Pearse Doherty (Donegal, Sinn Fein)
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Fuaireamar amach inné gur seoladh litreacha chuig 2,260 teaghlach faoin scannal tubaisteach maidir le hobráidí chromán na leanaí. Tá tuismitheoirí fós feargach nach bhfuil an t-eolas ón Rialtas ná na hospidéil á thabhairt dóibh. Yesterday we learned the scope and scale of the devastating hip surgery scandal. Some 2,260 families have been sent letters. I raised this issue on Leaders' Questions two months ago in March. I called on the Government to get ahead of it and to tell parents what was going on. Parents are still being kept in the dark, even today. What does it say about the Government that facing into this scandal, it took two months to even ask CHI how many children were affected and how many letters have been issued. The Taoiseach this week was still trying to downplay these letters, suggesting they were issued to reassure parents on the back of a media leak of the draft report. That is nonsense. These letters were sent out to implement an early recommendation of the draft audit. The recommendation calls for the recall of all these children for follow-up.

Why is CHI implementing an early recommendation of the draft audit? It is because the draft audit is shocking, devastating and damning. It states that 60% of surgeries in one hospital and 80% of surgeries in another were unnecessary. Let what that means sink in for a moment.

Children as young as one years of age have had their hips opened up, cutting into their bones. They have had to learn how to walk again. They have been left with scars for their life, and now we find out that these surgeries may have been unnecessary. Imagine having to bring your two year old little girl into that operating theatre, having to leave her in the hands of the system, only to find out that the surgery, the pain, the learning how to walk again and that scar she has on her hip was never necessary and the surgery did not need to happen. That is the experience of so many parents out there. It is the experience of one mother who I spoke to this morning. In 2015 she brought her little girl, two years of age, for surgery on her right hip. It was the only hip that was ever mentioned in all the assessments. After the operation she was told that she needed surgery on the other hip as well. She described feeling like a rabbit in headlights, but like any parent would, she followed the medical advice and after five weeks her daughter had the second operation. When this letter dropped in her letter box seven weeks ago, she was immediately concerned. She sent 30 emails over a period of five weeks to CHI without one response. Only when she got her solicitor involved did she get a response. She sought a second medical opinion. She is now sure that the first hip operation, at best, was premature and the second operation was not needed at all. She is frustrated at the lack of answers from CHI and from the Government. This is not an isolated case.

Every family I have spoken to over the last two months are looking for one thing more than anything else. They want to know if the surgery that was carried out on their child was necessary or not. The audit is not going to give them that answer. It is an anonymised study. It will not give them the individual answer. The Government is asking parents to wait. It is asking them to trust the process but trust has completely broken down. I have a simple question for the Government today on behalf of parents who have contacted me, Deputies Cullinane and Carthy and many others in our party and across the benches. Can you tell me that for every single one of those 2,260 anxious families, every one of their children will have access to an independent clinical assessment that will answer the simple question for them as to whether their child was operated on necessarily or unnecessarily? When will they be given access to that clinical assessment?

I asked the Government two months ago to get ahead of this. It is not fair that it has left families in this situation for that period.

Helen McEntee (Meath East, Fine Gael)
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I thank the Deputy for raising this matter. We agree on a number of things here. We are all working on behalf of the children the Deputy has mentioned. We are all working to make sure we get answers to what has happened here. We have discussed this a number of times in the Chamber. We are all extremely concerned at the thought of a child having a surgery where that was not necessary. We can probably all point to somebody we know or who has come to us where they were recommended the surgery and did not go through with it or were recommended it and went through with it but it was not needed, or indeed where they needed the surgery. The issue we need to get to the bottom of is where surgeries were carried out on children where they were not needed, where injury was inflicted on young people where it simply was not needed. The most important thing we need to ascertain at the outset is the facts. That is why this review is taking place. I appreciate we all want to know the facts as quickly as possible but we do not have those yet. I know the Deputy is referring to parts of the report but it has not been published. The Minister has not seen the report. While it has been made very clear to her that she will have the report in the coming weeks, we do not yet have the absolute facts of the review that is taking place. We all have a responsibility in this Chamber to make sure that what we are talking about is based on facts and reports that are published.

