Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I thank the House for the opportunity to discuss what is a most important issue to all of us.

At the outset, it is important that I clarify a technical piece in relation to protected disclosures and how they work. I am conscious that it was the subject of debate among the leaders last week, which I totally understand, but it is important that the House has clarity on it. The Protected Disclosures Act was agreed by this House without a vote. Everybody supports the idea of it and the purpose of it is to protect whistleblowers. It creates an obligation on the Minister to establish a channel on their website and an email process for whistleblowers to be able to make disclosures. That exists in the Department of Health. On the website, it is very clear that this is a channel to reach the protected disclosures commissioner. It is a separate, dedicated, secure mailbox, one that I do not see or have access to, nor do my private secretaries. The purpose of maintaining that separation is exclusively for the protection of whistleblowers. I know it was mentioned that this represented a lack of curiosity on my part but I would say to the House that if I or any other Minister were to start checking what is coming into the protected disclosures mailbox, it would create a completely new and different problem for whistleblowers. It would undermine the idea of there being a protected channel specifically for that. I know the House is already aware of that because of its support for the Act but I wish to put beyond doubt the need to protect whistleblowers and the reason for those steps. It is not, in fact, something that comes to a Minister's desk, nor should it come to a Minister's desk. It should be investigated separately and appropriately. If we had a Minister like me or anybody else who was interfering in a curious sort of way in what was in the mailbox, that would raise important confidence issues in that Minister. It is important to be clear in relation to that and I thank the House for indulging me in that way.

Much more importantly, on the question of paediatric spinal surgery waiting lists, which is the subject of our discussion today, I wish to thank all the Members of the House who have engaged with me on this in the past number of months since I became Minister for Health.

I have tried to place a significant and systemic focus on productivity, generally in our hospitals, but in this most acute area of need of pediatric spinal services. All of us do this because we are concerned about the children on whom this impacts. We are concerned about their quality of life, the nature of the supports and interventions they get and the necessity for those to be timely. In particular, I thank all of the patients, families and advocacy groups I have spoken to at different times throughout this year because, while we speak about numbers, initiatives and reforms what we are speaking about, of course, are children - patients - many of whom have quite complex medical conditions, a multiplicity of medical conditions, and who need very great care. I want to assure patients and families I have heard what they have said to me and that their perspective is vital in ensuring the reforms we know must be ongoing to ensure better, timely care.

I also say to Members of this House that I, like them, am the recipient of people coming to me with complex cases; cases where there is a sense that intervention is necessary now, that intervention has been too late and that there is a difficulty with communication. In my case, as Minister, I can take those cases up with the National Patient Safety Office and have them advanced and I know that has been the case with some of the people who have come to me and brought cases to me. I wish to say to Deputies that there is an open invitation to my door to anybody who wants or needs to bring a case to my attention. Deputies will appreciate we do all of this scheduling in a particular way and it is not perfect. Tomorrow I will be meeting CHI on two issues. One is the children's hospital and the second is yet another meeting in relation to what is happening on spinal services and what has happened since our last meeting. One of the things I will want to look at most closely is the specific care plan for all of those children who are at the level of most complexity in the system. There are certain GDPR constraints to the information that can be shared with me but I have several cases on my desk, as I know other Deputies have. There is a real openness here to get to an understanding that the most complex children can get the care and intervention they need in a timely and appropriate way. I want to say that as a general opening statement and invitation to all.

As we know, scoliosis affects about 1% of children and adolescents in Ireland. Many of those children do not, in fact, require surgery but for those who do, timely access to intervention and treatment is critical. For those children who need surgical intervention, we agree the waiting times are too long. I am acutely aware of the burden that long wait places on those young patients and it can make their situation very much more difficult.

Improving access to spinal surgery has been the focus of sustained and determined efforts over several years by several Ministers for Health and we have not fully reached our goals. I want to acknowledge that the efforts that have been put in so far have yielded tangible progress and I also acknowledge the dedication of the nursing team, the healthcare professionals, the multidisciplinary teams and, indeed, the surgeons who are delivering better outcomes than we have had before. In this House, we are dealing with patients on a day-to-day basis and we know we need to go further and do better.

There has been a significant focus on investment for those services. There has been new infrastructure. We have a fifth theatre in Temple Street, an additional MRI scanner in Crumlin, and 24 additional new beds. In 2024, my predecessor ensured 52 new full-time equivalent posts were approved to strengthen services, including surgeons, nursing staff, administrative staff, and all of the different pieces of that, including four orthopaedic surgeons, one of whom has been in post since August of this year. Of course, we would like to recruit all four but we have only been able to recruit one to date. Some 41 of the 52 staff are in post and we are actively trying to recruit the rest, especially at consultant level.

It is important to say we have tried to increase capacity in a range of different ways, both domestically within CHI and internationally. Let me address some of the complexities of the issues I have seen as Minister. For example, in 2024 we agreed with the Mater hospital that it would conduct an enhanced transitional service, adding to the transitional services already in place, and indeed it was funded to do so. An additional 29.5 posts were approved for the Mater hospital to enhance the adolescent transitional spinal service and try to improve the seamlessness with which transitional care would occur. It was only at the beginning of the second half of 2025 that this service began to operate, which I think is deeply regrettable. I know from my engagement with patients and parents that the service is, in fact, operating, and that there have been, I think, four outpatient clinics to date in the Mater during the second half of 2025, and three surgeries have been scheduled. I believe it is problematic and regrettable that that intervention and step taken by my predecessor in 2024, for which posts were allocated and funded, in fact only began in 2025. It is now the case that those posts are all in recruitment because the service has begun and there has been a commitment by the Mater for that to begin, and those posts should all be fully in place during the first quarter of 2026.

On international outsourcing, again my predecessor approved over €16 million for international outsourcing initiatives since 2024. That was designed to support earlier surgery for children with very complex cases to get the care they needed abroad as clinically appropriate. However, it is a source of great frustration to me that a total of only 19 children have been the beneficiary of that. It is a source of frustration to me that the number is not higher and it is a source of frustration to families who would like to travel and who either have not been offered the opportunity to do so or who believe they would have been suitable. I acknowledge that not every child is suitable for travel. There may be some for whom it is not suitable or who cannot travel. There is a tension here where I believe more should be done but there is a clinical element to those decisions and it is not appropriate for me, as Minister, to interfere with that on an individual clinical basis. Yet, when I look at the system, what I see is 1,000 surgeries, essentially - 500 last year and slightly more than 500 this year - available for children who have needed surgery and in the period of 2024 to 2025 where the international outsourcing option was available only 19 of those 1,000 surgeries have been done internationally. From a systemic perspective, that does not ring true to me. That has been the case to date but we are trying to expand our international options to drive even further the opportunities to travel, both in Europe, and for additional surgeries in the United States. At the moment we have the New York-Presbyterian Hospital and we have Great Ormond Street Hospital but CHI has gone through a tender process during the past number of months, at the direction of the Department of Health and at my direction, to try to expand opportunities internationally. That is bring finalised shortly and I believe it will involve multiple additional hospitals.

The point I am making to the House is that if the experience to date has been that there has been an international option but it was not available to patients at the rate that might be suggested with 19 out of 1,000, then it is essential that if we are providing additional international options, that there is a very clear understanding those options can and should be used. That is extremely important.

From an operational level within CHI, the pediatric spinal surgery management unit was established last year. It is a dedicated unit to try to co-ordinate surgeries better across Temple Street, Crumlin and Cappagh hospitals. It is working more closely with multidisciplinary teams to do that. Efforts to expand capacity within CHI progress and, indeed, will be the subject of my dialogue with it tomorrow, including ring-fenced theatres and dedicated orthopaedic beds. To be fair, that implementation has in fact reduced the waiting times for spinal surgeries in general. Additional outpatient clinics have also begun to assess new patients more promptly and that is both necessary and helpful. Since April 2024, over 800 new patients have been seen in those clinics and that has reduced the time to be seen by a consultant in addition to the dedicated referral pathways.

Domestic outsourcing arrangements have also been expanded, using pathways to Blackrock and Cappagh more quickly for non-complex spinal procedures. Over 74 children have used those pathways since the beginning of this year. As I said, we have tried to expand the international option.

In regard to these initiatives and investment, while I have expressed a measure of frustration with the pace and wanting to do more, I need to acknowledge all of the dedicated team - the nurses, anaesthetists, surgeons and so on - who are doing the work and that there are surgeries happening . We know children are getting surgeries and it is at an increasing rate. In 2024, CHI performed 513 spinal procedures, which was a 10% increase on 2023 and 35% increase on 2019. Already in 2025, 446 procedures have been completed, which is an 8% increase on last year. There is growth and there is more activity. Also, this year there has been an 8% increase in referrals and at this time we are 7% behind target. So, the picture is yet to improve but there are also an increase in referrals.

What matters most, of course, is the length of time that children are waiting on the procedure. There has been an improvement in the longest wait lists. At the end of October 68% of patients on the active list were waiting less than six months, which is an improvement on last year, which was 56%. Further, at the end of October, only 6% of patients were waiting 12 months, which again is an improvement on 16% at this time last year. Again, at the end of October, 38% of patients were waiting within the Sláintecare targets, although I would like that to be substantially increased. I will acknowledge all of the difficulties, the challenges and frustrations that I have but I will also acknowledge the progress that has been made and which we want to see continuing to improve. I am also seeing improvements in the outpatient wait list. The children without an appointment to date on the new outpatient waiting list has reduced by 48% since the start of the year. I am informed by CHI that currently there is no child waiting over nine months without an appointment for a new outpatient appointment. That improvement is ensuring children are seen more quickly.

While we absolutely must acknowledge progress, we also cannot mask the ongoing reality that too many children are still waiting and that too many children with complex cases are still waiting. Up to the end of October this year there have been an additional 462 children, or 8%, who have been added to the active surgical waiting list. It does reflect a growing need and it reflects a better referral pathway, but it is still children who need spinal surgeries. There is also a shift in the complexity of cases presenting at CHI because non-complex cases are now being referred to other hospitals to be done more quickly. That in itself is a good thing. I am, however, concerned about the children with complex cases who may need several procedures and who may need very significant multidisciplinary support.

I am also concerned about the communication. This is something that families have repeatedly expressed to Deputies across this House as being very challenging for them. I have made it clear that the nature, the style and the promptness of communications has to change. The way in which families are discussing surgeries, surgical interventions and the overall plan for their child is everybody's responsibility, and it is not to be approached in a siloed way. It is difficult for us to build a new theatre and to recruit a new surgeon, to be fair, but it is not difficult to pick up the phone to talk to somebody properly and in a comprehensive and timely way about the needs of their child. These are things that can be done and I have said this in the House before. To support improvement, we have appointed a spinal patient advocate liaison co-ordinator. There is a patient panel for spinal services to try to improve communication. There are 14 members on that panel at the moment. A key worker, or patient advocate function, is also being rolled out. I am saying to Deputies that there have been efforts made to try to improve communication. While I understand from parents that the benefit of this is not yet universal, steps are being taken and we have more work to do on it, which, essentially, is what I am trying to say in a truncated way to make the all of the points that I hope to make.

