Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

I want to try to address all the points, but there is a time limit. Let me try to address a couple of things quickly, and then some of the more detailed issues. In relation to the 2024 annual report for CHI, the annual financial statements are with the Comptroller and Auditor General. The intention is for it to be published by the end of the year.

Forgive me, but I cannot recall who mentioned infection rates. It is importanto acknowledge that there has been significant difficulty in the past but that is reducing. For example, the surgical site infection, SSI, rate was 8.7% in 2022. In 2023 and 2024, respectively, it was 4.3% and 4.4%. This year, I am pleased to be able to say it is below 3%, at 2.9%. That is a significant improvement, and I hope it will provide some confidence to families who have correctly raised this issue in the past as being a big issue. It is very much reduced. I think that is important.

My door is open to bringing cases, but it is not as though I will be able to clinically intervene. What I can do is to try to shine a light on the management of cases, particularly for those most urgent cases, which are of real concern to me. I have met many of the families directly and I am aware of the difficulties. I am not a clinician and I never will be, but I will do everything I can to make sure the correct attention is shone on those most urgent of cases.

In relation to the Nayagam report, there are two things. The CEO of the HSE has assured me that the matters that led to the report are being attended to in major improvement plans and patient safety measures. The report itself is not being waited upon to action that. Nevertheless, the CEO has also advised me that for significant legal reasons, he cannot at this time apprise me of the report, but we hope he may be able to do so in the near future. There is a significant legal issue in regard to that and I cannot go any further than that.

A number of Deputies correctly asked me about the audit because it is a really important part of waiting list management. I am informed that the qualitative element of it should be with the CEO at the end of November, so I would expect to be in a position to publish it in December. The technical draft of the more quantitative audit element being done by the internal auditor will be technically available in December, but there is always a procedure to triple-check - I cannot recall the audit phrase - when producing data of that kind. That will happen within December. We will publish it as early as possible outside of the normal quarterly cycles, but that has to happen.

Turning to the task force, there was some very strong, and somewhat unfair, criticism of the paediatric spinal task force that I think it is very important to address. The paediatric spinal task force is an entity separate to the management of lists within CHI. I think it is important to say that. Regarding its membership, Mark Connaughton SC the chair. Exceptional advocates for spina bifida and scoliosis are on the task force. There are also exceptional advocates who are not on it. All of them are contributing to the improvement of services. I thank all the advocates, both those on the task force and those not on it, and they will all contribute to the development of the terms of reference. They all have direct lived experience, either as a parent or as somebody with spina bifida or scoliosis. They all have very important perspectives and all have done exceptional work. The members are Gerry Maguire of Spina Bifida and Hydrocephalus Ireland, Elaine Kelly and Deirdre McDonnell of Scoliosis Awareness Support Ireland, and Lily Collison of the Cerebral Palsy Foundation. There are then different departmental, HSE and CHI representatives.

The terms of reference are to engage with stakeholders, listen, engage and act on advice and the concerns of parents, outline improvements, engage on the development and delivery of services, engage with the HSE and its spinal surgery management unit and provide oversight and assurance. I thank them for their work. It is ongoing work. It really has contributed valuable information, as have those advocates outside of it. Neither is better. Everybody is contributing their experience for the improvement of services. I really do thank all of them. It is important to say the task force has no operational oversight. I think Deputy Coppinger may simply have confused the two elements, but the task force is not responsible for operational oversight. It is a group to try to improve the services. It is different from the unit established in CHI last year that is responsible for managing the waiting lists.

The issue of the inquiry, possibly most important, was raised by several Deputies. I need to try to address a number of different issues, but what we can say with certainty is that it will be a statutory public inquiry. It will have the power of compellability, of necessity. We will also continue to try to drive improvements at the same time. Those things are not incompatible. We will absolutely engage with families, with children, in a voice-of-the-child appropriate way, and with stakeholders, the different representative groups and the different advocacy groups, all with a view to developing the best possible terms of reference.

If I may say so, Deputies have said a couple of slightly competing things that I think it is important that we together address. We want an inquiry that can have the power to investigate the issues of shared concern to us. We also want it to be an inquiry that will report and have teeth. It is a fact-finding inquiry and, therefore, we cannot take things necessarily as they are happening if the chair of the inquiry has to go through their own process. We are moving into a legal process that has to be managed by the chair of the inquiry. We will not be able to interfere with the inquiry and nor should we. It is also a legal process that is capable of legal challenge. As we are drafting the terms of reference, we do not want them to be so tight that they do not do the work we want them to do. Equally, we do not want the terms of reference to be so wide as to either run into legal challenge or get to a point where we do not ever get an outcome to the inquiry in an appropriate way. I am not time-binding it or limiting it in any way. I am just very conscious that in the past we have had discussion in this House about the need for an inquiry into a matter of significant and urgent public concern and it has taken many years. I am thinking of Siteserv, for example. As Deputies may agree, it went considerably beyond the terms of its discussion.

I am not trying to limit this inquiry in any way. What I am trying to say is that it is the Government and the Oireachtas that both set and sign off on the terms of reference. In every way imaginable, that will be done in collaboration and agreement with the advocates. There will come a point, however, where we will have to agree that we are reaching the best possible position for the functionality and legal robustness and endurance of an inquiry capable of challenge, that is, one that is going to be operationally effective and possible for the person chairing it and which will reach the sort of outcomes and findings that will be found. If I do not say this now, and if something happens to the inquiry in six, 12 or 18 months, the Deputies will quite correctly say that I did not set up the terms of reference properly. I am trying to set out at a very early stage the need for honesty and the understanding that we are operating within legal constraints that have important implications.

I will work with the members of the health committee in a public and private way, for example, to try to outline all the different issues I see coming up. It is really important we have the advice of the facilitator. I suggest that we work together, publicly and privately, because it is the Government and the Oireachtas that sign off on it, to ensure we have the best possible expression of all the stakeholders that contribute to it and to take the steps with legal advice that we believe will give us the best and most robust model of an inquiry as well. I am just trying to set that out honestly. I do not want to walk into a brick wall with something we all know is so very important.

There was a question about hip dysplasia. The chair was appointed on 24 October and that work will begin. I also understand CHI has written to patients in the last two weeks. It is important to say this to the House because I have this knowledge and I want to make sure I share it in the most appropriate way. I would like the opportunity to delve into this tomorrow but I do not want to withhold information I could give to the House.

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