It is also important to assure families where surgeries are taking place at the moment. We know there are children who do need surgery today. Revised procedures have been put in place and new protocols are in place. All surgeries are being assessed by a multidisciplinary team before any decision is being taken. Separate work is also being done which will follow through from the review to make sure absolute best and up-to-date practice, which is in place in other countries and should be in place here, is adhered to if any child is being put forward for these potential surgeries.

In terms of the overall numbers, we have to be careful. The figure of just over 2,200 young people does not suggest every single one of those young people had surgeries where they should not have had them. We have to be clear about that. It is important that these families have been written to and engaged with by CHI, but also by Cappagh. We know that 1,700 of these were with CHI and 500 of them were with Cappagh. Where there has not been follow-up in these instances, it is important that now begins. Many families where surgeries have taken place have had follow-ups, engagement and consultation with their consultants and their teams. For those who have not, there is a clear commitment that engagement and consultation will happen immediately.

As the Deputy said at the outset, of most importance is that we ascertain the facts. What has happened? What practices were followed? How many children were impacted? What do we need to do now? Above all and to the Deputy's point, how do we ensure that any follow-on support, including medical support, and any assistance that is needed by those families and children is provided immediately? However, we have to get to the bottom of this. We will have those facts, but we do not have them yet. We do not have the report. We know that the initial recommendation, as published by CHI in its statement this week, is the reason it sent the letters to families, ensuring that engagement starts immediately and we are not just waiting on the report. We need to have those facts and that information so that whatever practice is followed moving forward ensures this situation does not happen again and, above all, we can stand by the medical advice we are given when our children go into hospital and know that best practice is being applied in every case.

Pearse Doherty (Donegal, Sinn Fein)
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With respect, that is not good enough. The fact is that 2,260 letters were issued. The fact is the letters were issued as part of the implementation of a recommendation of the draft audit. The fact is the draft audit said all of those children should be recalled. The fact is there are 2,260 families out there that are anxious. The fact is none of those families knows whether their child was operated on. The fact is the Government has no plan at this point in time to provide a pathway that will allow them to determine if that is the case. The audit is not going to tell them that.

I asked the Government two months ago to get ahead of this. I pleaded with the Government. We have given countless examples of families who are no longer waiting for the Government and are instead seeking a second opinion. They have gone to America. They are going to London. They are putting their hands in their own pockets because the Government is giving them no answers. The fact is the parent I talked to this morning sent 30 letters looking for information without a response.

David Cullinane (Waterford, Sinn Fein)
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Hear, hear.

Pearse Doherty (Donegal, Sinn Fein)
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The Government needs to deal with this. I know every single person in this Chamber would be appalled at the idea of a young girl being opened up, her bone being chiselled into unnecessarily and left with a scar and pain, but it is the Government's responsibility to provide a pathway and certainty for those families. I ask the Minister a simple question - will the Government ensure that every single one of the 2,260 families that got that letter will be given an independent clinical pathway to determine whether their child was operated on unnecessarily? That is the first question they want answered.

Deputies:

Hear, hear.

Helen McEntee (Meath East, Fine Gael)
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I cannot be any clearer with the Deputy on this. We first need to ascertain the facts. We need to ensure that we have absolute clarity as to what has happened, how many people are involved and how we make sure this never happens again. At the same time, we need to ensure that, where families need follow-on care and further information and clinical support, that is provided. The Minister for Health could not be any clearer in the commentary she has made over the past number of months. We will provide any support that families and children need, going as far back as 2010. That year was chosen because 15 years is the skeletal reference age at which a child's bone density matures. Those are the parameters that have been chosen. Any child and his or her family within that timeframe will be provided with support. That is why those letters were written initially. Many of those families will have had continued engagement. Many of those families where surgeries happened years ago will have been engaging with their teams and will have had that support. However, for those who have not - I accept there are those who might not have and who do not know whether the operations should have happened or not - we need to ensure that we find that information as quickly as possible. Without a shadow of a doubt, they will get the assistance and medical support they need if this has not been done correctly.

