Louise O'Reilly (Dublin Fingal, Sinn Fein)
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When the Dáil resumed last week, a father, Mr. Aaron Daly, was waiting outside Government Buildings for the Minister for Health, Deputy Harris, because he wanted to tell him about his lovely daughter Sophia who is waiting for scoliosis surgery. Notwithstanding that others took the time to talk to him, the Minister did not, which is disappointing.

Mr. Daly is one of a large number of parents dealing every day of the week with the broken promises that have been repeatedly made. There is a pattern emerging in that whenever there is an exposé in the media, such as "Living on the Lists", the Minister issues an apology and commits to ensuring things improve, and when there is no improvement and this generates further media interest, we get another apology. The scoliosis waiting lists are not being dealt with in any meaningful way, particularly for those children who have complex medical needs. More than 60 children with complex needs who have been on the waiting list for a long time have been moved to what is known as a "suspended list", in some cases because they have been on the list for so long their health has deteriorated to the point of them not being able to have the surgery.

The theatre in Crumlin children's hospital is not yet open five days a week. It should be open seven days a week but it is not yet open five days a week as promised. Children were also promised that they would be sent abroad for treatment. So far this year, only one child has received treatment abroad. Hundreds of children await this surgery and only one has been sent abroad to have it. This is not fair to them. I met Sophia McGuinness, who cannot speak but uses assistive technology to communicate. The first thing she said to me was, "I am in pain". She is in pain while she waits for surgery but she is not the only one. There are other children in pain while they wait for surgery. Their parents want to see real efforts to address their children's pain. People like Aaron Daly should not have to stand outside Government Buildings begging for a few minutes of the Minister's time.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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The situation which reveals itself in the case of Sophia is shameful. I met her father a couple of weeks ago in Dún Laoghaire and he told me of her case. He has since told me that, in 2015, he wrote to then Minister for Health, Deputy Varadkar, who told him that no child would be waiting for scoliosis surgery for longer than 15 months. At that time, Sophia had to wait 16 months following her initial diagnosis in 2013. More recently, the Minister for Health said no child will wait longer than four months for surgery. Sophia was placed on the urgent list in April 2017 and, without having had her surgery, she was removed from it in August 2018, which is 17 months later. The Government, at the highest level, through the Taoiseach and Minister for Health, has let this young girl down. Sophia suffers from scoliosis. Her condition is deteriorating and she could face the possibility of emergency surgery because the screws in the rod in her spine, which goes into her hip, are loose. Her internal organs are being affected and the curvature of her spine is worsening. This deterioration may impact on her ability to undergo surgery. It is not fair to put a child, and her parents, through that suffering and pain.

As stated by Deputy O'Reilly, this is linked to the wider issue of 52 people having been removed from the surgery list, giving the impression that the list has reduced when in fact these people have only been moved to what is known as a "suspended list" and still need surgery. Many of them have complex needs and the State is letting them down. This is not acceptable and I want to know what the Government intends to do about it.

Jim Daly (Cork South West, Fine Gael)
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I thank the Deputies for the opportunity to address the House on this issue. The Minster for Health and I are sorry that any child and his or her family experience a long waiting time for treatment for scoliosis. Improving access for these patients is a key priority for this Government and specific plans have been developed and funded in 2017 and 2018. However, I fully accept there is room for further improvement in patients accessing timely scoliosis treatment. The Minister has prioritised the development of a sustainable scoliosis service in Ireland and an additional €9 million has been provided to the HSE in 2018 specifically to develop paediatric orthopaedic services, including further increasing access to scoliosis services.

Last Monday, the Minister met the deputy director general of the HSE and the chief executive officer, CEO, of the Children’s Hospital Group to discuss their short-term and long-term plans to provide a better service for patients and their families. The Minister sought assurance from the CEO regarding the management of children with complex needs, as a great deal of concern has been expressed by parents of children with such needs. The CEO advised that there are a number of complex and difficult cases at present and that the hospital has provided all support and services required to children and their parents, and will continue to do so.

Where a child has multiple clinical complexities and medical conditions, consultation between parents and a multidisciplinary team of specialist consultants is required to develop and manage a treatment plan. Given the complex nature of the care required, this often requires extensive discussions and planning so that appropriate surgery can be scheduled in a timely manner, if clinically safe. Notwithstanding that, the Children’s Hospital Group has made progress towards the development of a sustainable scoliosis service this year. It published the scoliosis co-design ten-point action plan in July and an orthopaedic implementation group has been established to oversee its implementation. The action plan was developed through the participation of professionals,

families and advocates. Importantly, this has ensured that the voice of the child has been incorporated.

