Naoise Ó Cearúil (Kildare North, Fianna Fail)
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I appreciate the opportunity to raise this issue, but I do so with anger and frustration on behalf of Evan Gardiner and his family, who are constituents of mine in Kildare North who have been utterly failed by Children's Health Ireland and by the system.

In September 2022, Evan was assessed by Mr. Pat O'Toole who recommended urgent surgeries on his knees, his ankles and, potentially, his hip. The advice was unambiguous: without intervention Evan faced the risk of lifelong mobility issues, including possible wheelchair dependency.

That was over three years ago, and no surgery has taken place. Since then, Evan's family have done everything that has been asked of them. They attended every appointment, followed every piece of medical advice and remained fully engaged with CHI, yet instead of action, they were told Evan had been lost in the system; a child with a severe and deteriorating condition lost in the system. That is completely indefensible. To make matters worse, Evan's father, Vincent, is himself undergoing cancer treatment. The family is under immense pressure, and they deserve clarity, compassion and timely care, not entities and cancellations and, to be honest, excuses.

My office became directly involved in May of this year. Since then, we have contacted CHI and the HSE over 40 times by email and over 20 times by phone. Every one of those contacts is documented and with me today. If this is the effort that a TD has to make to try to get some sort of answer, what hope do parents have in situations like this? It is completely farcical.

I will give the Minister of State another example. Last Friday, the family received a letter telling them that the surgery on 10 October was cancelled. I submitted today's Topical Issue last Friday, and on Monday, they sent a letter saying that the surgery on 10 October is back on. I will mention some of the other communications between CHI, the HSE and me and my office. On 23 June, I submitted a parliamentary question. The response took nearly four weeks and when it arrived on 7 August, it was incomplete. It failed to acknowledge two full years of Evan’s medical history, a critical period of assessments, consultations and missed opportunities. That omission was disgraceful. On 26 September, as I said, Evan's long-awaited appointment on 9 October was cancelled by phone with no explanation given. On 29 September, as I mentioned, CHI confirmed that Evan's surgery had been rescheduled for 10 October but yesterday afternoon, Vincent, his father, received a phone call from Crumlin hospital saying that Evan is now to be admitted on 9 October with surgery on 10 October. Does the Minister of State think it is any coincidence that once the Topical Issue matter was submitted for this morning, suddenly, CHI at Crumlin got into action? This is something we are seeing time and time again, not just myself but other Deputies. We raise numerous parliamentary questions. We contact the relevant phone lines and email addresses, yet it takes standing here in the Dáil for anything to happen. It is not feasible for the number of families throughout the country, like Evan's, that TDs, as in this instance, are raising individual cases to try to get some action. This case also shines a harsh light on how CHI is treating families. It also shows how CHI treats elected representatives. As I said, if a TD with every avenue open to him or her cannot get timely, honest information, how on earth are families supposed to get the answers they need?

I have a number of questions I will put to the Minister of State in the final two minutes. This is a situation we are seeing. Harvey Sherratt was one example, and now we are seeing an inquiry into what happened there. This is not just in relation to hip dysplasia and scoliosis. This is going across the board into multiple areas of children's health. I welcome the decision that CHI is now going to be subsumed into the HSE because as far as I am concerned, it is not fit for purpose.

Kieran O'Donnell (Limerick City, Fine Gael)
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I thank Deputy Ó Cearúil for raising this matter. I am taking this debate and matter on behalf of the Minister for Health, Deputy Carroll MacNeill. Deputy Ó Cearúil will appreciate that I cannot talk about individual cases before the Chamber. Obviously, if the Deputy has questions in relation to individuals, they can be raised directly with the Department of Health. I acknowledge the case he has highlighted, however. While I cannot specifically talk about it, I acknowledge how difficult it has been for the family. I welcome the fact that the procedure has now been scheduled. It should not have had to come to this, and I appreciate that. I acknowledge that he has raised it, but I cannot speak about individual cases.

It is acknowledged that acute hospital waiting lists are too long, and many patients are waiting an unacceptably long time for care. The Government is focused on having a public healthcare service in which everyone has timely access to high-quality scheduled care, where and when they need it. Since the commencement of the waiting list action plan approach in September 2021, significant progress has been made in reducing both the number of patients on waiting lists and the length of time they are waiting. In relation to the Deputy’s particular query on paediatric hip surgery waiting lists in north Kildare, I can advise that the National Treatment Purchase Fund. NTPF, does not publish data on subspecialties. Therefore, I will refer to the orthopaedic waiting list, within which hip surgeries are a subspeciality.

According to the NTPF, the total outpatient waiting list for orthopaedics in CHI was 3,406 at the end of August 2025. This compares to a total of 3,930 waiting at the same time last year. This is a 13% decrease. Additionally, the inpatient and day case waiting list for orthopaedics in CHI reduced from 764 in August 2024 to 671 in August 2025. This is a 12% reduction. Further, the percentage of inpatient and day care patients within the Sláintecare targets was 27.3% at the end of August 2025. This is compared to 22.1% at the same time last year.

