Pádraig Rice (Cork South-Central, Social Democrats)

I too welcome the establishment of a statutory public inquiry and the decision by Cabinet to appoint a facilitator on the matter. This public inquiry must have the power of compellability to establish facts. It must be independent and the voices of the children, their parents and families must be at the centre of this. Crucially, these families must get the answers to the long list of questions they have.

Public interest must be at the heart of this and nothing else. It must not be rushed, but it cannot go on forever either. Having looked at some examples of tribunals and commissions of inquiry, I have yet to find one where the State has got it right. There are real challenges in setting this up and getting one that is fit for purpose. There is a real challenge here to get a public inquiry that meets the needs of the families and parents, gets them the answers, does not get stuck in legalistic disputes with huge costs and runs for ages.

We need to learn from the lessons of the past in this regard. In particular, we need to learn from the Grace case and that commission of investigation. Inclusion Ireland published a damning report into that inquiry last month, stating: "From the outset the design and approach of the Commission sidelined and devalued many of those most affected by the issues it was considering." That cannot happen here. We cannot have the voices of the children and the families sidelined. The public inquiry must be fully human rights compliant, based on what is the best practice in other jurisdictions such as those identified by Inclusion Ireland in that report. Hopefully, that can be looked into.

When the Minister was talking about the issues in CHI, she referred to some of the reports published in the past two years. We have reports in this area going back to 2013. There was a report into the services for children with spina bifida that found major deficiencies in services at national and local levels, including limited co-ordination services. That report made recommendations for service improvements that were never implemented.

In 2017, the Ombudsman for Children's report found serious and ongoing violations of the rights of children waiting for scoliosis treatment. In response, the then Minister for Health, Simon Harris, promised no child with scoliosis would wait longer than four months for surgery. In 2023, the ombudsman published a report into CHI's care of Ivy, a child with scoliosis. It found numerous failings of governance and communication within CHI. Ivy had been waiting for spinal surgery for five years, during which time the curve of her spinal surgery went from 30°to 135°. The same year saw the Boston review, which found infection rates at CHI were way above international norms. In 2024, a follow-up report into Ivy's case was published and revealed that surgery had been delayed so long that Ivy was no longer operable. In 2025, an independent audit revealed nearly 80% of hip surgeries on children at Cappagh and nearly 60% on those in Temple Street were not clinically indicated, meaning potentially hundreds of children underwent unnecessary surgeries. In the same year, HIQA published a report into the use of unauthorised springs in spinal surgeries on children with scoliosis. It found there was no evidence of ethical approval and identified issues with culture, governance and internal communications. A report compiled in 2021, which CHI refused to publish in full, was leaked and uncovered bullying and a workplace culture with the potential to put patients at risk.

We also know there are outstanding reports. There is the Nagayam review into spinal surgery at CHI commissioned in 2023. The 2017 Dickson review into paediatric neurology services remains unpublished, with CHI rejecting its findings. We also have the audit into the waiting lists and equity of access the Minister mentioned. We have here evidence of over a decade of failure and findings that need to be implemented. We cannot have this inquiry stop this reform. All these recommendations need to be implemented and lessons need to be learned. That work needs to continue.

We also need continued reform of the culture within CHI. We know from parents and advocates about the issues around transparency and the culture in the organisation. Úna Keightley, cofounder of the spina bifida and hydrocephalus paediatric advocacy group said CHI is not an entity that values transparency, that it functions on a reactive basis to political, media and advocacy measures and that it does not follow any rules in terms of giving parents the information about their children. It knows parents have nowhere else to bring their children. I have seen this in terms of some of the parliamentary questions I have submitted to CHI. It refused to answer questions saying it was almost too busy to answer my questions. I sent them back and we had to push back on that. That is not acceptable. We need greater transparency and accountability from CHI.

We must not forget those children who remain on waiting lists for these services. There are 233 on CHI's spinal waiting list and 139 on the active list, up from 112 in January, and 45 waiting longer than six months, up from 37 in January. Just five children are listed for surgery abroad. In total, only 19 children have availed of surgeries abroad. I want to know why this is so low. The Minister said it is a source of frustration but we need more than that. We need to know why it is not happening and every mechanism and tool at our disposal needs to be used to ensure these children get the surgeries they desperately need. They cannot be left waiting months and sometimes much longer.

The children affected by unnecessary hip surgeries cannot be forgotten. It is welcome that the multidisciplinary team meetings moved ahead. However, there are concerns about the delay with the external review panel. That cannot be delayed too long. There are also concerns about the lack of accountability and transparency. The Minister said in July regarding referrals to the Medical Council that her Department had written to the HSE to clarify the matter and the HSE had contacted CHI. Will the Minister update us on those referrals to the Medical Council? What is possible in relation to those cases? We need greater accountability. Legislation for accountability is crucial. That is a part of the Sláintecare reforms that was never done. It should be done.

My thoughts are with the families and children affected. As time goes on, they have more questions than answers. Harvey Morrison's parents are an example of this. They want to know why Harvey was removed from the surgical waiting list. Was it a clinical error or a clerical error? How could this have happened? How many children and parents in continuous contact with CHI have been forgotten? Why were these children failed? Who is to blame and who will be held to account?

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