Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael) | Oireachtas source

There are many different issues and I want to try to respond to everybody individually. If I do not, I will do so when I come back in on a different section because I respect and appreciate all the important points people have raised. I do not simply want to read out speaking notes or anything like that. I want to try to address the points properly.

It was very important to me to be here to listen to what the Senators had to say and to respond to this legislation. I know they will appreciate that I am doing everything I can to learn as much as I can about quite a complex area. I will know more about this two months from now, for example, but I am totally committed to it and I thank the Senators for recognising that. I am evolving in my learning and understanding about the intersection of some of the aspects and the complexity of it. Yesterday, in preparation for this, I met David Moore from CHI, who is the lead paediatric surgeon managing this. I also spoke to Mark Connaughton SC, chair of the paediatric spinal task force, yesterday evening.

I will address some of the issues Senators have raised. Regarding the task force, I will clear this up now. I have no view that it should be discontinued. It is a very valuable tool that has done very good work. I respect that some of the advocacy groups have chosen not to engage with it, although the invitation remains entirely open to them. I know that officials on the patient safety side of my Department are trying to engage in different ways with some of the other advocates, who are entirely entitled to choose their own means of engagement. I respect all of that. Nevertheless, the invitation to them is there. They met as recently as 12 March. I would have liked to attend but I was away for St. Patrick’s Day. I said to Mr. Connaughton that I would like, where possible, as long as I am not out of the country or something, to attend the next meeting of the task force, not to step on its toes or interfere with its work in any way but simply to use it as an opportunity to signal my commitment to the resolution of the issue over time, my deep interest in the area and the political support for the work it is doing. I hope that answers questions related to the task force. I would like to think we will get to the point where the task force becomes redundant and unnecessary because we will have built up both the capacity and the processes to make it redundant. That is an ambition, however, not a plan. It is an idea and an ambition.

I take a similar view to the Senators. I recognise the need for legislation and, of course, we are not opposing it.I wish it had not been necessary to bring it to this point, and I would like to get to a point where this legislation is not necessary.

This is a ridiculous and academic point to make but, nevertheless, I need to make it anyway. None of us here wish to make clinical decisions or judgments through legislation. That is not the purpose of the legislation, and I acknowledge that. It is important we get to the point where the system is functioning without the need for this legislation and we are not using it as an idea or as a precedent across the board to make clinical judgments. That is very much an esoteric point and not something to dwell on. It is simply a recognition that I wish it had not been necessary. We are trying to do the work anyway and I would like to get to the point where it is not relevant. That is really the boarder point I am trying to make.

I will address the issues in the order they were raised with me. I recognise, as Senator McDowell said, that not all patients who present need surgery. It is important for the broader public understanding that that is not so. As I understand it from speaking with medics in this space, that, say, of the 506, about 4% of the patients who present convert to surgery or are appropriate to surgery. Some 47% are discharged for different reasons. We want to identify the total population of people who are presenting with some form of spinal difficulty. I do not want to be too determinative in my language. What is the total population and what is the earliest possible opportunity for an appropriate intervention, recognising that in many cases it will not be surgery? It would not, as I understand it, be appropriate to perform surgery on a three-year-old child, for example. There is a period of growth that is necessary to allow organs to develop. A period of growth is necessary where braces, casts or minimal surgical interventions are much more appropriate than the ultimate surgery. I hope that broader public consciousness can be developed because I think the four-month thing that people have raised is sort of a distraction from the need to make sure that there is the earliest identification and the earliest appropriate intervention, and that that is maintained. My perspective as Minister is to focus on making sure the capacity is there and the organisation and delivery is there, and on making sure those are the targets. Has the population been identified? Is it consistently being identified? What are the pathways to that? It was correctly pointed out that there is a necessity for triage of the different levels of severity, and I agree with that. There has been good development and it can go further in terms of how that outpatient list is being conceived and managed, including the number of Saturday clinics. I can speak to the numbers more directly on that, but there were 11 Saturday outpatient clinics last year, which quite apart from anything else is exactly how the health system should work. Particularly for parents of children, it is much easier to enable families on Saturdays than any other period. I would like to see the continuation of that approach where those cases can be triaged.