I will address some of the different reviews and issues that are occurring more broadly in CHI historically. Of course what we want is to have a future-looking system where everybody has confidence in the system. The difficulty with the issues of the past is that they must be addressed, there must be transparency, and it is very important to acknowledge that, while we try to look to the future and try to improve services, we also have to hear and understand the experience of the past and difficult experience of the current day. In April I stood in this House and we discussed the HIQA review of the governance of implantable medical devices in CHI, including the use of non-CE springs in Temple Street hospital. A month later we were here to discuss the Thomas independent external medical audit for Children's Health Ireland and pelvic osteotomy. At an early stage in April, I had a very clear concern about the culture in orthopaedic services, as I know Deputies across the House had, including the way in which waiting lists have been managed to date and how that has operated. A month later we had the 2022 report, the unpublished report, and the Nayagam review is also under way, phase 2 of which is reviewing the service, including the governance. There is a series of different reports and I am conscious that, behind every one of those reports, there is a patient and there is a child.

In response to the multiplicity of reports and in response to the concern I have about the culture and the waiting list management, I commissioned an audit the details of which we have not yet received. It is very important that we debate this when we do receive it. That audit has two elements. I commissioned this via the CEO of the HSE. It consists of an audit of governance and of equity in patient access and waiting list management, and that commenced in June. The audit is being undertaken by the HSE internal auditor. It is independent. I am told it is nearing completion and I expect the outcome shortly. It is really important to note that, at the time, I also asked for there to be a qualitative patient experience element to this. I asked Lily Collison, who is an advocate for spinal services, cerebral palsy and epilepsy, and who is, among many other things, a member of the HSE board, to complete that. Ms Collison has been in CHI this past number of months doing a survey of parents, speaking to parents who wish to speak to her, and trying to better understand the patient experience by asking how they ended up on a waiting list, what was their experience and what has happened to date. I expect her report shortly. I did not publicise her name at an early stage because I wanted to give her the opportunity to get on with her work in a quiet and effective way and to give her the privacy to do that. It is very important to say that we did both of those things at that time. I expect to have that report very shortly.

I will not address the spinal task force, which continues its work, as it is a question of time, but I do want to talk about the inquiry the Cabinet agreed to yesterday. It is our intention to have a statutory public inquiry into the care generally received by children with scoliosis, complex scoliosis, spina bifida and hydrocephalus, and the care issues around that. It is really important now that I become extremely careful with what I say about the detail of that. I am conscious that we want to establish a process that is legally robust and that has very clear terms of reference. We have asked the parents, the advocacy groups and the breadth of stakeholders, including the advocacy groups that are on the spinal task force, to engage with a facilitator who will help and listen to understand the best scope and help develop a proposal to me so I can properly draft terms of reference and have those agreed by the Government . It is the intention to do that with families in the most appropriate way, recognising that it is, of course, the Government and the Oireachtas that will have to ultimately sign off on them. The Attorney General is already engaging with potential people and potential names, including senior counsel and so on, to determine who may have availability to do this work and to get that going as quickly as possible. Of course, the calibre, the quality and the experience of the people we want to do this work is not always immediately available tomorrow. They have schedules and commitments already, so we are trying to do our best to get somebody as quickly as possible but also who is as capable as possible for doing that.

I am very conscious that my colleague is going to speak and I do not wish to speak across her. Perhaps I can address any questions that Deputies have in my concluding remarks. I am conscious there will be a lot of interest in that.

We are continuing with the journey in relation to the integration of CHI into HSE. I am not sure I have had the opportunity to formally update the House in relation to the board members who have been appointed or the chair being confirmed by Cabinet last week. That work is ongoing. We will need to now prioritise the legislative element of that and bring it to the House, I hope in 2026, to begin the process of making that transfer more formal. I wish to give my colleague the opportunity to speak now.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Minister for her opening statement. I know how hard she has been working on this for the last few months. My heart goes out to the families. The Minister and I are thinking of them, the children who are on waiting lists waiting for surgery and those who have lost children.

It is right to say that we are not where we need to be, as the Minister has said. We need to address the urgent problems in spinal care, despite sincere efforts of successive Ministers, and that is true. I acknowledge again the Minister's work on this in the recent months in driving measures to address the urgent problem. She has met with the family of Harvey and she is working to improve access to services. This is under way, including a ring-fenced theatre, extra outpatient clinics, and national and international outsourcing to maximise capacity. Every effort is being made to reduce waiting times but we know that there are still challenges and reform is needed.

I welcome the Government's approval yesterday of the Minister's proposal for a statutory public inquiry. I fully support this inquiry. I have met with affected families from my own area and I know that they are keen for this inquiry to take place as soon as possible. It is a very important step to ensure that we have the best healthcare system possible for our children.

Every child's journey to spinal surgery is different. Some steps may take longer, especially when the case is complex and several specialists are involved. Every precaution must always be taken to make surgery as safe as possible, to ensure that the children who need complex care are fully prepared, and that their care plan is the right care plan for them.

I understand this can take time. Strengthening governance and oversight, driving down waiting times, and ensuring increased engagement and timely communications with families must be priorities. As the Minister said, working with families and making them a priority is very important. I know she is also committed to this. We must work to ensure there is a cultural change so that families can have trust in the system. I know the CEO of the HSE has established the CHI improvement steering group and has commissioned an audit to assess equal access to care in CHI, and this is a welcome step.

We must continue to listen to and work with the parents and advocacy groups who are highlighting hugely worrying and important issues. Like the Minister, I have been there, speaking to families and working with them. I assure her I will be working with her to give any help and support I can. I know the Government is committed to this. As the Minister has said, our aim is that children receive the care they need when they need it. I look forward to the inquiry taking place as soon as possible.

David Cullinane (Waterford, Sinn Fein)
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In 2017, the Tánaiste, Simon Harris, made a promise to children with scoliosis and spina bifida that long waiting lists would essentially end and that children would no longer wait in pain, deteriorate or lose the chance of life-changing and, in some cases, life-saving intervention. He promised that no child would be left waiting longer than four months for surgery. Since then, as we know, countless children have suffered in agony, without surgery within four months and, in many cases, tragically, without surgery at all.

We have to go back to the very beginning. Children's Health Ireland was legally established by Simon Harris in 2018. Yet, from its first days, it has lurched from crisis to crisis and the children who depend on the services have paid the price. CHI, as we know, was formed to amalgamate, essentially, the children's hospitals in Dublin, with a promise to provide a world-class service for children. Despite the Trojan work of healthcare workers in Crumlin, Temple Street and Cappagh, and I know that many people who work in these hospitals provide a tremendous service, the promise of providing a world-class service for all children never materialised. At the heart of this is exceptionally poor governance, which is made worse by four years of delays to the new children's hospital, a hospital that has made a mockery of the State because of a fundamentally flawed contract. It has to be said that this another calamity with Simon Harris's fingerprints all over it because he was, after all, the Minister who greenlit that project and signed off on the contract.

We know that children with spina bifida and scoliosis have waited far too long for essential surgeries. Even today, there are 232 children on waiting lists for spinal surgery, with most of them having waited longer than three months. We do not know how many have waited for longer than four months because CHI does not publish this information. Even when it comes to waiting lists and how they are presented, there is an appalling lack of transparency. What we do know is that behind every number is a child sometimes in pain, losing mobility and getting worse. The waiting list figures are concerning. The number of children without a date for surgery is up to 139, and another 43 are waiting on a date for a further procedure. Only nine actually have a date; the rest are suspended for various reasons. One child has now been waiting over 48 months for surgery, more than four years on the waiting list. Seven more have been waiting over a year. Children cannot wait months or years for time-sensitive and, at times, life-saving and life-changing spinal surgery. We know that many have not received proper pre-operative or post-operative care. We also know that many children are staying in hospital longer than expected because of high infection rates. This means many children stay in for weeks instead of days, causing distress, pain, time lost in school and time lost with family, and knock-on delays for other children waiting for care. Families tell me they are not being given the real data on infection rates, so they cannot give proper, informed consent. They are told to trust an organisation that has repeatedly abused and broken that trust, according to these very same parents.

One of the saddest failures in CHI is the abandonment of a group of children who came to be known as the Crumlin orphans. These are a group of children left without the care of any consultant in orthopaedics or urology. When this group of children was identified by what was known as the Dixon report, CHI said nothing. In fact, it never published the report and, worse than this, it never accepted the findings, despite the fact that we all know the findings were conclusive and were correct. CHI could not even say how many children were in this group. When this issue was identified again a few years later in another unpublished report, CHI still did not know how many children were in this group. This is a group of children who simply fell through the cracks. It is not that nobody knew this. The parents knew. They were screaming from the rooftops, but nobody in CHI management or in Government Buildings was listening.

Since then, we had the case of unauthorised non-medical-grade springs being implanted in children's backs. The HIQA review of these cases found severe governance failures, which allowed these tragedies to occur in the first place. HIQA found a lack of formal approval processes, inadequate oversight, poor record-keeping or a lack of consent from parents - the Minister mentioned this and poor communication earlier - poor tracking and traceability of devices and hygiene standards, and exceptionally weak clinical governance structures. These were not one-off lapses. They were the product of a system where governance was weak, where oversight was absent and, as the HIQA report said, where children were not protected from the risk of harm.

This scandal goes beyond spinal surgery waiting lists. We also know there have been potentially hundreds of unnecessary hip surgeries carried out on children. We have unpublished reports raising even more serious concerns about how CHI is governed and how children's services are delivered. We are still waiting on the Nayagam review, which may be next year. We were promised interim reports but they never materialised. We still have questions over new funding for children's orthopaedics. The Minister mentioned funding that is available. There are question marks around whether this is sufficient, whether it is targeted and whether it will deliver the capacity that children urgently need.

If anybody wants to understand the cost of these failures, they need look no further than the case of Harvey Morrison Sherratt. Harvey Morrison Sherratt was just one year old when the Tánaiste made his four-months-to-surgery promise. It took another seven years for Harvey to get that surgery. During the delays, Harvey's spinal curve deteriorated from severe to catastrophic. By 2022, his spinal curvature was 65° and by 2024, it had reached 110° and then 130°. Harvey was placed on an urgent waiting list for scoliosis surgery but he was also taken off that urgent waiting list and his parents still do not know why. Why was he taken off? Who took him off? I know the inquiry will obviously have to answer these questions. What we do know is that it happened without the consent of his parents, and his parents were not even informed. It is breathtaking to think that would happen.

It has since come to light that Harvey was allegedly and wrongfully removed from the list because he was listed as a palliative care patient, despite the fact that a consultant at Great Ormond Street Hospital had assessed him and found him as suitable for surgery. This compounds the anger the family justifiably have. While there was still potential to save young Harvey's life, it seems that someone took him off the list, and worse, it seems that someone decided not to communicate this to his parents. It was only late last year when Harvey eventually received his first surgery. Harvey's condition was entirely treatable, as far as I am concerned. His parents, Stephen and Gillian, campaigned with extraordinary courage to get the care of their son needed but, after years of delay and avoidable decline, Harvey tragically passed away this year, at the tender age of nine. Harvey was entirely failed every step of the way. CHI failed to give him the care he needed when he needed it. His case is now a defining symbol of systemic failure.

