Erin McGreehan (Louth, Fianna Fail)
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I am speaking on behalf of the families whose lives have been turned upside down by the hip dysplasia scandal, particularly those who have sat in my constituency office in Dundalk over the past couple of weeks upset about the care for their little children. How is the Department planning to support those families to get treatment and follow-up care for children who have had surgery for hip dysplasia? These families did everything right. They brought their children to hospital and trusted the system. They believed the care their children received was necessary and in their best interests. Now the families are in limbo.

The recent audit is welcome, necessary and important, but let us be honest: it has not brought certainty and will not bring trust or confidence in the system. Instead, it has brought fresh fear and confusion. More importantly, an audit will not sort out the issue I raise, which is that the families want and deserve financial supports. They want to be compensated or to be facilitated in getting their children treated elsewhere. Parents no longer know whether their child needed the surgery and no longer trust the hospital, the consultants or the system. Many of them are asking the heartbreaking question: was my child operated on needlessly? If that was the case, it was a grave violation and nothing short of a serious assault on that child. Can we as a Government and society seriously expect the families to return to the same hospital for follow-up care, check-ups and X-rays? Can we ask them to place their children back in the care of the system now they believe they could be harmed by that system? It is not tenable or reasonable. As a mother, I would not let them near my child if I thought there was a hint of a suggestion that surgeries had been done that were not necessary.

Many of these families are scraping together whatever money they can find to seek second opinions, mostly going to Northern Ireland, to ensure their child receives safe and trusted care. That situation should not exist in a functioning healthcare system. It is not acceptable these parents are paying out of pocket for something the State should ensure. Potentially, parents are getting loans to do this.

Let us be very clear. This is not the Government's fault but it is absolutely the Government's responsibility. Responsibility means stepping up with supports the families can trust. Sympathy is not enough; we need action. These families need immediate access to independent care pathways, financial support to access second opinions and trauma-informed services. Most of all, they need to know they are not alone in this. They felt abandoned by the hospitals, they feel abandoned by the doctors and they are desperately worried about their children. What happened is deeply serious. The outcome depends on how the State responds. Supporting the families would send a message to every family in the country that we will treat our children with respect and dignity and that we value accountability, and it would show that our healthcare is worthy of trust.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Deputy for raising this very serious issue. I have spoken to families and I see the concern and hurt. It is important this is raised in the House.

A clinical audit has been conducted by an external international expert on surgery for children with developmental dysplasia of the hip across CHI and the National Orthopaedic Hospital Cappagh, NOHC. The clinical audit involved a random anonymised sample of patients aged one to seven years of age who had pelvic osteotomy procedures for development dysplasia, DDH, from 2021 to 2023 in CHI and the NOHC. The purpose of this audit is to assess whether the indications and threshold used to select patients with DDH for pelvic osteotomy procedures were in keeping with international standards of practice. The audit process is at an advanced stage. CHI and NOHC are committed to sharing the findings of the audit once it is completed.

An action plan is currently being drafted in advance of the final audit report. This plan includes identification of groups of patients not included in the audit sample but who may be affected by any findings of the audit. A communications plan is being developed to support the publication of the final report and further communications to patients and families. As a patient safety precaution, a single cross-site pre-operative decision-making process for any planned DDH surgery in CHI and NOHC has been implemented. All cases are being reviewed before any decision for surgery is made by clinicians from CHI Crumlin, Temple Street and NOHC. This multidisciplinary team, MDT, commenced the first week of March 2025. In addition, CHI is establishing an expert reference group, including international experts, to develop the standards and criteria for the MDT decision-making process for CHI.

An early recommendation from the audit is that, in line with best practice, patients who have DDH surgery should have clinical follow-up at skeletal maturity. This is at about age 14 or 15, when bones have fully grown and developed. Clinical advice is that this follow-up is part of normal post-operative care. Plans are being put in place for patient follow-up in line with good practice and will consider any recommendations on clinical follow-up from the final report. CHI and NOHC have issued letters to all patients and families who have had this procedure since 2010 to provide reassurance and information about the audit and to ensure all potential cases have been included. The total number of letters sent to date is 2,259. The majority, 1,757, have been from CHI, while 502 have been from Cappagh. The number of patients and families involved is subject to ongoing refinements due to clinical review.

The HSE funds certain treatments in other EU member states and, as the Deputy knows, we have a similar scheme for the UK or Switzerland, when this treatment is not available in Ireland. As surgery for children with developmental dysplasia of the hip is available in Ireland, financial supports for treatment outside of the State are not available. However, I assure the Deputy that currently all cases for DDH are being reviewed by a single cross-site pre-operative decision-making process before any decision for surgery is made by clinicians from CHI at Crumlin, CHI at Temple Street and NOHC.

Erin McGreehan (Louth, Fianna Fail)
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I thank the Minister of State, and I understand she is reading out an answer from the Department and it is not her line responsibility.

I am getting a huge of sense of frustration here. My question was on the financial support. The Minister of State said that certain treatments are available in Ireland and therefore, it is a "No". I am sorry; this is not a normal situation, where the trust breaks down. I will repeat what I said: if there was even a hint of a suggestion that my children were operated on wrongly or unnecessarily, I would not let anyone in that hospital touch them. Their little bodies are precious. To a point, it is disingenuous of the Department to come back here and tell a parent that the hospital should be trusted with the dignity and integrity of their child's little body. I am sorry but the Department is going to have to look at this again, listen to parents, reconsider and support parents, whether it is to get a different doctor to come from abroad to look at these files who is not associated with CHI or Temple Street or who has anything to do with them. It is an unprecedented situation and it calls for an unprecedented response. We need to instil trust in these parents and families.

It is hugely disappointing that we are at this point where the Department is right and proper in doing these audits and all the processes. I have nothing to disagree with. However, where a child's health and physical body is concerned, and their tiny wee bones that could be operated on unnecessarily, they and their families deserve the respect and to be told, "Yes, we will make sure that we will get a doctor that you can trust and believe."

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I assure the Deputy that the Minister and the Department are taking this very seriously. This is very serious, and we know that. Nobody wants anyone, particularly those children or their families, to be in this position today. I can guarantee that the Minister is very conscious of the concern that will be felt by all the patients and families affected. The audit process is nearly complete and she has been advised that it will be finalised and completed soon. She will then be in a position to comment further once the audit is published. I assure the Deputy that the she is committed to this, as are all of us in the Department of Health.

She is also committed to ensuring reform remains centred around putting children and their families at the very heart of this. I do understand. As I said, I have spoken to families in my constituency of Carlow-Kilkenny and I have seen the hurt and pain. I assure the Deputy that the Minister is committed to this, as we all are. We will come back to her with more information. I thank the her. It is important that we work together on this and make sure that the children and families are to the forefront of this, and they will be.