Helen McEntee (Meath East, Fine Gael)
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I do not think it is helpful for any of us to be discussing certain elements without having the full facts. I appreciate fully and agree with the Deputy that families want all of the facts. They want the information and they do not want it piecemeal. They certainly do not want parts of an unpublished document being published elsewhere and not coming through the Minister or not having that direct engagement with the Minister, CHI or the other hospitals involved.

The most important thing is to have the review completed. The information that has been provided to me is that the Minister for Health has been told she will have the review next week. I do not have the exact day, but as soon as the Minister has it next week and is able to, she will engage with the families first and foremost. She has recently spent quite a number of hours in the Dáil answering questions, not just on this, but on many other issues as well. There has never been any doubt that the Minister does not want to engage, does not want to talk to families or does not want discuss this matter in the Chamber.

To go back to the basic facts here as we have all outlined, there is not a single one of us who could even comprehend what it is like for a family to believe or know that their child has had a surgery the child did not need. As a mother of two young children, the very thought of that is terrifying. I apply that to anybody who has children, grandchildren, nieces or nephews. We all want to make sure that we get to the bottom of this, that those who need any further clinical assistance get it and, above all, that the practices that have to change do. That is what is happening already. While we need to ascertain the facts for the families involved, it does not prevent us from starting work on looking at why these practices were carried out and how to ensure that surgeries happening at the moment are not applying the same practices. That change is taking place already. For any surgeries at the moment, there is a multidisciplinary team that sits down, looks at the cases and then decides whether to go forward. That is really important progress that has been made.

In terms of the letters, it is important that families have communication throughout all of this. There is piecemeal information being put out there and, in my understanding, it was the Minister who asked for the correct figure to be put out there, as it was increasing and decreasing. We now have that figure because it was asked to be put into the public domain. That alleviated some of the concerns around the increasing numbers overall. We have established helplines or email addresses for patients to make queries: there is ceo@childrenshealthireland.ie and cappaghkidsenquiries@nohc.ie. These are dedicated email addresses that have been put in place for families to be able to communicate separate to the letters they have received, which very clearly state that if they have not had engagement from their hospitals, follow-up or engagement in the past year or 15 years, we will engage with them and reach out to them.

There are a number of strands. I appreciate that it would be better if everything was happening at once. The review is looking at exactly what has happened. Separately, CHI has given an element of information to be able to engage with those families and to make that communication at the very outset, which is set out as best practice. Third, work is under way in our hospitals to make sure that anything that the same practice is not being applied to anything that is happening now and procedures that are in place. Of course, once this report is received, the first thing the Minister will do is reach out to the families and make sure that she can engage with them on the facts and information that she has.

Helen McEntee (Meath East, Fine Gael)
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I cannot be any clearer on this. The Minister does not have the report. She does not have recommendations. While elements have been unhelpfully published in online articles, the report has not been presented to the Minister. It stands to reason that while this work is being done, the hospital is not going to sit still and say it will wait for everything. It knows it needs to change its practices. That is why it has put new multidisciplinary teams in place. It knows it is important to write out and to engage with the families as it has identified them because those figures have been intentionally put into the public domain to try to alleviate any concerns that they are escalating beyond anything we would have thought. That work is under way.

It is simply not the case that the Minister has and is working on a concrete set of recommendations and is not telling anybody. The report has not been finalised and presented to her, but once it has been, the Minister will first and foremost engage with families, Cappagh hospital, CHI and of course will engage with the Dáil to see what we need to do now and what the next steps are. Where there are recommendations and changes that need to be made in procedures and patient and client engagement in our hospitals, they can proceed and start immediately.