When I think of Harvey, I also think of the countless children and young adults who have been failed by CHI. I think of Dollceanna, who died at the age of ten after complications during surgery on her spine at Temple Street. I think of young TJ, who was diagnosed with spina bifida and scoliosis. He was denied early intervention and has now been told his condition is inoperable because he spent his childhood on waiting lists.

I think of Mikey from Mayo, who is still waiting for care. In fact, I think his parents have reached out looking for a meeting. These are just three children and there are many more names that we do not know. However, we know these children's names because their parents were forced to campaign, go public and have their cases raised here in this Chamber. It is only because of the courageous work of advocates that we know any of this. If CHI had its way, none of this would have come to light.

The tragedy here is that if the Government had listened to parents and advocates sooner, we might not have been here today discussing this issue at all. If it had delivered the resources and funding sooner, many of these tragedies would have been prevented. I pay tribute to Stephen and Gillian, Harvey's parents, as I have done in the past, but also to Amanda, Una, Claire and all of those advocates and mothers and fathers who went above and beyond the call of duty. They became advocates for others, not just their own children. I also pay tribute to the whistleblowers who came forward. We owe them a debt of gratitude as well.

What is needed now is not another internal review, another limited report or another chapter in a long pattern of deflection and delay. We need a full, independent, statutory public inquiry that is fit for purpose and can establish the facts, trace decisions and failures and finally deliver real accountability. Crucially, this inquiry has to have the full backing of families and advocates. It must be developed with them and it must get answers to the questions they have. It is important that we also improve the services. While an inquiry will be established, it is equally important that we invest in services. We have to make sure that every single child has timely access to care. I know from dealing with and talking to many parents that it is not just the surgeries. It is the pre-operative and post-operative care and the totality of that child's care that are really important.

I am thankful for the opportunity to raise these issues today. I know we will have an inquiry but we will watch the terms of reference and see exactly what that inquiry will be. I really hope that it is fit for purpose. I hope we see full co-operation from everybody involved and that all of those children and families get justice. I hope we can learn from this but also crucially invest in the services that need it.

Verona Murphy (Wexford, Independent)
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Before I move forward, this is not a reprimand to Deputy Cullinane in any way but I ask Deputies to be mindful when we mention children's names as to the consequences or a request to have that deleted from the record. That is all. I am sure everybody is well aware but this is just a reminder.

Marie Sherlock (Dublin Central, Labour)
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I very much welcome our having these statements today, and the big breakthrough that has happened over the past week in terms of the agreement to the inquiry. Obviously, we have to see what the exact form of that inquiry will be. We have seen scandal after scandal in spinal services within CHI over many years. It is very welcome that there will now be a proper investigation of that. I know we have had statements before and have paid tribute to the parents of Harvey Morrison Sherratt but in particular, I pay tribute to their immense dignity and incredible strength in dealing with the revelations they have had to encounter over the last fortnight and in the face of their absolutely devastating loss. How badly failed they were by the health system that should have been there for their son has played out so publicly. I am also hugely mindful today that when we talk about spinal services, for some children and young adults it is now too late because of the failures within the system. They carry those questions for the rest of their lives about what could have been if their treatment and care had been different and if those failures had not been present. To those families who are currently fighting for surgery, of whom there are many, there is a bitter irony that the families of these children, some of the sickest children in this State, are having to put up the greatest of fights for appropriate care. That is wrong.

While we talk about the patient, the child and the family at the heart of this, we know there are many nurses and doctors who are going day in, day out into a very difficult work environment and trying to do the best by their patient. Unfortunately, however, there is a system and there are some decision-makers and clinicians who have failed in their duty. That is what needs to dramatically change. I do not think it is an understatement to say what has happened has been a national scandal. When we look back in ten or 20 years, we will wonder how children have been so badly failed. These are children who have been in the health service for a long time. Their conditions have been recognised for a long time, yet the systems of care have failed so badly.

In that context, I welcome the Government's announcement that it will have an inquiry, but I have to ask what it will lead to. To my mind, it is not just about what has happened but what is currently happening within CHI. If we think back - other Deputies have referred to this - over the past eight years, we have had at least five reports into the failures within CHI. There was the Dixon report, which now seems to have been disowned by CHI because it was then obviously known as Temple Street. There was the Boston report in 2023. There was the HIQA report, which was commissioned in 2023 and published earlier this year. The Minister referred to the Simon Thomas report and, of course, we are awaiting the Nayagam report. Between the Boston report and the HIQA report, there are 59 recommendations as to how to overhaul services within CHI. Those are recommendations that all arise from the same dysfunction and the lack of proper processes, toxic culture, appalling management and lack of collegiate responsibility.

The reports themselves should be sufficient to bring about necessary change, but the Government's agreement to an inquiry is an admission that they are not. The devastating allegation that Harvey Morrison Sherratt was moved to a palliative care list is a really distressing new low for CHI. If it is true, how could anybody in good conscious make that change and not follow up as to how that child was doing? Time and again, there is this bitter irony that we are not talking about thousands of children. We are talking about a small number of children who have been so badly failed. One parent whose child has now passed away said to me that her child became a political football between the egos of consultants. While, as I said, there are some really good spinal surgeons out there working in our system, we have to ask how we have got to this place.

With regard to what is happening now, we know the list is longer this year than it was last year, as the Minister alluded to, and there are 139 on the list now. There is an element of us not even running to stand still. We understand that no child has been scheduled for treatment abroad over the past number of months, and we have heard the Minister's frustration on this. A big deal was made about referring children to Great Ormond Street Hospital or Morgan Stanley hospital. One family have told me their child has been on the waiting list for 12 months. The child has been told they need surgery. The family believe the child can travel. They have not been offered the option to travel and when they spoke to their surgeon, they were told that surgeon does not have a list in the Blackrock Clinic and, therefore, could not refer that child to the outsourced option, whereas that option appears to be available to other children. How can we have a dysfunctional system where one surgeon decides who gets outsourced, whereas another surgeon cannot? This is the dysfunction at the heart of CHI.

With regard to this inquiry, so much is riding on what it will produce where it seems a number of reports have failed. Obviously, it is really important that it will have compellability because, ultimately, any inquiry is only as good as the fulsome participation of the clinicians and management. There are serious questions as to whether they will participate willingly or not. I, and we in the Labour Party, believe that compellability will be important. It is vital that the advocacy groups be there all along the way. I pay particular tribute to the tenacity and perseverance of the Scoliosis Advocacy Network and the Spina Bifida and Hydrocephalus Paediatric Advocacy Group. Many of those parents already have so much on their hands trying to care for their child. They are fighting for their family but they are doing much more than that. They are fighting for other families who do not have that capacity. It is absolutely exhausting and they have been at it for so many years.

With regard to getting truth, accountability and justice out of this inquiry, the critical thing for us is that we believe a twin-track process needs to be in place.

There will have to be a series of stage reports. First, we need a module on whether CHI is implementing the change that it has promised to deliver. In effect, we need a mediated process whereby the record is set straight between clinicians and parents as to the status of the child's care. All too often parents come to me and to other Deputies here who feel gaslit, who feel they are not being told the truth and who feel they are being told conflicting stories by the clinicians and the health staff that they interact with. I hear what the Minister said regarding the process that is up and running with regard to that lady who is already interacting with those families but it needs to be a mediated process between the clinicians and the families because ultimately many of the families feel they are not getting the truth they so rightly deserve.

The second key issue is the investigation into the cases of children who passed away because of the failings in care and those children for whom surgical intervention was too late. There will inevitably be allegations that will lead to litigation and so on. It will potentially go on for a very long time. We believe the onus is on the Minister to ensure that this inquiry will deliver the answers that we, the public and particularly the parents, so much need. Our request to the Minister is that this inquiry can get those answers, which may turn adversarial, while also ensuring that the system improves. There are very real question marks about how that can happen with a very limited number of staff at the heart of these questions over the coming years. That will be no easy task. We in the Labour Party have said for many months now that the HSE needs to take over the board of CHI. We very much welcome the Minister's move in that regard. We urge her to move with speed on that issue. It is no silver bullet but it will be progress. Ultimately, the biggest question in my mind now is getting this inquiry right, getting the answers and making sure that systems improve at the same time. The people needing to provide the answers will also have to improve their act with regard to the services.

Verona Murphy (Wexford, Independent)
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Deputy Doherty missed his speaking slot due to a conflict with a committee meeting. I propose that he would take his four minutes with the agreement of Members. It will not put anybody out. It is the four minutes that we are ahead. Is that agreed? Agreed.

Pearse Doherty (Donegal, Sinn Fein)
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I thank the Ceann Comhairle and Members for facilitating me. We are here today because of the heroic efforts of the parents of children with scoliosis and spina bifida, because of their determination and because their love of their children. We are also here because they never stopped fighting tooth and nail. In particular, we are here because of the parents of Harvey Morrison Sherratt, Stephen Morrison and Gillian Sherratt. They found the will, even when grieving the loss of their son, to take on the Government. I cannot imagine the suffering they have been through or even fathom as a parent myself how to find the strength to keep fighting. They want to know how their son and many others could have been failed so badly by the State and why children continue to be failed in the most horrifying ways. The removal of Harvey from surgical waiting lists to be treated as a palliative care patient without any discussion with his family is the most recent, shocking piece of information to come to light. What else remains hidden? What other cover-up is there in the hope it never sees the light of day? Let us be clear: a public inquiry is no one's first choice. People want public services to work for the State to function properly. When things go wrong, people want a system that can respond. Instead we have a system that is threatened by transparency and allergic to accountability and that looks to protect itself at all costs. When all else fails, people expect the Government they elect to be on their side, not to turn a blind eye to their suffering; a Government that takes responsibility, not leaders that default to spin and deflection when people are crying out for help.

Eight years ago, Deputy Simon Harris, when Minister for Health, promised that no child would be waiting longer than four months for scoliosis surgery. That promise has never been delivered. It is a shameful chapter in this State and it is not over. How could this ever have happened? How could failure get stacked on failure without any accountability or action? The HSE was set up in 2005. It was billed as some type of innovation at the time. However, it created a buffer between the Department of Health and the Government on the one hand and the health service and the people within it on the other. At the time, Dr. Liam Twomey, a TD representing Fine Gael said: "One can only imagine the scapegoating that will be due to the CEO of the HSE when the Government fails." Last year, the then Taoiseach of this State, Deputy Simon Harris, fulfilled that bleak prediction. When it was put to him that he and his Government had actively, consistently and comprehensively failed children with scoliosis and spina bifida, that children's spines twisted and curved, leaving them in agony as little rib cages pressed against lungs making it more and more difficult to breathe, and that children were left waiting so long that they became inoperable, he said, "It was said to me by the then director general of the HSE that the executive would have put a plan in place to ensure that no child waited longer than four months." The Taoiseach of the day, a former health Minister, said he was only the messenger. Someone told him that they would make a plan and it was nothing to do with him. That is why we are here today. That is why we need a public inquiry. It is because of gross political failure, a failure of leadership. Children and families have been left with no option. A public inquiry is their only hope. It has to deliver the answers. It has to deliver accountability and real change. That is why the process needs to be fully independent of CHI and the HSE.