I can also advise the Deputy that for Kildare specifically, the number of children waiting for inpatient and day case paediatric orthopaedic procedures in CHI has reduced from 58 in August 2024 to 46 in August 2025. This is a 20% decrease. This highlights that the waiting lists are trending in the right direction. I acknowledge the case he has raised on behalf of his constituents, however.

Further developments to these lists are under way, including the migration of the specialty to a central referral system. The NTPF has advised the Department of Health that it has approved both outpatient and inpatient and day case initiatives for orthopaedics, which will facilitate treatment for patients on these waiting lists in Children’s Health Ireland.

As the Deputy is aware, the final report of the developmental dysplasia of the hip audit was published on Friday, 23 May. The Minister’s immediate priority following the publication of the Thomas audit was to ensure there was clinical follow-up and care for patients who had undergone pelvic osteotomy surgery. All patients and families were sent a letter from CHI and the National Orthopaedic Hospital in Cappagh about the next steps that will apply to them and their child, and how they can get further information or support. As of Tuesday, 23 September, a total of 196 patients have had clinical reviews as part of the multidisciplinary team clinics.

In relation to retrospective reviews of cases to determine the indications for surgery, the HSE is establishing a separate process involving external experts. It is expected that the panel will be established in the coming weeks and that the review of individual cases will commence in January 2026. The recently established HSE CHI improvement steering group is overseeing the progress of these reviews. This group was established by the HSE CEO in recognition of the need to co-ordinate oversight of a range of matters of focus in CHI in a cohesive fashion. This group most recently met on 29 September 2025, and senior officials from the Department of Health attend these meetings. The improvement of waiting times and particularly waiting times experienced by children and young people remains a priority for the Minister for Health. The Minister is committed to ensure that reform remains centred around putting the child and their family at the very heart of our paediatric services.

Naoise Ó Cearúil (Kildare North, Fianna Fail)
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Go raibh maith agat, a Aire Stáit. This surgery was scheduled previously, and it was cancelled. Surgery is a traumatic and worrying period for any person no matter what age. For any of us with children, it is even more worrying and scary. Then for the child, it is extremely traumatic, and how a parent deals with that is extremely difficult. For surgery to be scheduled, cancelled, rescheduled and cancelled is far more difficult on a family than the actual surgery itself in a lot of instances because of the fear that the hope of getting something done will be taken away. There is also, naturally, concern about the impacts and dangers that come with surgery.

I know the Minister of State is not the direct line Minister for Health, but I will ask three particular direct questions of him today. If he could give them to the Minister, Deputy Carroll MacNeill, I would appreciate an answer. How can it be justified that a child at risk of permanent disability has been left languishing in the system, in this case for over three years, and in other cases even longer? How is it acceptable that CHI can refuse to provide written explanations to a parent whose child's surgery is being cancelled? What accountability will be put in place to ensure the culture of indifference finally ends? As I said, this is not an isolated case. Families across Ireland are waiting far too long for essential procedures. CHI's failures are well known, and while it is now being folded into the HSE, changing the letterhead will not fix the problem. We need structural reform and a complete change in culture that places the child at the centre, not bureaucracy.

I ask the Minister of State to acknowledge the unacceptable delays in Evan's case, investigate why this family were put through years of suffering and ensure that the Gardiner family receive not only timely surgery but also a full apology for how they have been treated. Evan's surgery must now proceed on 10 October, and nothing less will do to be honest.

Kieran O'Donnell (Limerick City, Fine Gael)
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Once again, I thank Deputy Ó Cearúil for the attention he has given to this important matter. As I already said, I am taking the matter on behalf of the Minister for Health, Deputy Carroll MacNeill. Once again, the Deputy will appreciate that I cannot speak on individual cases, but I do want to acknowledge the matters he has raised in respect of his constituents.

The procedure needs to go ahead as scheduled. That is hugely important. I acknowledge the angst and anxiety caused to families when operations and procedures are cancelled. I acknowledge that. I will bring the three points the Deputy has raised to the attention of the Minister for Health, Deputy Carroll MacNeill, and the Department. I suggest the Deputy also communicate formally with the Department on this matter.

The Minister for Health is conscious of the impact the prolonged waiting times are having on patients and their families. The Deputy has brought up the specific case of his constituents. The waiting list action plan 2025 follows an outcomes-informed approach and specifically focuses on reducing the length of time that patients wait for care. The total CHI paediatric orthopaedic waiting list has reduced compared with this time last year. Importantly, the length of time children are waiting has also decreased. Nevertheless, the Deputy raised the specific situation of his constituent, and I acknowledge that.

Work is ongoing to improve services, including a migration to a central referral system and a national reporting initiative to increase capacity. The HSE CEO has also commissioned an audit to assess the governance and inequity in access to care within CHI, especially regarding the balance between public and private patient management. Further consideration will be given to any additional actions required.

The HSE CHI improvement steering group, co-chaired by the REO for Dublin and the midlands and the chief clinical officer, is co-ordinating the oversight of the implementation of the recommendations from the completed reviews, including the audit of developmental dysplasia hip surgeries in CHI. I assure the House that the Minister for Health remains fully committed to the improvement of waiting lists, including in respect of children awaiting paediatric orthopaedic surgeries.