Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I do not mean to be disrespectful to the Minister of State but does the Minister, Deputy Harris, ever take a Topical Issue matter? I have been here as long as some Members but my understanding is that it is customary for the Minister to take Topical Issue matters where possible. My colleague, Deputy Quinlivan, has raised 13 Topical Issues regarding Limerick hospital and I have raised countless Topical Issue matters related to health and I do not believe the Minister for Health has ever taken one of those. I do not mean that in a disrespectful way to the Minister of State and I am glad that she is here.

In February 2017, following a very harrowing "Prime Time" documentary, many promises were made regarding waiting lists, particularly for children with scoliosis. Those promises were made under pressure in the limelight and they have not been kept and children and their families are still waiting and unfortunately they are waiting in pain.

As matters currently stand, 3,500 children are waiting for their first appointment and those are the children about whom we know. Also, it is estimated that approximately 10,000 children waiting are hidden on adult waiting lists. If there are hidden waiting lists, children who are hidden on adult waiting lists, how will it be possible to plan for the surgery, appointments and all that those children will need because the Minister cannot tell how many there are?

We have seen in recent weeks the parents of children with scoliosis being forced to take to the media. No parent wants to do that. I am a parent and I would not want to have to do it and I know that they do not want to have to do it. It was reported in the newspapers that Deirdre O'Keeffe, a mother from County Cork, said that her daughter, Alison, aged 14, was put on the list for surgery in Crumlin Hospital in December and she was deemed urgent. I do not know what that means to the Minister of State but to me it means that the procedure needs to be carried out in a timely manner. She had a pre-operative assessment in February and at Easter she was told that her name was highlighted on a board to be brought for surgery. She was told she would be brought for surgery but she is still waiting with no operation date, and that is an urgent case.

Joseph Hornick and his daughter, Amber, are in a similar limbo. She was diagnosed in October and her family had to pay for a private outpatient appointment and an MRI at a cost of approximately €600, which for many families is money that cannot not easily be found. She was seen in Crumlin Hospital in February and again told that her case was urgent and that her surgery would be done in two to three months. Her dad says he calls the hospital two to three times a week but still has no date for surgery.

All the promises that were made by the Minister, Deputy Harris, and all the apologies that were issued mean absolutely nothing to those children who are waiting in pain. The complications that arise from being left waiting are many. Children develop internal complications as the curvature of their spine worsens.

Not only are they in pain - the Minister of State should be under no illusions about that - but their internal organs are being damaged as the condition worsens. This is wholly unacceptable, as the Minister admitted when he promised in February 2017 that no child would be left waiting for longer than four months. More than two years later, that target has not been met. The families are due another apology but they would prefer if their children were able to access the surgery they need.

Catherine Byrne (Dublin South Central, Fine Gael)
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I apologise for the Minister for Health's absence. I am not sure where he is. I did not know until two hours ago that I would take this matter. When a Topical Issue matter is submitted I suggest that the Ceann Comhairle contact the office of the relevant Minister to ask if he or she will be available to take the matter. I do not know if that is possible but it would give Deputies an opportunity to withdraw the matter until such time as the Minister becomes available.

On behalf of the Minister, I thank Deputy O'Reilly for raising this issue. It gives me an opportunity to provide an update to the House on the progress to date on the reduction of waiting times for children with scoliosis. The long-term strategy to develop sustainable scoliosis services in 2018 and 2019 is a priority for the Minister and the HSE. Children's Health Ireland advises that the impact of investment and the implementation of the scoliosis ten-point action plan is now delivering results with an improvement in waiting times being recorded.

In 2018, Children's Health Ireland was provided with €9 million in funding by the HSE to address paediatric orthopaedic waiting lists, including the provision of scoliosis services. Last year saw the delivery of results from this investment, with a consistent reduction in waiting times being recorded for scoliosis. As a result of this increased investment, the total number of surgeries performed in 2018 was 418 compared with 371 in 2017, representing a 12% increase in activity year on year and a marked increase in activity of 87% compared with 2016. This increased activity has had a positive impact on the numbers waiting. Children's Health Ireland advises that, as of 14 June 2019, there were 193 children waiting for a spinal fusion or other spinal procedure. This constitutes an 11% decrease on the same period last year. The figure includes suspended patients, a category that has seen a 70% reduction in numbers year on year. Children's Health Ireland advises that the numbers of spinal fusion patients waiting for more than four months has also decreased this year, with 30% of fusion patients waiting longer than four months compared with 39% at the end of 2018. More broadly, all patient referrals to the orthopaedic spinal service at Children's Health Ireland are reviewed and clinically prioritised by a consultant. These patients are seen in order of clinical priority.