I commend every parent and family, every loved one of those children who have been failed by this State. We on this side of the House commit on behalf of Sinn Féin never to give up and to continue their fight.

Erin McGreehan (Louth, Fianna Fail)
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It important to speak on this issue on behalf of children and families who have been let down. I am devastated for them. Deputies across the House are angry and upset because what unfolded in our paediatric spinal service is not just some abstract policy failure. It is a human tragedy. It is a breach of trust. It is so profound that any parent would question how they would ever rely a system that left their own child waiting in pain again. I am glad the State is confronting this horrendous situation fully and, in particular confronting how we allowed children to suffer under our watch. I appreciate and respect the work the Minister is doing. She is clear and unapologetic in her statements. The country now knows of the heartbreaking story of Harvey Morrison Sherratt, a nine-year-old boy removed from an urgent spinal surgery waiting list without his parents' knowledge or consent. Parents were begging for answers that never came. Now those same parents live with their unthinkable grief. No parent in Ireland should ever fear that their child has simply vanished off a waiting list. No parent should be forced to battle a system that feels faceless, careless or evasive. No child should ever be left to suffer because of a broken system that could not protect them. That is exactly what happened.

In my previous contributions in this House, which I firmly stand over, I said that when the State asks families to trust us with their children, we must be worthy of that trust. In the case of Harvey and so many others, we were not. Now families across the paediatric spinal services understandably ask whether this will ever change. I know the Minister is committed to that change, to rebuilding that trust, to ensuring that our children receive the care they deserve. Progress has been made, additional clinics and a ring-fenced theatre, increased activity with 446 spinal procedures this year, reduced lists of long waiters. More children are being seen sooner. These reforms matter. I acknowledge the extraordinary staff who are pushing beyond all reasonable limits every day.

However, numbers will never balance the scales where there is the loss or ill treatment of a child. They cannot ease the fear, stress or the anguish families feel, watching their children deteriorate while surgery seems endlessly out of reach. Multiple reviews are under way, which the Minister highlighted them in her contribution. They will be important but reviews alone will not heal the trauma. Families need the truth, they need justice and they need a system that will not hide from the convenient ambiguity of fractured governance. That is why I am delighted at the Government's decision to move ahead with the full statutory inquiry, beginning with the facilitator to scope its terms of reference. It is not just welcome; it is essential. It must be thorough. It must place the voices of children and parents at the centre. We owe parents nothing less and we owe every family living in fear nothing less than reform. Reform cannot pause while the inquiry proceeds. Failures in communications must be fixed. The Minister noted these in her contribution as well. Clinical governance has to be tightened, not on paper but in practice.

No child must ever again be removed from a list without explanation and capacity must continue to expand so children are treated before harm becomes permanent.

I acknowledge the significant structural reform under way. In September, the Minister confirmed her intention to integrate Children's Health Ireland into the HSE. The decision follows careful reflection on the governance structures underpinning our health system, engagement with stakeholders and discussions with Government colleagues. It is really important. During previous contributions, Members spoke about how our faith in CHI had diminished.

Finally, I wish the Minister the very best as she takes on this work. This crisis was not of her making but it is absolutely in her hands now. I am confident she will bring this to a conclusion. I know she is committed to ensuring that families and children finally get the timely and proper care, as well as the answers, justice and decency that they deserve. While none of this is easy, the Minister has the determination to bring it through.

Cathal Crowe (Clare, Fianna Fail)
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I am glad to have the opportunity to speak on this issue. I apologise; I was gathering notes when I came into the Chamber.

I want to join others by referring to poor little Harvey Morrison Sherratt and all that he endured, as well as the arduous campaign his family have waged for justice ever since his death. It is very important to recognise that there is going to be the statutory public inquiry that they have long sought. I look forward to that getting under way.

I know these are statements, but at the end of these statements, the Minister gets to respond to some of the points raised. I hope she will give some detail. We have certain briefing notes on what is at stake and we have read about it in the media, but it is important that the Minister gives whatever additional detail she can about the statutory public inquiry. Do not get me wrong: these public inquiries are very important. This campaign ran across the summer. Justice for Harvey trended on X, formerly Twitter, for several weeks and it was also front and centre of all newspapers in this country.

A statutory inquiry is crucially important. It is central to the ask of the family and has been a central political ask in these Houses for a long time. How long will it all take? Unfortunately, there are many Harvey Morrison Sherratts in queues in Ireland. Their families do not know when their children will get this all-important medical care. They also do not know what it will look like, when it will happen or where it will take place. A statutory inquiry is important, but timelines and some parameters would also be helpful at this point.

A whole other body of inquiry and investigation is also under way. CHI has suspended surgeons and so forth. I do not want to get into the depths of all of that. However, that there are two sides to this. Unapproved medical springs were used and that has been well-documented. There has been an in-depth investigation into that issue and the Minister and her Department were very much involved in that.

While I am not going to name people here today, there is a body of parents, whom I and many other Members from both sides of the House have met, who feel aggrieved that one of the key surgeons that their children was on the list to see is no longer performing surgery in Ireland for many reasons. This issue has to work its way through due process and all of that. One issue mentioned to me was that at an Oireachtas health committee meeting that took place on 8 July 2022 someone shone a spotlight on a €90 million scoliosis fund, which was misused. These parents believe that this issue has been used as a stick to beat a certain surgeon. It is important to say that on the record.

In the Minister's summing-up at the end of this debate, I ask that she gives the House any additional detail she is able to regarding the statutory public inquiry. It would be very much appreciated. She has been in this job for nine or ten months and, like my colleague who spoke previously, I have full faith in her to fulfil her duties. This problem was not of her making but she will be the Minister who oversees the establishment of the statutory inquiry and please God the outcome of it.

It is very important that Harvey's family are not locked out of the process. When inquiries are set up, parameters become very rigid. This needs to be delicately handled and Harvey's family needs to be front and centre in everything that happens over the coming months. Ultimately, there also needs to be a strategy that is effective, that does not involve arduous waits and that ensures children who have scoliosis have a pathway to treatment.

Rose Conway-Walsh (Mayo, Sinn Fein)
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Let me make it clear: we have only reached this point of establishing a statutory inquiry into the failures in paediatric spinal care in Ireland solely due to the brave families and advocates who have forced the Government to act. I acknowledge that the Minister has listened to the families and they are taking it in good faith that she will do what they are asking her to do.

It should never have taken years of campaigning, media appearances and unimaginable heartbreak to secure a statutory inquiry. These families refused to be silenced. They deserve the truth and proper accountability. To do these families justice, this inquiry must be fully independent, legally underpinned and completely free from the influence of CHI and the HSE. There must also be compellability. CHI has resisted transparency for far too long. Only an inquiry with real powers that moves quickly, compels co-operation and establishes all of the facts can deliver the truth and rebuild trust in the system.

This inquiry stems from a broken promise made by Deputy Simon Harris in 2017 when he pledged that no child would wait more than four months for scoliosis surgery. Years of delays have led to disability for many children and for others, like Harvey Morrison Sherratt, it cost them their lives. Harvey should have had the surgery when he needed it. Instead, he and his family were failed again and again by a system that hid the truth. The revelation that Harvey was removed from the surgical waiting list and treated as a palliative care patient without any discussion or disclosure to his family is profoundly shocking. No parents should ever learn after the fact that the system, which was meant to protect children, effectively gave up on their child.

I again send my sincere condolences to Harvey's mum and dad, Gillian and Stephen. We are all mindful as we come up to Christmas how excruciatingly painful it must be for the family and other families as well.

Shamefully, Harvey is not alone. The Minister knows about Mikey Henry Benson from my constituency. I thank the Minister for meeting them on Monday, giving them time and listening to what needs to be done.

While the inquiry will cover the scandal of what has gone on in the past, we have to keep alive the children who are still alive today. They have been absolutely neglected, but they are alive and must be kept alive at all costs. We will work with the Minister to ensure that is done but there is a real urgency around what needs to be done. Other ancillary supports that are need for these family need to be provided as well in combination with the disability services.

Pádraig Rice (Cork South-Central, Social Democrats)
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I too welcome the establishment of a statutory public inquiry and the decision by Cabinet to appoint a facilitator on the matter. This public inquiry must have the power of compellability to establish facts. It must be independent and the voices of the children, their parents and families must be at the centre of this. Crucially, these families must get the answers to the long list of questions they have.

Public interest must be at the heart of this and nothing else. It must not be rushed, but it cannot go on forever either. Having looked at some examples of tribunals and commissions of inquiry, I have yet to find one where the State has got it right. There are real challenges in setting this up and getting one that is fit for purpose. There is a real challenge here to get a public inquiry that meets the needs of the families and parents, gets them the answers, does not get stuck in legalistic disputes with huge costs and runs for ages.

We need to learn from the lessons of the past in this regard. In particular, we need to learn from the Grace case and that commission of investigation. Inclusion Ireland published a damning report into that inquiry last month, stating: "From the outset the design and approach of the Commission sidelined and devalued many of those most affected by the issues it was considering." That cannot happen here. We cannot have the voices of the children and the families sidelined. The public inquiry must be fully human rights compliant, based on what is the best practice in other jurisdictions such as those identified by Inclusion Ireland in that report. Hopefully, that can be looked into.

When the Minister was talking about the issues in CHI, she referred to some of the reports published in the past two years. We have reports in this area going back to 2013. There was a report into the services for children with spina bifida that found major deficiencies in services at national and local levels, including limited co-ordination services. That report made recommendations for service improvements that were never implemented.

In 2017, the Ombudsman for Children's report found serious and ongoing violations of the rights of children waiting for scoliosis treatment. In response, the then Minister for Health, Simon Harris, promised no child with scoliosis would wait longer than four months for surgery. In 2023, the ombudsman published a report into CHI's care of Ivy, a child with scoliosis. It found numerous failings of governance and communication within CHI. Ivy had been waiting for spinal surgery for five years, during which time the curve of her spinal surgery went from 30°to 135°. The same year saw the Boston review, which found infection rates at CHI were way above international norms. In 2024, a follow-up report into Ivy's case was published and revealed that surgery had been delayed so long that Ivy was no longer operable. In 2025, an independent audit revealed nearly 80% of hip surgeries on children at Cappagh and nearly 60% on those in Temple Street were not clinically indicated, meaning potentially hundreds of children underwent unnecessary surgeries. In the same year, HIQA published a report into the use of unauthorised springs in spinal surgeries on children with scoliosis. It found there was no evidence of ethical approval and identified issues with culture, governance and internal communications. A report compiled in 2021, which CHI refused to publish in full, was leaked and uncovered bullying and a workplace culture with the potential to put patients at risk.

