David Cullinane (Waterford, Sinn Fein)
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3. To ask the Minister for Health the steps she has taken to improve governance and accountability at Children's Health Ireland, CHI; if she will publish the unpublished review of a department at CHI at Crumlin; the steps she has taken to address issues highlighted in that report; and if she will make a statement on the matter. [34743/25]

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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Will the Minister detail the steps she has taken to improve governance and accountability at Children's Health Ireland and will she publish the unpublished review of a department at CHI at Crumlin? Will she outline the steps she has taken to address the issues highlighted in the report?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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In response to a series of reviews which raised corporate and clinical governance concerns at CHI, I have moved to strengthen governance and oversight structures at CHI in a range of different way. This was done via the appointment of two members of the HSE board to the board of CHI on 28 May. There are more board appointments to be made. This means that all but one members of the board have been appointed since 2024. This is a different reference period to some of these activities.

The service level agreement between CHI and the HSE has been strengthened, and there is significantly increased involvement from the Dublin and midlands regional executive officer. Recognising the need to co-ordinate oversight of the range of matters of focus in CHI in a cohesive fashion, the HSE CEO has established the HSE CHI improvement steering group. These actions are designed to support the new CEO in CHI and enable her to continue with the transformation programme she has started.

Regarding the 2022 internal examination referenced by the Deputy, I have been advised by the Attorney General that I do not have the legal basis to publish this report. I sought that legal advice with a view to trying to put it into the public domain correctly. I received it correctly but it is the property of CHI and I do not have the power myself to publish it. Any publication must be made by CHI. On 16 June, CHI published a summary of the report. Subsequent to my letter on 26 May requesting a response from the CHI board to the report, on 18 June I wrote to the CHI board requesting assurance that the recommendations have been addressed in full. I also emphasised the priority I place on child patient safety issues and asked the board to report directly to me on the status of the children that may have been impacted.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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There has been scandal after scandal at CHI. There were inappropriate spring implants, possibly hundreds of unnecessary hip surgeries and now a scathing leaked report of an examination of a clinical department at Crumlin hospital. The report has raised exceptionally serious concerns and it follows the Boston review, the HIQA review into unauthorised springs and the hip dysplasia audit. We would not know about the first two reports if it were not for whistleblowers who came forward, and the third report was released by HIQA. The approach from CHI has been unacceptable. It has stonewalled and refused to release the report in full. It has also refused to report the misuse of public funds to the Garda. The HSE took doing this into its own hands earlier this month. The HSE said CHI did not even share the report with it until after it was leaked. At a time when we hope to move into the new children's hospital in the coming two years, confidence and trust in CHI has never been lower. What steps is the Minister taking to address this? In terms of the new board members coming in, how does she intend to hold the previous board members to account?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The Deputy will note the number of resignations from the board. She has identified a series of important and serious issues, most of which we knew would be coming because of the concerns raised by whistleblowers and others. Reports were correctly commissioned with HIQA by the HSE and CHI. We knew they would come but, as she pointed out, the report that was not shared with either the HSE or the Department raises very serious concerns. It comes from 2022 when it should have been shared and addressed properly but it is today that we have to address it. I recognise that we have nearly a new board. We certainly have a new CEO who was appointed in February and is establishing an executive team around her, all of whom are new to the system. I will work directly with them to ensure this is taken forward. Of course I have stronger confidence because of the increased involvement of the HSE. There is ongoing reporting to me of what is happening about the implementation of the various issues. I am concerned in particular, of course, from a patient safety perspective.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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There are still 226 children waiting on spinal surgery. Of these, 34 children have been waiting longer than six months. There are also many more who were removed from waiting lists because they were left for so long that they have become inoperable. One of these is a young lad called Mikey. He is from Mayo and is aged 16. He has severe scoliosis. Last September Mikey's parents were told by CHI that he is not fit for surgical intervention. The letter did not indicate any pathway for Mikey. His parents have asked many times for a second opinion abroad. Last month my colleague Deputy Conway-Walsh, who is from the county, raised this with the Taoiseach and he stated he was of the view that a second opinion should be facilitated. The family has had no update from CHI in this regard. Will the Minister make sure that Mikey and children like him get the second opinion they need?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I want to be very careful of the privacy of Mikey and his family but I have met him and I have met his family. I am aware of the various issues. On foot of meeting them, I put in train a process and perhaps I might speak to the Deputy about it privately rather than on the floor of the Dáil, recognising his privacy.

With regard to scoliosis and the issue of waiting times, it is a source of great frustration to me that there has been so much additional investment, both financial and personnel, into the system but we are not getting what I would regard as a commensurate increase in output or productivity. They sound like harsh words but I mean surgeries for children who need them. It is very important to look at the work the HSE internal auditor will do. The auditor will look at three specialisms, two of which will be surgical and one medical.

The auditor will examine the waiting list management within that, and I imagine that scoliosis will be one of those areas that will be examined. Again, I reiterate the importance of a central referral system, which manages it on behalf of the team, rather than individuals managing their own lists.