This year, the group aims to deliver 447 procedures. This equates to a near doubling of 2016 activity. By the end of last week, 314 surgeries, of which 151 were spinal fusions, had been delivered. Overall activity is slightly ahead of surgical targets. Waiting list figures for 21 September show that there are 77 active patients waiting for scoliosis treatment, of which 35 have been waiting for more than four months, which is a reduction of 21 since the start of this year.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I thank the Minister of State for his reply but it was an elaborate response to a question I did not ask. This is about children with complex needs. The Government's mechanism for dealing with these children is simply to move them from the primary list to a suspended list. These children do not need an action plan or another working group; they are in pain and need surgery. Is this lost on the Minister of State? What these children and their parents need from the Minister for Health is a timeline for treatment for those on the urgent list; confirmation of when the theatre in Crumlin children's hospital, which is currently only open three days per week, will be open five days a week; an explanation as to the reason only one child has received treatment abroad, although they were told this mechanism would be used to address the waiting lists; and if will he commit to an independent clinical review of the cases we have raised, namely, the children who are on the urgent list, the children that have been forgotten and those who are in the most pain?

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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With no disrespect to the Minister of State, it is disappointing that the Minister is not present. It is even more disappointing for Sophia's father that despite repeated requests the Minister will not meet him. Consequently, we get answers which do not respond to the questions asked. Yesterday, I asked the Taoiseach when the backlog of urgent and complex will cases be addressed. The Government needs to stop trying to manipulate the figures by moving people to a suspended list. As stated by Deputy O'Reilly, only one person has had scoliosis surgery in the UK under the treatment abroad scheme, despite many people being in pain and suffering. Why has the scheme not been approved for people on the list who are urgent, complex cases? If the Minister or the Government does not fully understand what is going on, they should meet Sophia's father who will explain the problem and discuss what solutions can be found to end Sophia's suffering and the suffering of other urgent and complex cases.

Jim Daly (Cork South West, Fine Gael)
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There is nothing simple about this. Deputy O'Reilly keeps using the word "simple" in that she wants simple answers to simple questions but this is a very complex, difficult area of surgery. The Deputy can nod her head all she likes but we sometimes have to listen. Nobody in this room has a monopoly on understanding or compassion for what is involved for these patients. I am a practising politician the same as everybody else in this House and we all have constituents and are aware of people, sometimes family or other people connected to us, who are awaiting these urgent, difficult and complex procedures. There is a variety of challenges and difficulties, both in capacity of personnel and in a lack of theatre space. There are other competing procedures because scoliosis is not the only procedure that has waiting lists. There are many other waiting lists in the medical system competing for the same theatre space, skill set, time and resources. We as a Government prioritised scoliosis in 2018 and put an additional €9 million towards it. As I understand it, as of today that money will not be spent by the HSE in its entirety because of the difficulties and challenges that are there. Despite what the Deputy might say-----

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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What about the treatment abroad?

Jim Daly (Cork South West, Fine Gael)
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-----neither the Minister, Deputy Harris, nor I have ever carried out one of these procedures and never could do so because it is a clinical matter and there are clinical decisions and considerations. The Deputy can shout me down all she likes but it would be in her interest and in everyone's interest to listen to me as well. She can nod and if she wishes to play politics with this she can continue to do so but there is another side to the story that has to be understood before we can reach a solution to this difficult and challenging issue. It is not just about resources because that is what is within our gift.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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If the Government simply kept the promises it made-----

Jim Daly (Cork South West, Fine Gael)
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We can throw money at it and we are doing that but there are other challenges in the system.

As a matter of absolute fact, and I am not manipulating waiting lists, this year there will be 447 procedures carried out by the children's hospital group. Two years ago 224 procedures were carried out by them so that is a 100% improvement rate in two years in the amount of procedures carried out by the children's hospital group. That is a matter of fact and it is not borrowing from any other list to manipulate the figures. It is on the record to be understood and I would like the Deputies to take note of that.

Richard Boyd Barrett (Dún Laoghaire, People Before Profit Alliance)
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We asked about the treatment abroad scheme.