospital, as the Minister knows. We need to get this right. We need to spend time and carefully consider it and I ask for that to be part of her consideration.

In terms of the bigger picture, there seems to be a lack of controls and accountability. We in the Social Democrats have long argued that the mix of public and private together in an uncontrolled system without accountability is toxic for our health service. This is why we fundamentally believe in the delivery of universal healthcare through Sláintecare. That needs to be accelerated, however. We are now a number of years into a ten-year plan and we do not believe it is happening quickly enough. Until we deliver universal healthcare that is free at the point of use in the community and based on need and not ability to pay, these issues will arise again and again, and we will face future scandals. While this is looking at one particular issue in one particular section in one particular hospital, the issues are systematic and will not be addressed until we rebuild and reform our healthcare services and deliver the type of universal, single-tier and high-quality services that are enjoyed by people throughout Europe. As an Oireachtas, we need to collectively get behind the agreed Sláintecare reform plans and accelerate those because the children of Ireland deserve better than what we are seeing in these reports and scandal after scandal.

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