Roderic O'Gorman (Dublin West, Green Party)
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I want to draw the Minister's attention to comments made in the past fortnight by the Minister of State with responsibility for forestry, farm safety and horticulture, Deputy Michael Healy-Rae. It is really one of the first opportunities we have had to get an insight into this Government's thinking on climate and nature. The Minister of State told the Seanad during statements on forestry on 29 April:

I and my officials in the Department will look at planting more peatland. Farmers want to plant peatland. Farmers do not want to plant their green ground because they have worked so hard to get the bit they have. They broke their backs and bones to make the land green and they do not want to plant trees on it but instead use it for grazing. We want to use green ground for grazing but plant trees on rough ground and peaty ground. I am afraid that this is just one of these things on which we cannot always agree.

This was not a throwaway remark. The Minister of State came back to the topic again and reiterated the point. It is clear that he strongly believes that we must only encourage afforestation for export, that land not in service of agriculture can be directed towards this and that somehow this would be better for the environment. It is also clear that he is leading officials in his Department to develop a new policy that implements this view.

To be crystal clear for the record, a policy of planting on peatlands, which we have spent years trying to restore and preserve, would be environmental madness. Aside from it being in breach of EU law and indeed of Irish policy, it would destroy an extremely delicate and complex habitat that can provide a large and effective part of Ireland's capacity to store carbon - all of this is in order to develop cheap, quickly grown timber. UCD client scientist and lecturer, Florence Renou-Wilson, said planting on peat is , "just not a viable option for climate, for nature restoration, for anything." She continued, "Peat is a huge carbon store – a much, much better permanent carbon store than temporary forestry. [Peatlands] need to be wet to keep this carbon in."

Will the Minister please confirm whether it is the policy of the new Government to ignore science, to abandon our legal obligations and to destroy some of our best chances to capture carbon while preserving unique habitats? Has the Minister of State instructed his officials to begin implementing a new forestry plan to include planting on peatlands? If not, why is he going around telling people that this is what he has done?

Helen McEntee (Meath East, Fine Gael)
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It is clear that to meet the 18% forest target set out in our national forest strategy, we have a huge amount of work to do. We need to plant an additional 500,000 acres and, therefore, it is important that we continue to examine all of our lands, invest in research and make the best decisions possible. A huge amount of work has happened and more is under way to address our overall forestry targets and approach. To outline some of that progress, we have a new forestry programme from 2023 to 2027, approved by the previous Government on 6 September 2023, which the Deputy was part of, with funding of €1.3 billion. The programme provides unprecedented incentives to encourage the planting of trees as well as a range of measures to support owners of existing forests to manage their forest sustainably, forest creation measures, including native woodland expansion, and planting of small native tree areas. We have a comprehensive package of measures, including the programme, with an increase in forestry premiums of between 46% and 66%. Farmers will receive 20 years of premium payments compared with 15 years for non-farmers. We also have forestry licensing, which is a complex process due to the requirements to take account of environmental requirements, which are set out in both national and EU law. All of these measures in the programme are measures that will continue, which were supported by the Deputy and the previous Government.

Anything that we do in this regard has to be backed by and informed by science. That is not going to change. That is the approach that we have taken from the outset. It is for those reasons that we have started to see significant progress on climate. It is one of the most pressing challenges for our society. It is already causing an increased occurrence of extreme weather events, whether those are storms or flooding. We only have to look at Storm Éowyn recently, at once-disappearing lakes in County Roscommon and the midlands, which are now permanent, and the impact that it is having on homes. We have to take action and address the root causes while at the same time making sure that we prepare for the impacts of climate change. It is working. I am not saying it is working at the rate and speed that we want it to, but it is certainly working.