We also know there are outstanding reports. There is the Nagayam review into spinal surgery at CHI commissioned in 2023. The 2017 Dickson review into paediatric neurology services remains unpublished, with CHI rejecting its findings. We also have the audit into the waiting lists and equity of access the Minister mentioned. We have here evidence of over a decade of failure and findings that need to be implemented. We cannot have this inquiry stop this reform. All these recommendations need to be implemented and lessons need to be learned. That work needs to continue.

We also need continued reform of the culture within CHI. We know from parents and advocates about the issues around transparency and the culture in the organisation. Úna Keightley, cofounder of the spina bifida and hydrocephalus paediatric advocacy group said CHI is not an entity that values transparency, that it functions on a reactive basis to political, media and advocacy measures and that it does not follow any rules in terms of giving parents the information about their children. It knows parents have nowhere else to bring their children. I have seen this in terms of some of the parliamentary questions I have submitted to CHI. It refused to answer questions saying it was almost too busy to answer my questions. I sent them back and we had to push back on that. That is not acceptable. We need greater transparency and accountability from CHI.

We must not forget those children who remain on waiting lists for these services. There are 233 on CHI's spinal waiting list and 139 on the active list, up from 112 in January, and 45 waiting longer than six months, up from 37 in January. Just five children are listed for surgery abroad. In total, only 19 children have availed of surgeries abroad. I want to know why this is so low. The Minister said it is a source of frustration but we need more than that. We need to know why it is not happening and every mechanism and tool at our disposal needs to be used to ensure these children get the surgeries they desperately need. They cannot be left waiting months and sometimes much longer.

The children affected by unnecessary hip surgeries cannot be forgotten. It is welcome that the multidisciplinary team meetings moved ahead. However, there are concerns about the delay with the external review panel. That cannot be delayed too long. There are also concerns about the lack of accountability and transparency. The Minister said in July regarding referrals to the Medical Council that her Department had written to the HSE to clarify the matter and the HSE had contacted CHI. Will the Minister update us on those referrals to the Medical Council? What is possible in relation to those cases? We need greater accountability. Legislation for accountability is crucial. That is a part of the Sláintecare reforms that was never done. It should be done.

My thoughts are with the families and children affected. As time goes on, they have more questions than answers. Harvey Morrison's parents are an example of this. They want to know why Harvey was removed from the surgical waiting list. Was it a clinical error or a clerical error? How could this have happened? How many children and parents in continuous contact with CHI have been forgotten? Why were these children failed? Who is to blame and who will be held to account?

Sinéad Gibney (Dublin Rathdown, Social Democrats)
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I welcome the opportunity for statements on this topic though I pushed for this to be questions and answers rather than statements given the sprawling nature of the issues that surround CHI. I want to cover three key points: the human impact on these families, the constant crisis, which is unnecessary, and the fact we seem to want to hide from our failures instead of addressing them as a State.

It is important to spend some time reflecting on the human impact and the realities of the long and painful wait for spinal surgery in this country. These children are left in limbo and are denied the opportunity to enjoy their childhood and have the best possible chance at life. Long waiting times have resulted in children no longer being able to get surgery because their condition has progressed so much. They do not get to enjoy school, playing sport or hanging out with their friends without the worry of medication, pain and hospital appointments, or, even worse, no hospital appointment at all. My heart goes out to the family of Harvey Morrison Sherratt and all the children and families who continue to be affected by a lack of care for scoliosis and spina bifida. They deserve better from this State and we must deliver better.

This constant crisis is unnecessary. In the face of repeated failures and the promise years ago from Deputy Simon Harris that no child would wait longer than four months for surgery, and in every new revelation about how these children and their families have been let down, most frustrating is that all this suffering is entirely unnecessary. We are an incredibly wealthy country with billions of euro going into our health service. We have a national focus and public backing for issues to be addressed. We have a plan to fix the problems in our health system and to introduce an efficient, public and robust healthcare system in Sláintecare yet we still have children becoming inoperable because they have waited so long and children in pain while their families watch on given we seem to want to hide from our failures instead of addressing them. Children's Health Ireland has been plagued with scandal, with each new detail worse than the last. We have clear systemic problems in our health service when children are being implanted with non-medical grade devices, when unnecessary hip surgeries are performed on children and when children who do need treatment cannot access it or are removed from waiting lists without their or their families' knowledge. These revelations came out piece by piece. We need a public inquiry that delivers for those affected and the publication of all reviews. We should not have to be here to talk about what we can do to give these families justice and services. They should have received timely care but it is left to us now to deliver on the broken promises and ensure change.

I am very familiar with the Commissions of Investigation Act and agree with my colleague that it has not yet yielded enough examples of human rights-compliant commissions of investigation, public inquiries or tribunals. It is up to the Government to use that legislation in the right way and meet the standards and obligations we have to be human rights-compliant in this inquiry.

Naoise Ó Cearúil (Kildare North, Fianna Fail)
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I acknowledge the Minister's ongoing efforts relating to this emotive issue, particularly in relation to CHI. I thank her for her help with some constituents in Kildare North and her work with the families. It is important that is acknowledged. However, it is incumbent to speak of the hundreds of children still waiting for spinal operations that are time-sensitive. In October, CHI reported 223 children on a spinal surgery list. Around 140 of them are actively waiting. That means they are ready for surgery but still have no date. Some children have been waiting more than 18 months. A very small number have waited more than three years. For a child, three years can change everything. No one should spend their childhood waiting for essential surgery.

These delays are not just numbers; they are children in severe pain. They are nights when a child cannot sleep comfortably, school days missed, opportunities lost and parents watching their child struggle while feeling they cannot do anything to fix it. Families are trying to stay hopeful but long silences, sudden cancellations and mixed messages take a huge emotional toll.

I recognise that progress has been made. CHI has increased throughput. The spinal surgery management unit has been established to strengthen co-ordination. Additional surgeons, nurses and specialist staff have come on board and new theatre spaces and a new MRI have helped speed up care. Children have been sent abroad when needed and that has offered timely treatment for many families. These steps matter and I welcome them but progress is still uneven. Capacity has improved yet cancellations continue to disrupt families. Communication gaps leave parents unsure and anxious and too many children continue to wait far too long for surgery that could prevent long-term deterioration.

When a surgery is cancelled at short notice, it affects children and their families and their sense of trust in the system. If we want to fix this properly, we need four things: accountability for delays; full transparency about waiting times and cancellations; clear communication so families know exactly where they stand; and follow-through on our commitments to reduce long waits. Promises must become practice.

This is not about blaming staff. Ireland has outstanding clinicians who want to give all children the care they deserve. They need a system that supports timely planning, consistent scheduling and clear, reliable pathways. Children only get one childhood. We cannot let long waits define or limit it. If we stay focused, support the health service and its staff and work with families, we can build a spinal service that is timely, transparent and fully centred on the child. We owe that to the children waiting today.

One image that will stay with me was tweeted by Harvey Morrison Sherratt's mother, Gillian, this morning. It was of his bedroom door. As I have a nine-month-old child at home, it really shook me and I cannot imagine the pain she is going through. It is important that we all think not only of Harvey but of the other children who have been affected.

As I said previously, I thank the Minister for her work. A lot more can be done.

Verona Murphy (Wexford, Independent)
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Before Deputy McGuinness begins, I welcome members of the Dublin Chamber who are here as guests of Deputy Devlin.

John McGuinness (Carlow-Kilkenny, Fianna Fail)
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This scandal has gone on for years under the noses of the Department of Health and all those involved in what should have been the management of a serious issue. Nothing was really done during those years to encourage parents to engage with consultants and hospitals to ensure there would be early intervention for them. We have seen failure after failure and nobody is held to account. In that time, we have seen significant money being allocated to the Department of Health and all to no effect. We are now talking about more action and more people being involved in the management. This is a failure of the Department of Health and those who work in administration of the hospitals and so forth, and a failure to look after young people who deserve a hell of a lot better.

I cannot express my position any better than Claire did when she wrote to me about her son, Darragh:

At Darragh's outpatient appointment in November 2024, I asked directly whether he could be considered for surgery in New York, London or the Blackrock Clinic. I was told emphatically "No". In the months that followed, Darragh underwent all required pre-op assessments, which were completed and signed off in early 2025 confirming he was ready for surgery and despite that, no date was set for that surgery and no further information was provided. His clinical plan was for surgery to take place before Easter 2025. That was considered the timeframe for the best possible outcome. That is why it mattered. This is a child that has already been brought through so much. He deserved the chance at a best outcome, but that chance has now been lost. As a result of the delay to surgery, Darragh's spinal condition has progressed. He now has a worsening lower curve while the upper portion of his spine has become auto-fused. At his most recent appointment, I was informed that the section of the spine can no longer be surgically addressed due to its complexity.

I find it harrowing that a mother would have to look at her child going through this and then for that child not to be able to have the surgery that is required. Claire goes on:

To make matters worse, I have learned that visiting spinal surgeons from Morgan Stanley were in CHI, not only on 31 March and 1 April 2025, but also in December 2024. These were at least two clear opportunities to put Darragh forward for potential care on an international pathway and both were missed instead. When we attended the clinic on 3 April, we were told plainly that there is no date and there is no timeframe for surgery. That is not waitlist management. That is abandonment.

I agree absolutely with Claire. I have mentioned Claire, but there are many mothers like Claire and many sons like Darragh fighting to have their cases heard and to have the surgery that would make life very different for them. Claire continues:

I also know that not one child under the care of the Temple Street service has accessed surgery at the Blackrock Clinic via CHI in the past years. That is a deeply troubling fact. It means that a large cohort of children, entirely based on the CHI site they attend, have had no access to major outsourcing initiatives. This is not equity. This is not national planning. This is exclusion. This causes a fundamental and urgent question. What is the pathway for access to Blackrock Clinic, Morgan Stanley and Great Ormond Street Hospital? Who decides which children will be selected? It feels like my lovely son was simply overlooked, forgotten and that is something no parent should have to live with.

I can point to a second case, again in Kilkenny, in which the operation was carried out in 2004, which Deputies might say was a long time ago. Conor was seen in 2004 when he was four. Then in 2009 he had surgery. In 2013, he was seen again. Surgery was promised in 2014. Now he is starting to fall out of the system and he has still not got the surgery required for the problems he is now experiencing. I want the Minister to take note of this. When his mother went about getting the information from 2009 and the various other dates from then to now, she was made to ask for that information through all kinds of avenues. She got little or no help. No one reached out to her. No one understood or wanted to understand what she was trying to achieve. Now, this young man has carried the problems of his childhood through his teenage years to his life as a young man. How is that right? There is nothing the Minister can say to these parents this evening that will satisfy them in the context of dates and times and the reduction of the waiting list. However, I encourage her to read her emails. These emails have been sent to her by the parents. I urge her to respond, engage and prevent further pain for the families.