Work to address the complex issue of scoliosis is included in the wider plans to improve orthopaedic services at Children's Health Ireland. More than 30,000 children attended the paediatric orthopaedic outpatient departments at Children's Health Ireland and Cappagh National Orthopaedic Hospital in 2018. An additional 800 outpatient appointments were given to patients in Children's Health Ireland at Crumlin children's hospital in 2018 compared with 2017, which contributed to a 31% reduction in the overall orthopaedic outpatient waiting list. In addition, an outpatient initiative for long waiters carried out by Children's Health Ireland at Crumlin children's hospital facilitated 443 appointments from the orthopaedic outpatient waiting list.

The paediatric scoliosis services co-design group established in March 2017 includes the scoliosis advocacy groups. These groups work with professionals and managers to design comprehensive scoliosis services to meet the needs of children, young people, their families and healthcare professionals. The work of the co-design group continues to form the basis for the ongoing development of the scoliosis service in 2019. I understand that the co-design group published the scoliosis ten-point action plan in July 2018 and will publish a further update at the end of this month.

In reference to Deputy O'Reilly's question, if the Deputy forwards the names of the children to whom she referred, I will bring them to the Minister's attention.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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The procedures for dealing with Topical Issue matters provide that a Minister or Minister of State from the same Department will reply. We have all noticed that the Minister of State, Deputy Catherine Byrne, comes in here and takes the heat on many of these issues. However, it is perfectly in compliance with the strictures of the House to have a Minister of State from the relevant Department take a Topical Issue matter. If Members are dissatisfied with the position, we should review the arrangements to address that.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I was not suggesting there was anything untoward happening.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I know that.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I was pointing out that the Minister has never appeared for the Topical Issue debate in my experience.

Seán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I have no problem with what the Deputy or the Minister of State has said.

Louise O'Reilly (Dublin Fingal, Sinn Fein)
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I thank the Minister of State for the reply. Notwithstanding the aggressive management of waiting lists that has been reported and the absolute promise and commitment given by the Minister that no child would have to wait longer than four months, the best the Minister of State can do is report a slowdown in the rate of increase. That is not good enough. These are sick children who are in pain and they are being left to wait.

As we speak, the orthopaedic theatre in Crumlin children's hospital, which is in the Minister of State's constituency, is still only operational three days a week. How can the Department expect to make good on promises made by the Minister if resources are not being provided and the resources available are not being utilised to their full capacity? The orthopaedic theatre in Crumlin children's hospital should be open for longer than eight hours a day. It should be open seven days a week until the backlog has been eliminated.

The parents of these children are in the unfortunate position that they are forgotten about the moment the spotlight comes off this issue and the Minister no longer has a microphone and camera in his face. That is how they feel. If they do not go to the media, they cannot get any traction. Many of them are at home looking after their children. They do not want to have to talk to me or the Minister of State or engage with politicians. They want to live their lives and they want their children to get the surgery they need but they are forced to go to the media and kick up a fuss just to get basic services. The best the Minister of State can do is report that there has been a slight improvement because the rate of increase has slowed. She stated that 30% of children with scoliosis wait longer than four months. It is nearly two and a half years since a promise was made that no child would wait more than two months.

I am not asking the Minister of State to agree with me because if she did, I am sure she would not say so, which is fair enough. Surely anyone looking at this would agree that is not fair and that the promises that were given to those parents count for nothing. The parents will have to keep advocating, lobbying politicians and going to the media when they want to spend time with their sick children.

Catherine Byrne (Dublin South Central, Fine Gael)
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I thank Deputy O'Reilly again. I assure the Deputy that the Minister has met regularly the senior management of the HSE and Children's Health Ireland to discuss their short and long-term plans to provide a better service for patients and their families. Nobody wants to see children waiting on a hospital waiting list, particularly children with a severe illness such as scoliosis.

I am not too sure about some of the issues the Deputy has raised, for instance, children being hidden on adult waiting lists. I will have to inquire about that because I do not have any information on that. I assure the Deputy that I will convey her remarks to the Minister. I apologise again for his absence. I am sure the transcript of these proceedings will be made available tomorrow and I will bring it to his attention. I will request that the Minister take some Topical Issue matters in future, if possible, as that could help Members who have raised issues here on a number of occasions when the Minister has not been here to reply to them directly. I am given the written word and while I can intervene on some issues, I do not have answers to some of the questions asked. I do not know whether the Minister has answers but I will go back to him.