Looking at our emissions, the most recent inventory report from July 2024 shows a decrease of 6.8% in Ireland's greenhouse gas emissions in 2023. This is compared with 2022 when we saw a 1.9% reduction on the previous year. It is reducing further for the year coming. Where have we seen that reduction? There is a 21.6% reduction in electricity, 5.8% in industry, 4.6% in agriculture, where we are making progress, and 7.1% in residential. This is all because of the interconnection, increased renewable energy capacity, reduced nitrogen fertiliser use in agriculture, and fewer fossil fuels in our home, all at a time when last year alone we saw a 5% increase in our overall economy. Our economy is growing yet we are still managing to reduce our overall emissions. The work that has been done and the measures that have been put in place include those of the previous Government, in which we worked together collectively, but also those started by Richard Bruton when he was Minister for climate in 2019, when there was the first all-of-government climate strategy. All of us this work collectively, backed by, adhering to and following science, has brought about these changes. We absolutely need to do more, which is exactly what we will do.

Roderic O'Gorman (Dublin West, Green Party)
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I appreciate the Minister's comments but we are still left with the words of the line Minister for forestry. It is worth quoting what he told the Seanad: "That is why I and my officials in the Department will look at planting more peatland." Is the Minister of State being allowed to indulge in a bit of Trump-lite, be anti-science and anti-climate, while at the same time purport to speak for the people? Instead of "Drill, baby, drill", it is "Dig, drain and destroy." Who is actually in charge of the policy here? If the Minister is not able to set that out, can she ask her colleague, the senior Minister for agriculture, and indeed the Minister of State, Deputy Healy-Rae, himself, to come before this House and explain if Government policy has changed and if it is now the policy to allow the destruction of our upland bogs?

Helen McEntee (Meath East, Fine Gael)
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If we are to achieve our overall targets, which we have set out clearly in law, we need to take a number of measures. I have mentioned just some of the reductions we have seen, including in energy or agriculture overall, which includes our forestry targets, and focusing on our environment, overall economy, transport and private sector.

The critical issue is that whatever we do - and I will repeat this whether it relates to agriculture, forestry or plantation - it has to be backed by science. We know that there are certain permits for planting on shallower peat soil, less than 30 cm deep. Again, where it is permitted, possible and follows the science, we must explore all avenues. We have a huge amount of work in planting 500,000 acres to be able to meet that 18% target but there are other areas in which we need to make progress as well.

We have made huge progress, with more than 50% of our energy coming from renewable energy at a certain time last March. We have a target of 80% and we need to do more to ensure we can reach that target, otherwise we are at risk of energy insecurity and the challenges that come with that.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Thank you, Minister.

Helen McEntee (Meath East, Fine Gael)
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This is across a number of different avenues. Our farmers, business people, those involved in transport and private economy and all of us in our homes need to make sure we are doing every single thing possible to contribute to the overall reduction so that we can achieve our targets. It is something we are committed to doing, as I know the Deputy is.

Ken O'Flynn (Cork North-Central, Independent Ireland Party)
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I raise an issue with the Minister that has gone unaddressed in this House for far too long. It is a blatant discrimination built on the taxation regime targeted squarely at citizens with no children in this country. I ask her plainly if it is acceptable for the Government to oversee, implement and defend a taxation system that discriminates against people purely based on the fact they do not have children.

Every day in Ireland, those without children are treated as second-class citizens under the capital acquisitions tax, CAT, regime specifically regarding inheritance tax. These individuals are prohibited by law from passing on the same value of their hard-earned already taxed asset to loved ones, as those with children can. Why is this? It is not because they have earned or contributed less to society but simply because they do not have children.

In budget 2025, the then Minister for Finance, Deputy Chambers, increased the threshold of groups A, B and C in the inheritance tax bands, which may seem fair but the actuality is group A, the parents with children, enjoy a larger tax-free inheritance without increase while the increases remain untouched for those without children. Let us imagine if the opposite had occurred. If group A had been reduced to €40,000 and groups b and c up to €400,000, we could picture the outrage on the streets of Ireland of those parents, rightly so, because that would be deeply unfair. The hypocrisy is when childless couples and citizens face the reverse scenario, they are told to sit down, shut up and accept it and that is it and that they are less deserving and their relationships with their niece, nephew, siblings or lifelong friends simply do not count.