Louise O'Reilly (Dublin Fingal West, Sinn Fein)
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I welcome the opportunity to make a small contribution to this debate. I pay tribute to the parents of Harvey Morrison Sherratt, people like Claire Cahill of the Scoliosis Advocacy Network, the parents of Mikey and all those campaigners who time and again have brought to the fore the issue of the scandalous treatment of children with scoliosis. We should not know the names of these children. They should be able to live their lives in peace and not have to continually waive their anonymity and beg for every tiny bit of attention to get the treatment they need.

Families have been advocating, as I am sure the Minister will agree, for far too long. I imagine they are worn out. This issue is not new. This is not even the first or second scandal that relates to this area. Children have been utterly failed by the State and successive governments. When I looked back at the record, I saw that the first time I raised this was in 2016.

In 2017, I debated this matter with the then Minister for Health, who is now Tánaiste and Minister for Finance. The debate started with a reference to the great efforts of campaigners like the Scoliosis Advocacy Network. The staff in RTÉ were thanked for highlighting the issue. The then Minister thanked me for raising this serious matter and for giving him an opportunity to update the House. This, of course, was following on from an RTÉ programme. As often happens, people have to go to the media to bare their soul to get any attention from the Government. The then Minister for Health, Deputy Harris, continued:

I assure colleagues that improving scoliosis services is an absolute priority for both me and the Government. I am monitoring closely - indeed, on a weekly basis - the progress being made on addressing waiting lists

He said that "the HSE and the Children's Hospital Group have confirmed that they are committed to ensuring that no child will be waiting over four months". I emphasise that the then Minister for Health said that he would be monitoring the waiting lists not on a monthly basis but "on a weekly basis". What happened? The attention of the Minister was right on this "on a weekly basis". He confirmed it in the Dáil. What happened? Hopefully the inquiry will get some answers because parents have waited for far too long. They have been let down by far too many health Ministers and I really, genuinely hope that they get the answers that they so desperately need.

Paul Murphy (Dublin South West, Solidarity)
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I welcome that we are finally going to have a statutory inquiry into the care of children with scoliosis and spina bifida at CHI. It is unfortunate and outrageous that it has taken what it has taken to get to this point where we have an inquiry. Campaigners have been calling for one for a long time, as have some of us in the Dáil. It is not just about the hundreds of children who have been left waiting in pain, getting worse and in some cases becoming inoperable; it is not just about the scandal of the unnecessary, unlicensed, non-medical grade, non-medical devices - springs - being inserted inside children; it is not just about the death of Harvey Morrison Sherratt after having previously been wrongly taken off a waiting list; and it is not just about the outpouring of anger we saw on the streets at the end of the summer around the idea of justice for Harvey, which represented the idea of justice for all our children who are being failed, in particular by CHI but also in general by the State. It is also about the really horrifying revelations from a whistleblower about the treatment of Harvey and the idea that he was palliative, and yet nothing seemed to happen in palliative care, and about what we heard at the weekend - that Harvey was "not fit for a sneeze", which is an awful way to speak about a young child. It is awful that parents have to hear it and then speak out about it.

I pay tribute to Gillian and Stephen for speaking out, obviously at a moment of immense grief, and to all the campaigners and advocate groups who have been pushing for so long for justice and answers when they really should not have to. For me, the key issue in the inquiry is that it is done and that it is co-designed with the agreement of families and advocacy groups. I understand that they want to see a tribunal of inquiry that happens in public, with powers of compellability and all of that. If we could have a reassurance that this will be the approach of the Government, that would be welcome.

I want to raise some related issues. I ask the Minister about the status of the Nayagam report. I got a parliamentary question reply in October saying that this started in September 2023 - we are now in November 2025 - and that "the risk assessment aspect of the review has been completed and is being considered." I ask the Minister if the risk assessment will be published in full and not be redacted. The Nayagam report obviously relates to a particular surgeon. We should not be limiting an investigation of what happened to children. I have been contacted, as I have mentioned twice on the Dáil record before, by an adult patient of this surgeon with many concerns. I am obviously not qualified to say whether there were problems but at the very least, given what we know, adult care also needs to be looked at.

I also want to ask about Cappagh hospital being fully included. I previously referenced the email from the clinical director at Cappagh hospital about ending the multidisciplinary teams, MDTs, because of osteotomies not happening. I got a new parliamentary question reply saying that hip dysplasia and osteotomies are still only going back to 2010, even though we know that these novel osteotomies go back to 2002. It makes no sense to me.

On another issue, the Minister might help me to get parliamentary question replies. I tabled parliamentary questions in early September about diffuse intrinsic pontine glioma, referred to as DIPG, a form of very aggressive brain tumour, and the number of biopsies that are happening. I am still waiting for answers to those questions from the HSE. It has come to my attention that Ireland may be doing an unnecessary number of these biopsies. There are many biopsies when other countries are not doing them, potentially with fatal results for children, so I am looking for answers to those questions.

Ruth Coppinger (Dublin West, Solidarity)
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I am in a small party so I do not get as many speaking opportunities on this issue as other, bigger parties, but I have been in here many times asking for a public statutory inquiry from the word go. I have known Gillian and, particularly, Stephen for just over a year, from before the tragedy with Harvey. We have to learn lessons from this because time and again, on so many issues, parents and relatives have had to campaign for years and years for justice on these questions. I remember saying that we would be in here and we would have a statutory inquiry. It should not have taken the death of Harvey to get this, because I wonder, had he not died, if we would still be here asking for this. We have to be honest about that. What if the whistleblower had not spoken out?

I want to make a quick point about the inquiry and about the waiting lists. Participation in the inquiry has to be mandatory. Importantly, because this has been raised by parents, children who were affected by this should be allowed to testify. Many of them are older now and they should be listened to. That is really important. If issues are found in the process of the inquiry, they have to be dealt with there and then. You cannot just wait until the end of the inquiry because we all know that it could take some time.

Parents have raised this. Does the Minister still have faith in the spinal task force, given how badly it has failed in its role? The paediatric spinal task force group was explicitly created to decrease the waiting lists. It had its first meeting in May 2024 and at that time there were 246 children on the waiting list. In October 2025, there are 223 and another 139 actively waiting for surgery. It has failed in its objective. It was complemented by the paediatric spinal surgery management unit. It is hard to get your head around all of these terms. That was meant to be in charge of managing spinal surgeries. That is the unit that is directly implicated with Harvey falling off the list. Whether it was a clinical error, as the whistleblower claims, or whether it was an administrative error, as a newer report claims, is irrelevant. That group of people still failed to treat Harvey. There are other examples of incompetence there, with ten children who were crossed off the waiting list by somebody under orders. That person apparently was disciplined for that when they were actually just carrying out an order.

Other children have been harmed, as Harvey has.

I also want to raise the issue of staffing, although I will not have time to raise all of the points. It is very hard to fill posts throughout the care system, as we know. Of 52 approved posts, 34 have been filled. Is this another problem that we have? There is also the culture of staffing. Anyone using the term "not fit for a sneeze" should not be working in the health system, or it should be taken up with them how acceptable it is for people to talk like that.

As to what needs to be done very quickly to bring down the lists, two things were raised: either requisitioning space in other hospitals in the private health system, which is packed to the gills with equipment and money, or sending children abroad. Yet, we find that only two children were sent abroad for treatment despite a ministerial order to give all parents that option. It has to be questioned why the lists are still so high after all this time.

Martin Daly (Roscommon-Galway, Fianna Fail)
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Every one of us in the House has met families whose lives have been shaped by scoliosis or spina bifida. These are families who do not have the luxury of waiting until next year for improvements. They need treatment now. As a GP, I have seen how timely spinal care can change the entire trajectory of a child's life, and that perspective shapes what I want to say today. Yes, progress is being made, but we have a long way to go before any of us can be satisfied. We need to be honest. Too many children have waited too long for spinal procedures. While some indicators are now moving in the right direction, nobody should pretend that the job is done or that families can suddenly feel reassured. They do not, and I do not blame them.

Up to the end of October, 446 spinal procedures were completed, slightly more than last year, but demand is rising even faster. Some 462 new cases have been added to the list this year, which tells its own story. We are adding cases more quickly than we are clearing them. Nonetheless, there are improvements. Some 68% of children are now waiting less than six months compared to 56% a year ago. The number of those waiting over a year has halved and outpatient lists have fallen by almost 50%. These are signs of a service that is trying to pull itself out of a very difficult period, but it is also a reminder that the gains are fragile and that the system is still heavily stretched, especially when one retirement or one ICU bed shortage can derail a week’s worth of surgeries.

I welcome the hard work of clinicians, the spinal management unit, the multidisciplinary teams and the new transition pathway for adolescents because it is their efforts that are turning numbers into reality for families. However, I will also say this. They need more support, more capacity and more consistent communication structures. Families cannot be left chasing letters, clarifications and updates. The various reviews, the HIQA report, the Boston review, the internal examinations and the ongoing Nayagam review are not comfortable reading, nor should they be. If anything, they show that oversight did not come soon enough. The audit into governance and equity of access is essential and, frankly, overdue. Families deserve transparency, not a maze of inconsistent processes and varying standards. The planned statutory inquiry into spina bifida and complex scoliosis services is a necessary step. It is not a tick-box; it is not a gesture. It must be a turning point.

I want to acknowledge the families and advocates whose persistence has brought us to this point. They have shown more courage and patience than any system should ever demand of them.

As for the integration of CHI into the HSE, it may well be the right long-term move, but let us be clear: structure alone will not fix culture. Governance changes must be matched with accountability and day-to-day improvements must be felt by real families. Progress is real but it is not enough. We need more theatre capacity, more consultants, better planning for surgeries and demand, and communication that treats parents as partners, rather than supplicants. If we want families to regain trust, we have to earn it. As a GP and someone who believes the health system should serve the most vulnerable first, I will continue pushing for urgency, honesty and accountability because these children deserve nothing less.

Catherine Callaghan (Carlow-Kilkenny, Fine Gael)
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I acknowledge the work of the Minister, Deputy Jennifer Carroll MacNeill, who, since she became Minister for Health, has been proactive in tackling many pre-existing inefficiencies in the health system. It is also important that I acknowledge and recognise the very hard-working staff within our hospital system. None of what I am saying is a slight on those dedicated and committed members of the hospital network, the HSE or CHI.

It has been apparent since Deputy Carroll MacNeill became Minister for Health that she is actively driving multiple efforts to address the challenges that have been ongoing in relation to paediatric spinal surgery waiting lists. I know from conversations we have shared that the Minister met with the HSE and the CHI board and executive in August and September, and that she was very clear in ensuring that everything possible must be done to reduce the amount of time children are waiting for procedures. I am heartened to know that further meetings will be taking place and are scheduled.

At the end of October, 68% of patients on the active waiting list were waiting less than six months, which marks an improvement from this time last year, when 56% of patients were waiting less than six months. However, any time a child is waiting for spinal surgery is too long and, therefore, I have to share the following example with the Minister.

