Paul Murphy (Dublin South West, Solidarity)
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83. To ask the Minister for Health when she anticipates that no child will have to wait longer than three months for spinal surgery; and if she will make a statement on the matter. [52561/25]

Ruth Coppinger (Dublin West, Solidarity)
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The Tánaiste made an infamous promise to parents in 2017 that nobody would be waiting for a scoliosis operation for more than four months. When are we going to reach that point? It seems that 226 children are on the CHI spinal surgery list. In August, 135 were actively waiting, ready to go. The numbers on the spinal outpatient lists are over 461. The CHI spinal surgery management unit said there are delays of months before children can even be seen. When will this promise be kept?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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As the Deputy is aware, the Sláintecare target is 12 weeks for an inpatient procedure. That is how we measure performance across the entire health sector. Some 39% of the children on the active spinal waiting list in CHI were within Sláintecare targets at the end of August 2025, which is an improvement on 28% at the end of August 2024. Additionally, only 7% were waiting over 12 months, which is compared to 24% at the same time last year. There is, therefore, some progress being made in reducing waiting times, especially longer waiting times.

It is supported by a couple of different initiatives. The dedicated GP referral pathway supports the appropriate prioritisation of urgent patients. Children requiring non-complex procedures have pathways to Blackrock and Cappagh to maximise the capacity for the complex procedures that are happening in CHI. International outsourcing has supported 19 patients to have surgery abroad. As I said earlier in the House, I am disappointed with the figures this year and I am unclear as to the referral pathways to maximise that. There is a new orthopaedic surgeon adding some capacity since 11 August.

Crucially, the Mater hospital is now fulfilling its obligations in the adolescent transition spinal service to support seamless transition of care. I am trying to explore what additional measures can be taken. I have asked for a proposal from the Mater to see what more is possible in that regard. We are making some progress, but I acknowledge that it is too slow, and too many children are still waiting. I have met with the HSE and CHI board and executive several times over the past couple of months. I have made new appointments, in particular the appointment of Mr. Fergus Finlay to the CHI board, who will be an excellent advocate on the board working and seriously engaging with spinal services in particular. I have great confidence in him. I have also commissioned an audit of governance and equity in patient access and waiting list management, which has a very important qualitative element to ensure the patient and staff experience is also captured.

Ruth Coppinger (Dublin West, Solidarity)
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There are three issues. Does the Minister have confidence in the clinical lead of the paediatric spinal surgery management unit? This is the person who took Harvey Sherratt off the waiting list without parental knowledge or consent. How many other children were taken off the lists in that way?

Second, does the Minister have any knowledge of any other medical devices that have been used in an off-label fashion at CHI without parental consent?

Third, to refer as she did in a previous answer to the nature of an inquiry, the Minister mentioned that the person leading the inquiry would have a say. I do not really understand that point. The key people who should have a say on this are obviously the people affected. I urge the Minister to ensure that any inquiry is public and is satisfactory for the parents who have been lobbying and campaigning, especially those, like Gillian and Stephen, who have lost a child and continue to campaign on this issue.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Yes, that is my intention. It is a partnership approach. At the end of the day, some terms of reference are going to have to be settled and it is absolutely our intention to do that in a partnership approach. The person leading it, of course, must have some knowledge of how it is going to be done and some hand in how best it can be delivered as well. That is an important perspective. It should not be coming from me to impose it upon them. We are genuinely trying to deliver a partnership approach. We are some weeks away from trying to get the exact model in relation to that. However, I hear very clearly the Deputy's perspective. Yes, I have a concern in relation to medical devices, which I am referring to HIQA to do an investigation and get its perspective. I have a concern generally in relation to governance, equity in patient access and waiting list management at CHI, which is why in May or possibly June - I would like to confirm that; forgive me, please - I asked the HSE to conduct an internal audit specifically into waiting list management and equity of access. I hope and expect to have that back at the end of November or beginning of December.

Ruth Coppinger (Dublin West, Solidarity)
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So the Minister has confidence in the clinical lead, or does she not?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I did not make any comment on that. I said there was an audit-----

Ruth Coppinger (Dublin West, Solidarity)
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Okay.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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-----so please do not put words with me because I did not say anything in relation to that.

Ruth Coppinger (Dublin West, Solidarity)
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I am sorry; I will clarify. Parents and advocates are asking about three particular issues in this regard. First, they want to know if the Minister has confidence in the clinical lead. Second, which I do not think she referred to either, is she aware of any other devices that have been used in an off-label way - parents have said this - and inserted into children? Third, we all know that it is not the best approach, obviously, for children of this nature to be going abroad. Why is it always that we cannot bring surgeons here or upskill enough and invest enough that the resources and equipment can be available here? It can be very difficult and expensive for children to go abroad in this way.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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Yes, I would also like to do that, but we have to recognise that there are some children for whom it is suitable and who have had good outcomes.

I answered the Deputy's question in relation to medical devices. I said I was referring a concern that I had to HIQA.

In relation to the clinical lead, I said that I have commissioned an audit, which is a really important process. I do not wish to step across that. I am very happy to discuss the outcome of the audit with the House once I have it, but I cannot step ahead of that.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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Deputy Brennan had indicated that he wanted to come in on a previous question; I am sorry.

Brian Brennan (Wicklow-Wexford, Fine Gael)
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I need an update on behalf of the people of Gorey on the new ambulance station and the primary healthcare centre. For too long, Gorey has waited on this issue. Gorey is one of the fastest-growing towns in Ireland. Come summertime, an extra 40,000 people move in between Courtown, Castletown, Ballymoney and these areas. We just do not have the medical infrastructure to cater for these people. We really need an update. At the moment, we feel the primary healthcare centre has been pushed down the line. The module at the moment is not fit for purpose. We feel that the money being offered per square foot is not enough for a developer to build. In terms of the ambulance service, the people who are running it are incredible workers, but at the moment, they are working out of a prefab. This is simply not acceptable in 2025. The people of Gorey really deserve an update on both of those issues.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the Deputy. I know he has been a very strong advocate for the Gorey primary care centre, the need for which has been well identified. A tender process has been undertaken. As he is aware, a preferred provider had been selected, with a letter of intent issued in 2019. Unfortunately, that selected preferred provider encountered difficulties regarding economic viability resulting in the collapse of the process in 2024. To facilitate the readvertisement of this primary care centre, a full review was taken with relevant stakeholders. A number of stakeholders require accommodation in that centre and a scope has been established. That review is now complete and a tender process is under way. The stage 1 tender advertisement was published on 24 June 2025. Stage 1 expressions of interest were received and evaluated and letters have now issued to all parties. It is anticipated that stage 2 priced offers will be advertised on the eTenders procurement platform in the final quarter of this year. The readvertisement and retender process for the project are necessary under the procurement rules.

On the ambulance service, HSE capital and estates, in collaboration with the National Ambulance Service, has identified and agreed a suitable facility for use as an NAS ambulance base and is in the process of securing approval to purchase same, subject to planning approval being obtained. The facility will require capital investment to fit it out as a purpose-built ambulance base. The NAS and HSE capital and estates have completed the necessary documentation to facilitate the progression of the project in quarter 4 of 2025, which I hope is a good update for the Deputy. The HSE is working to appoint a design team in this quarter, with the aim of developing and submitting a planning application in early 2026 to progress the project. Those are two important updates for Gorey.