The Government response so far has centred around a minor threshold adjustment spread over time but that does not reform or justify this and it is certainly not equality. A structural discrimination system cannot be fixed with a few tweaks of the job here and there. Is it equitable that parents like the Minister with two children can leave up to €800,000 tax free, while people like myself with no children or single persons or people who cannot have children can leave €80,000 tax free to loved ones? That is ten times less. The system penalises the childless citizen of this country for the simple fact that they do not or perhaps cannot have children.

Helen McEntee (Meath East, Fine Gael)
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I thank the Deputy for raising this matter. This is something that impacts a significant proportion of our population and there are very different reasons people may not have children, choose not to have children, cannot have children or are in different scenarios where it does not happen.

It is always open to any individual or group of people to make representations, be it prior to the budget or any time of the year, to try to put forward changes to our taxation system, whether that is to inheritance tax or any other part of our system. This is no different. I am aware there is a briefing due to take place next week on this particular matter where many of the issues the Deputy has outlined will be discussed and raised. We as Deputies have an opportunity to engage with and listen to the various different challenges, concerns and issues he has just outlined. There is absolute merit in what he is saying. The relationship a parent has with his or her child is so often similar to the relationship a person has with his or her niece, nephew or indeed with a close friend. We must ensure our taxation system works for everyone but also that there are clear lines and strict rules that can be clearly followed.

As a Government, we have made changes to our inheritance tax system in recent years. I appreciate it does not apply to the scenarios the Deputy has referenced. We have tried to make sure where families are passing on something, be it their home, land or property, that insofar as possible as much of that goes directly to their children and family so they can plan for their future. That is why so many of us invest in what we do and why so many of us work; it is to make sure we can provide for and plan for our family and those closest to us. What the Deputy is suggesting is that this would go broader than the immediate family unit, as has been set out. That is a discussion we as the Dáil and as colleagues can and should have. Ultimately, it is a decision that must be taken within the budget and its parameters. That can be done prior to the budget and as I said, there is a conversation due to take place in the AV room next week.

Ken O'Flynn (Cork North-Central, Independent Ireland Party)
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This is not a hypothetical or abstract policy debate. This affects hundreds of thousands of people in this country. On 19 March in the Upper House, the Minister for Finance, Deputy Donohoe said he would address the fundamental points of discrimination. He also made the statement that it seemed to be constitutional, yet he has not provided any proof or legal argument and no documentation has ever been published by this Government or previous Governments to support that claim; there is absolutely none.

I ask the Government the following - and I hope the Minister can respond with clarity and commitment on this: does the Government believe the current inheritance tax system is fair and equal in its treatment of childless citizens when compared to those who have children? Has the CAT regime, in particular the inheritance tax, been reviewed since 1991 to ensure compliance with the equal status legislation? Will the Government publish all documentation and supports that do not infringe the breach of the constitutional rights of the childless citizen?

If I leave all my money to the dog's home, the dog's home pays absolutely zero tax. Therefore, the chihuahua has more rights in this country than the childless citizen, or my niece or nephew.

Helen McEntee (Meath East, Fine Gael)
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Our job in this Dáil is to ensure any of the rules we adhere to and abide by and any of our taxation measures are as fair as possible. It is our job to make sure anything we put in place is fair and applicable to all citizens. It is about understanding what the potential implications are, what measures need to be taken and what the overall cost will be. The Minister for Finance said this is something that can be discussed or is open to discussion as part of the overall budget conversation because that is where it must come from. I appreciate the Deputy's point that this is more than a budget conversation or taxation measure; we are talking about people's lives. I certainly do not think a dog's life is worth more or a dog should be in a better position than a young person, niece or nephew as he mentioned.

This is about all of us collectively looking at our rules and how we can make them more equitable, fairer and how we apply them equally. We have to do so, however, within the parameters and contexts available to us. I am very aware of this and I am sure the Minister is open to doing that.