A young child in my constituency has been recommended for surgery for over two years. They had pre-operation appointments in early 2024 and 2025. They were offered surgery abroad and were due to travel to New York for spinal fusion last March. However, the child's parents were then advised by the medical team that surgery in Ireland was in the patient's best interests. The family was assured that surgery could be and would be completed by summer 2025 because the child is only ten years old and was, therefore, classed as a priority case. In June, the family was informed that before spinal fusion could take place, additional surgery was also needed, even though this was first identified by MRI in 2019. That is a wait of six years before the surgery happened. I am happy to report that the surgery was successfully performed on 1 July, and by August, the child in question was ready for spinal fusion. A date for surgery was confirmed for last week, that is, not the end of summer 2025, but in November. Unfortunately, four days prior to that surgery date, the surgery was cancelled. That was due to an emergency case, which I can appreciate, but no further plans or details were given to the parents. We can imagine the feeling in the family at that time, and the child asking, “Why am I not an emergency case? I have been waiting so long.”

Children and parents like the ones I have just spoken about are at their wits’ end. I appeal to the Minister to keep up the drive that she has brought to this role and to ensure her ambition is carried through. I understand it is a challenge, and I recognise the work she has done up to this stage. The children of Ireland need that drastic change to happen at speed so they can access the treatment they so desperately need. The prolonged waiting needs to stop.

Thomas Gould (Cork North-Central, Sinn Fein)
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I want to express my sincere condolences to the family of Harvey Morrison Sherratt. While he was failed by this State, he was very lucky to have such loving, strong parents, Gillian and Stephen, who fought and did everything they could to get him the treatment he needed. Unfortunately, it was too little, too late, but they continue to fight for all children like Harvey.

Before coming to the House today, I rang a constituent of mine who has a son with scoliosis who is in a wheelchair. I want to let the Minister know that these are issues that are coming directly from people on the front line. Her child does not qualify for scoliosis surgery because the curvature of his spine is not considered severe enough to join the waiting list. If he lived in England or America, he would be on the waiting list for surgery.

From what I am being told by parents, the criteria for children are too strict. The most severe cases are on the waiting lists but these children are left waiting for months, if not years, for urgent treatment and surgeries. The boy’s mother believes early intervention will give him the best opportunities in life and the best chance to correct the curvature of his spine. The system is in chaos while parents hear about scandals over springs and hip operations. How can parents trust the clinical decisions they are hearing about right now? The woman’s son is losing out because he was born in Ireland, and he is also losing out because he was born in Cork. I will explain why. He has two choices at home: to be in his wheelchair or to be in bed. There is nowhere else for him to be. He does not have a second chair, a specialist chair, in which he can sit, watch television, have meals or play games. What kind of system are we running when a child who uses a wheelchair cannot access another suitable chair? These are basic necessities for children who have disabilities. This is all wrong. How are we running the health service like this? It should be based on need, dignity and clinical decisions, but instead it depends on where someone lives. Is it a postcode lottery? This parent told me she knows of other parents whose children do have access to the equipment I have mentioned.

The Government should be ashamed of itself over how it has acted and treated these children and their families. Yesterday, we were in here and Simon Harris, the man who broke his promise to them, gave himself another promotion, to the position of Minister for Finance, but the only legacy people will remember is one of broken promises and his failure of the most vulnerable children in this State.

Michael Collins (Cork South-West, Independent Ireland Party)
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Our health system has failed some of the most vulnerable children in the State. In 2017, a clear promise was made that no child would wait more than four months for spinal surgery. That promise was broken, with devastating consequences. Right now, 139 children are actively waiting for spinal surgery this year. Four hundred and forty-six surgeries were completed, yet 462 new patients joined the list. We now know that the pledge of four months was based on assurances given to the then Minister by HSE leadership and senior officials at CHI, who told him the target was achievable. Those assurances were wrong and parents paid the price. The tragic death of Harvey Morrison Sherratt and the allegation that he was removed from the waiting list because he was deemed palliative have shattered public confidence. His parents have been clear that they want a statutory public inquiry with full powers to compel evidence and broad scope to uncover systemic failures over decades, accountability in respect of those who made harmful decisions, and above all, real change with ring-fenced funding, stronger governance and a national spinal treatment service so no child will suffer like Harvey did. The Government has now agreed to an inquiry, but this cannot be a box-ticking exercise; it must be family led, transparent and fearless in exposing the truth. When it concludes, its recommendations must be implemented, not ignored. I ask those on the Government benches to commit to implementing in full every recommendation of the inquiry and guaranteeing ring-fenced funding and a timeline for reform. Anything less represents another broken promise. There can be no more broken promises and certainly no more preventable tragedies.

Richard O'Donoghue (Limerick County, Independent Ireland Party)
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The Minister came to Limerick and we opened the 96 beds. I welcomed it. We now have options A, B and C, which we were looking for in Limerick for the care of the people of the mid-west. Developers have come to us saying that if the State does not have the money to build the facilities, they will build them for it and sell them back for €1 after 35 years. The reason I am saying this is that I hope our new Minister for Finance, who was in the position of the current Minister for Health and failed in it in areas where she is excelling, will not stop the funding for the delivery of healthcare. I hope a political situation does not develop in which the Minister for Finance sees the current Minister for Health as a threat to his leadership and also fails in this respect. We now have a chance to deliver infrastructure for the people of the mid-west and the rest of Ireland if the Minister for Health is allowed to put procedures in place whereby we can have buildings in which we can actually care for people. I do not want money to stand in the way. I want delivery on budget and on time, and I believe the Minister can deliver in this regard. I hope nothing stands in the way. If the budget does not allow for it, there are people who will develop the projects for the Minister and give her the infrastructure she needs to ensure the delivery of care for people in a short length of time.

Ken O'Flynn (Cork North-Central, Independent Ireland Party)
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I have been 18 years in public life, having served as a city councillor in Cork and as a TD for almost a year in this House. Not a day or week goes by when I do not meet a parent with a child with a special need or difficulty, or a child in need of an operation. They are put to the pins of their collars and are desperate. Although I am not a parent myself, I see from my brother and in-laws how they rear their kids. They would kill for their kids. If you could take on their pain, you would. I see parents struggling to secure operations, services and attention that their children need, and also trying to meet the social welfare criteria, and then I hear excuses in this House about dissatisfaction with the numbers sent to Great Ormond Street or elsewhere. This has been going on since 2012, over ten years ago. In September 2023, safety and governance were raised. In 2012, concerns were raised about the hospital. In 2016, failures regarding the pledge of four months were first noted in this House. This goes on and on and on. I welcome the inquiry and I wanted it. We agreed we would have it, but it must have teeth and finish, and there must be accountability. The assurances the Minister gave this afternoon will not help any parent worrying about a sick child to sleep well tonight.

Paul Gogarty (Dublin Mid West, Independent)
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It is good that we have the opportunity to make some statements, particularly after the announcement that a tribunal of inquiry is to be set up. It is welcome news, but I will be very interested in the terms of reference when they are on paper and when we have sign-up involving all the families and children involved. We may have made some progress in reducing numbers, but more children are joining the lists and at a faster rate. There have been questions about why children were bumped off the list before. They have not been answered and there is no accountability. In my previous contribution, I mentioned parents who have had legal action threatened against them for trying to advocate for their children. Unless these issues are dealt with concurrently with the tribunal, we are going to have problems.

I want to talk about some of the demands made by the children with scoliosis and spina bifida and their parents: children who have aged out of services must be included; there should be a transition pathway for scoliosis and spina bifida; the consequences of neglect by CHI should be addressed; children who have passed away must be included; there should be power to compel persons to provide evidence and provide documents; and healthcare reforms must be implemented while the inquiry is ongoing. I hope these can be dealt with.

Peadar Tóibín (Meath West, Aontú)
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In her opening remarks, the Minister said her door was open to TDs to bring specific cases to her attention. I have engaged with her Department on, for example, the case of Mikey, who was so long on the waiting list that he aged out. The Department shut the door on me and said it was not its place to intervene with clinicians regarding the care of children. That is one problem.

Second, if we are honest, the Minister has for several months been stonewalling those asking questions on this issue. It has been 14 months since I raised the question of Harvey Morrison Sherratt’s removal from the waiting list. I asked how many other children have been removed from the list and the Minister told me she would answer that question soon.

She said in October that she would answer the question in November, but that question has not been answered as of yet. It is absolutely startling that information is still not available to people at this time. When will the Minister let the Dáil know what is happening in this regard? I asked why CHI has not published its 2024 annual report on its accounts and spending. I have also asked questions around the funds for surgeries for children abroad and why no one on that list at the moment is scheduled for operations abroad. In all the months that we have been talking about CHI, the situation is actually getting worse for so many families.

We in Aontú have difficulties regarding this inquiry and, first of all, how it refers to complex scoliosis. There is no definition of complex scoliosis in the document so far and we are worried that this is an attempt to water down the number of children who will form part of that inquiry. I am also disappointed that the statement announcing the inquiry was first seen by the advocacy groups of these children in the media.

How many children have been removed from CHI waiting lists without their parents’ knowledge? I will ask the question again: how many children like Harvey Morrison Sharrett were wrongly removed from the waiting list? How many children have died while awaiting surgery in this country? How many children have been removed from the waiting lists without surgery having aged out? Outside of the inquiry process, will the Minister commit to furnishing this House with that basic information and detail, which should be available at any stage to any TD who is asking a parliamentary question of the Minister? The Boston report said that one child went back for 33 surgeries but, because of CHI data, it looked like 33 children were operated on. There is a lot of confusion and a lack of transparency in relation to these figures. Given all that has happened here, the very least that the citizens of Ireland, elected representatives and these families themselves are entitled to is transparency.

Gillian Toole (Meath East, Independent)
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Níl a fhios agam an mbeidh mo chairde sa tSeomra i gceann tamaill. I thank the Minister for her update. It was very comprehensive. I was here earlier but I had to step out for a while. I will confine my comments just in case my colleagues thunder in, but I can jump back if necessary. I will consider five As, like an A rating. The first A is that consideration be given – the Minister has even addressed one already – to the asks of the parents and advocates of the children. The second is to acknowledge the conscientious and hardworking healthcare professionals already involved over the past 13 years, and probably longer. The third A, which is probably the most serious and one, to my science background mind, I consider the common denominator no matter what subject of healthcare we discuss here, is to always get the why. What has happened and, more importantly, why has it happened? It is that issue of accountability, particularly the accountability of senior HSE management. If we look at the mission statement and values of the Health Service Executive, they are listed as care, compassion, trust and learning. We have had a breakdown on several fronts in that regard. That is a key area. The fourth A is action. Again, that is linked to the first A, namely, the asks. I ask the Minister to consider the 2024 scoliosis Bill brought forward by Senator McDowell because the accountability is built in. The fifth A is, to go back to the beginning, to acknowledge the efforts of the Minister in a short space of time against a system that is stacked against her.

