Eugene Murphy (Roscommon-Galway, Fianna Fail)
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I thank the Minister of State, Deputy Jim Daly, for being in the House to answer my questions. I call on the Minister for Health to urgently address the failings identified in a review of paediatric audiology services provided in more than 900 cases by one audiologist in counties Mayo and Roscommon in the period from 2011 to 2015 which may have left some children with lifelong hearing impairments. I congratulate "RTÉ Investigates" on another outstanding piece of work in uncovering this issue. As we now know, the HSE carried out a review of services provided in counties Mayo and Roscommon in the period from 2011 to 2015. More than 900 cases were examined and 49 children found to be affected. This is yet another unbelievable failure on the part of the HSE. It is staggering to think the particular audiologist had been working in the Mayo-Roscommon area for more than ten years. It is unforgivable that many of the children identified in the review may be left with lifelong hearing impairments. It is utterly shocking. What good is the apology that has been given to the families if their children were at an increased risk of a missed diagnosis or may be left with lifelong hearing impairments?

I also understand the clinical team which undertook the review found that many of the hearing assessments did not meet national audiology standards. Time and again, we hear about failures in the HSE such that it is now extremely difficult for the public to have faith in the organisation, which is a pity because there are some things it does very well and there are some excellent front-line staff, as the Minister of State has seen. If the review only covered the period from 2011 to 2015, what about the many other cases with which the individual audiologist was involved given that they worked in the Mayo-Roscommon area for over ten years? I call on the Minister - I know that the Minister of State is here to represent him - to clarify whether the review will be extended to cover the full period of time the audiologist worked in Mayo-Roscommon area, as well as to other parts of the country where they may also have worked. I have submitted a number of parliamentary questions on this matter in a bid to seek urgent clarification on this latest unwelcome development.

I have been contacted by a constituent whose daughter was misdiagnosed by the audiology service. Although the constituent was told that her child's hearing had not been impaired, her mother's instinct led her to pay for a private consultation and the child did have a hearing impediment. The family paid privately for an operation to deal with the problem. They paid over €2,000 to have their child's hearing impediment corrected and hearing protected. Will they receive a refund, given that it was HSE failings that led them to seek private treatment?

Jim Daly (Cork South West, Fine Gael)
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I thank the Deputy for giving me the opportunity to address the issue. This is an important forum in which to raise such issues where the Deputy has a chance to represent the views of the people he has the honour to represent to bring their fears and concerns to the fore and receive answers. On the other side, it provides an opportunity for the HSE, not to defend but to explain some of the background and put it in context.

Concerns raised by the HSE assistant clinical lead for audiology services in Mayo-Roscommon arising from a routine review of services in 2015 led to a look-back of paediatric services provided between 2011 and 2015. The HSE finalised the report on the look-back and shared it with the 49 families concerned on 7 June 2018. The report represents a thorough analysis of the quality of service delivery in the area against standards for such services that were set out in the national audiology review group's report. Since 2011, the recommendations made in the report, including on clinical governance and quality assurance processes, have been the benchmark for the quality of service delivery throughout the country.

The report and accompanying communication from the HSE include a clear apology for the failures identified and the anxiety caused for families and those who might have been harmed. The HSE has invited the parents of the children to meet a senior manager and a senior audiologist to discuss the findings made in the report and be updated on their child's care. Some have taken up this offer. The HSE has stated all of the families affected were informed that the audit was taking place and verbally advised of the reasons. All 49 children who needed a follow-up as a result of the look-back process are either receiving or have already received the appropriate care they need.

To respond to the Deputy's question about the audiologist's previous working arrangements, the HSE is reviewing the employment history of the individual clinician who provided the service. The review is being expedited. It is appropriate that the health service strive continually to improve the quality of the services it provides and promote a culture of learning in which shortcomings are identified.

The priority of the Minister for Health in regard to the families and children on whom the findings of this look-back have had an impact is that the HSE takes swift action, including the provision of appropriate care, and the Minister is satisfied this has been done in this case. In addition, the HSE now has clinical governance and a quality assurance process in place for its audiology services, including any contracted services. This is in line with the national audiology review group report published in 2011.

The recommendations made in the look-back report on policies, procedures, team-based approach, audits as part of clinical governance, care pathways, recording of client information and service level agreements for external providers have been addressed and completed at both regional and national level. Outstanding recommendations, including the roll-out of an audiology patient management system, are being progressed.

Eugene Murphy (Roscommon-Galway, Fianna Fail)
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While I welcome the Minister of State's response, it is not adequate, and I am sure he will acknowledge I say that sincerely. The Minister of State is here to represent the Minister, Deputy Harris. In his contribution, he referred to the swift action of the HSE. He is quite an intelligent man. This review goes back five years and we could be looking at cases going back ten years with regard to a failure within the system. I would not call that swift action. More seriously, 49 of those who were reviewed were found not to have been properly diagnosed. If they ended up with issues for life, would the Minister of State or I not feel guilty? Should the HSE not feel guilty? Apologies are no good at this stage. Everyone who has been offered further assistance should take it up, however, and I am sure most of them will.

This is a very serious matter. It is more serious because the issue goes back over ten years whereas the review deals with five years. The HSE needs to revisit this and examine where this audiologist was working. Perhaps there could be an audit of the equipment as there might be equipment issues, although I do not know that. We have to stop this. People have trust in the service but they are let down by it. I rest my case.

Jim Daly (Cork South West, Fine Gael)
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I note the sincerity and passion of the Deputy, who is noted for that in any of his presentations in this Chamber and in any other fora where I have had pleasure of working with him. To put this in context, a national audiology group was established in 2011 and one of its recommendations was that a national clinical lead be appointed. Subsequent to the recommendation, a national clinical lead for all audiology services was appointed, and in 2015, that national clinical lead carried out a routine review of a series of cases, something that is done periodically. Concerns arose during that routine review which led to this very specific look-back, which covered all the cases from 2011 to 2015.

The Deputy's community healthcare organisation, CHO, area was one of two CHO areas that had to outsource work to external staff due to the lack of available staff expertise within the CHO area. It was a routine review, like others carried out periodically in all services. There will be such situations, given 110,000 people are working in the HSE. Unless we robotise it and have procedures carried out by robots, there will always be error, which is a fact of life where human beings are involved. It is important that the HSE continues to carry out all of these routine reviews and reacts to any red flag that is raised, as it did in this case. I am not here to defend anybody, just to explain the situation. The HSE had a proper look-back for the cases from 2011 to 2015 and it identified these anomalies. As the Deputy knows, 990 children were called back and some were deemed to have issues arising. All of those children are either getting care at present or have received the care they need.