Mattie McGrath (Tipperary South, Independent)
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I am a bit out of breath but I am delighted to be able to speak on this. I am delighted go bhfuil an tAire anseo and listening to the debate. It is very important. This has to be sorted out. I raised today during Questions on Policy or Legislation the issue of CDNTs in Clonmel. They are so depleted. There have been 11 staff vacancies there for years. I said mol an óige agus tiocfaidh sí. There are children who have varying degrees of needs - some with very little - in need of assistance. This scoliosis issue beggars belief. It is such a profound, challenging illness that is so obvious to parents and everyone.

Some years ago, when this was debated, there was some proposal to send children and patients to America by aeroplane. Obviously, that was a no-brainer given they could not travel by aeroplane because of their condition. I suggested at that time that if we were serious about this, we would get some specialist surgeons from the United States or wherever and bring them here to deal with the backlog and waiting lists. I do not have to remind the Minister of what her party leader and current Tánaiste promised and what happened there. Money went in and it was ring-fenced, but it turned out it was not ring-fenced but, rather, was used up elsewhere. What kind of out-of-control HSE health system do we have? It seems to totally lack in compassion and empathy. There are many good people involved. My late brother was a paediatrician of some renown and he cared deeply. I know many health people do but it is the management. “Management” is such a bland word. How can these systems be so callous and unempathetic in how they deal with people on a daily basis? How can they see a problem and just walk away from it? It would not happen on farms. It would not be allowed to happen. It is so devastating for families. We saw loss of life and how files were wrongly entered or classified. It is so simple to say that but it is so deeply hurtful, sad and troubling to parents, anyone with a heart and anyone who is human.

The HSE is not fit for purpose. It has not been for a while. CHI is not fit for purpose by any means, nor is Tusla, but we keep piling on, giving them more and more money, adding more directors and letting them all have big fancy titles while the basic, decent humanity of a required surgery cannot be done in a timely manner. If we do not have the expertise here, we should be importing it from abroad and trying to show some compassion. Otherwise, we should fold up our tent in here and go away. We are like a Third World country. It is shocking. It hurts me deeply to have to talk about it.

Ruairí Ó Murchú (Louth, Sinn Fein)
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Más rud é nach bhfuil fadhb ag duine ar bith, tá muid ag dul ar ais go dtí Sinn Féin leis an Teachta Ward.

Mark Ward (Dublin Mid West, Sinn Fein)
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I wish the Minister well as she tackles this issue. There is no one on any side of the House who does not want to see children get timely access to the care they need. I commend the advocates who have long been calling for a statutory public inquiry into spina bifida and complex scoliosis services. I cautiously welcome the fact the Government has agreed to this. The reason I say I cautiously welcome it is because the terms and references have to be spot-on in this. We have all heard about the unregulated springs used in operations of children and the unnecessary hip operations, so we need to find out from a governance level what actually led to these failures in the first place so that they do not happen again. We simply cannot allow the wreckage of the past and a toxic culture in CHI to take hold in a new CHI hospital.

The scope of this public inquiry must not be too narrow. We do not need to see little bits of the jigsaw but, rather, the whole picture. The public inquiry must look at this and it must be able to compel people to appear to simply get the answers. Documents must also be compelled to help the inquiry. The facilitator appointed to consult stakeholders must be independent and he or she must ensure that no cohort or particular group of children are left out of this process. We need to have an overall view of the care children have received. This includes an investigation into the deaths of children and whether these deaths are linked to waiting on scoliosis surgery. The inquiry must also look at children who have post-op complications, including infections. The inquiry also needs to look at HIQA’s role in all of this and why it did not sound the alarm bells sooner. We need to see full accountability.

The tribunal should be able to issue recommendations while it is ongoing. That is what the advocacy groups have been calling for. While the inquiry is ongoing, these recommendations must be implemented in a timely manner.

It would be remiss of me if I did not mention the tragic death of nine-year-old Harvey Morrison Sherratt. I have got to know Harvey’s parents, Stephen and Gillian, over the last couple of years. They have tirelessly campaigned, both before Harvey passed away and since his untimely death, for better healthcare for children. Last year, I asked in this House why Harvey was removed from the waiting list without his parents’ knowledge. Today, as we speak, Stephen and Gillian still do not have an answer to this.

We have seen reports from a whistleblower - reports I know the Minister is well aware of - stating that Harvey was removed as CHI deemed him to be palliative. This is totally unacceptable. We just need to get to the truth of this matter. Why was Harvey removed from the list, who knew about it and when did they know about it? This is about what happened at CHI level and at Government level. It is not about a witch-hunt or anything like it. It is just about finding out what happened so that it does not happen to another child. Harvey's case must be a reminder that management and political failures have real-life consequences. We need to see full accountability. The statutory inquiry should be how we finally get justice for Harvey.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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I want to try to address all the points, but there is a time limit. Let me try to address a couple of things quickly, and then some of the more detailed issues. In relation to the 2024 annual report for CHI, the annual financial statements are with the Comptroller and Auditor General. The intention is for it to be published by the end of the year.

Forgive me, but I cannot recall who mentioned infection rates. It is importanto acknowledge that there has been significant difficulty in the past but that is reducing. For example, the surgical site infection, SSI, rate was 8.7% in 2022. In 2023 and 2024, respectively, it was 4.3% and 4.4%. This year, I am pleased to be able to say it is below 3%, at 2.9%. That is a significant improvement, and I hope it will provide some confidence to families who have correctly raised this issue in the past as being a big issue. It is very much reduced. I think that is important.

My door is open to bringing cases, but it is not as though I will be able to clinically intervene. What I can do is to try to shine a light on the management of cases, particularly for those most urgent cases, which are of real concern to me. I have met many of the families directly and I am aware of the difficulties. I am not a clinician and I never will be, but I will do everything I can to make sure the correct attention is shone on those most urgent of cases.

In relation to the Nayagam report, there are two things. The CEO of the HSE has assured me that the matters that led to the report are being attended to in major improvement plans and patient safety measures. The report itself is not being waited upon to action that. Nevertheless, the CEO has also advised me that for significant legal reasons, he cannot at this time apprise me of the report, but we hope he may be able to do so in the near future. There is a significant legal issue in regard to that and I cannot go any further than that.

A number of Deputies correctly asked me about the audit because it is a really important part of waiting list management. I am informed that the qualitative element of it should be with the CEO at the end of November, so I would expect to be in a position to publish it in December. The technical draft of the more quantitative audit element being done by the internal auditor will be technically available in December, but there is always a procedure to triple-check - I cannot recall the audit phrase - when producing data of that kind. That will happen within December. We will publish it as early as possible outside of the normal quarterly cycles, but that has to happen.

Turning to the task force, there was some very strong, and somewhat unfair, criticism of the paediatric spinal task force that I think it is very important to address. The paediatric spinal task force is an entity separate to the management of lists within CHI. I think it is important to say that. Regarding its membership, Mark Connaughton SC the chair. Exceptional advocates for spina bifida and scoliosis are on the task force. There are also exceptional advocates who are not on it. All of them are contributing to the improvement of services. I thank all the advocates, both those on the task force and those not on it, and they will all contribute to the development of the terms of reference. They all have direct lived experience, either as a parent or as somebody with spina bifida or scoliosis. They all have very important perspectives and all have done exceptional work. The members are Gerry Maguire of Spina Bifida and Hydrocephalus Ireland, Elaine Kelly and Deirdre McDonnell of Scoliosis Awareness Support Ireland, and Lily Collison of the Cerebral Palsy Foundation. There are then different departmental, HSE and CHI representatives.

The terms of reference are to engage with stakeholders, listen, engage and act on advice and the concerns of parents, outline improvements, engage on the development and delivery of services, engage with the HSE and its spinal surgery management unit and provide oversight and assurance. I thank them for their work. It is ongoing work. It really has contributed valuable information, as have those advocates outside of it. Neither is better. Everybody is contributing their experience for the improvement of services. I really do thank all of them. It is important to say the task force has no operational oversight. I think Deputy Coppinger may simply have confused the two elements, but the task force is not responsible for operational oversight. It is a group to try to improve the services. It is different from the unit established in CHI last year that is responsible for managing the waiting lists.

The issue of the inquiry, possibly most important, was raised by several Deputies. I need to try to address a number of different issues, but what we can say with certainty is that it will be a statutory public inquiry. It will have the power of compellability, of necessity. We will also continue to try to drive improvements at the same time. Those things are not incompatible. We will absolutely engage with families, with children, in a voice-of-the-child appropriate way, and with stakeholders, the different representative groups and the different advocacy groups, all with a view to developing the best possible terms of reference.

If I may say so, Deputies have said a couple of slightly competing things that I think it is important that we together address. We want an inquiry that can have the power to investigate the issues of shared concern to us. We also want it to be an inquiry that will report and have teeth. It is a fact-finding inquiry and, therefore, we cannot take things necessarily as they are happening if the chair of the inquiry has to go through their own process. We are moving into a legal process that has to be managed by the chair of the inquiry. We will not be able to interfere with the inquiry and nor should we. It is also a legal process that is capable of legal challenge. As we are drafting the terms of reference, we do not want them to be so tight that they do not do the work we want them to do. Equally, we do not want the terms of reference to be so wide as to either run into legal challenge or get to a point where we do not ever get an outcome to the inquiry in an appropriate way. I am not time-binding it or limiting it in any way. I am just very conscious that in the past we have had discussion in this House about the need for an inquiry into a matter of significant and urgent public concern and it has taken many years. I am thinking of Siteserv, for example. As Deputies may agree, it went considerably beyond the terms of its discussion.

I am not trying to limit this inquiry in any way. What I am trying to say is that it is the Government and the Oireachtas that both set and sign off on the terms of reference. In every way imaginable, that will be done in collaboration and agreement with the advocates. There will come a point, however, where we will have to agree that we are reaching the best possible position for the functionality and legal robustness and endurance of an inquiry capable of challenge, that is, one that is going to be operationally effective and possible for the person chairing it and which will reach the sort of outcomes and findings that will be found. If I do not say this now, and if something happens to the inquiry in six, 12 or 18 months, the Deputies will quite correctly say that I did not set up the terms of reference properly. I am trying to set out at a very early stage the need for honesty and the understanding that we are operating within legal constraints that have important implications.

I will work with the members of the health committee in a public and private way, for example, to try to outline all the different issues I see coming up. It is really important we have the advice of the facilitator. I suggest that we work together, publicly and privately, because it is the Government and the Oireachtas that sign off on it, to ensure we have the best possible expression of all the stakeholders that contribute to it and to take the steps with legal advice that we believe will give us the best and most robust model of an inquiry as well. I am just trying to set that out honestly. I do not want to walk into a brick wall with something we all know is so very important.

There was a question about hip dysplasia. The chair was appointed on 24 October and that work will begin. I also understand CHI has written to patients in the last two weeks. It is important to say this to the House because I have this knowledge and I want to make sure I share it in the most appropriate way. I would like the opportunity to delve into this tomorrow but I do not want to withhold information I could give to the House.