It is also important to note that a number of the less acute surgeries have been moved to other facilities, Blackrock and Cappagh in particular. That capacity has been expanded, particularly in Cappagh, quite considerably. We need to conceive how we might consider the non-acute surgeries – the more routine surgeries – as an elective process within the paediatric system. We have not brought it into the elective system. We might consider how we develop the capacity in Cappagh and look at some of the capacity for more routine surgeries. I am thinking as well about the allocation of the theatres in the new children’s hospital, the expansion of orthopaedic surgeons we have more broadly, how they will need access to theatre and the best way that we can organise that. As Senators will be aware, there is good excitement about the prospect in the children’s hospital facilities. It is a major step forward. I just want to have at the side of our mind that we might need to also go down this road. It might be a valuable thing to do to increase capacity broadly and separate out this more elective concept from the more acute concept as being a pretty reasonable clinical thing to do.

Regarding the NTPF and the international arrangements, I respect the point Senator Boyhan made on the NTPF and I will consider it. While the arrangements that have been made in respect of New York and Great Ormond Street are not what one would want in the first instance, they are very much better than not getting this done.Where they are clinically appropriate, it is better to do it than not. I would much rather invest in anything that we can do to remedy the current situation. It is not, as Senator McDowell said, the model that we want entirely, but sometimes the perfect is the enemy of the good, and it is better to use these arrangements where they are appropriate.

It is also appropriate to recognise, as I understand better and better even in the short period during which I have been Minister, that not all cases are suitable for surgery, in part because of some of the complexity and the comorbidities that can present. I am not clinically qualified to make those sorts of adjudications, nor do I believe, with respect, that any of the Senators here are. We will have to strike a balance between the individual cases that are raised and the complexity and humanity of them versus the clinical advice we are getting. As Senator Clonan said regarding the respect we have for clinicians and the standard we want for them, how we manage those intersections over time will be important. I will respond and try to engage with every case that is brought to me but there will be cases where, although it is difficult to hear sometimes, surgery is not appropriate, due not to delay but to comorbidities. These can be complex cases. As I understand it, many of the cases in Ireland are more complex for different reasons and there is a higher incidence of complex cases. The routine cases should be higher in the broader population, and while it is best not to get into some of the reasons for that, there are very complex cases. I say that to recognise that the clinical response to these cases should be very individualised and bespoke but also very timely. Those are not contradictory ideas. The responses should be bespoke but, as Senators have said, they must also be timely. I totally agree with that.

On some of the funding issues that have been raised, including the €19 million, I hear what Senators have said and I will reflect on that. Of course, I have been told the additional resources have supported the hiring of more staff at Crumlin, Temple Street and Cappagh. They have also led to a fifth theatre in Temple Street, an additional MRI scanner, 24 beds and further routine activity at Cappagh. However, I will go back, having heard the Senators, and make sure I am satisfied that all of those things are so. If I am not satisfied that they are so, I will investigate and test it. As Senators are more than aware, there was also additional funding of €5 million in 2024 to hire more posts into spinal services. We are talking about 52 full-time equivalent staff, 14 of whom are now in post, so we have some spend yet to do. There are four consultant orthopaedic surgeons, two consultant paediatric anaesthesiologists, one consultant paediatrician with a special interest in paediatric neurodisability, which is an important complementary element to it, and a number of others, including a plastic surgeon, respiratory consultant nursing posts and so on.

I hear what Senators have said regarding the hiring standards and the higher specialist training in particular. There is the consultant applications advisory committee, CAAC, but I will check and reflect on that because we want consultants of the highest standard. It is difficult to recruit them in a timely way. CHI might have the funding for it, but to hire a specialist surgeon who is already practising in an international practice is a challenge. Let us respect that we want our specialist doctors to go abroad to get training elsewhere and to perform surgeries at a critical mass that is not necessarily available here and come back with their expertise. We are trying all the time to bring people home who have acquired better expertise in hospitals with a larger critical mass and more specialist training and are linked to particular research universities. These are good things for the medical system. We want to try to bring those back, but if we think about the hiring process plus the giving of notice and relocation, it can take a bit of time. That is not great and I would prefer if it could be done immediately, but that is the reality of it. However, I will be working with the task force and the Department to stay on top of this. It will not be for drift, on my part anyway, that it is not done.

Senator Clonan raised the risk management aspect of this. I thank him for articulating the experience of his son and family and the difficulties that delayed treatment presents in a very real and direct way, physically, mentally and on the total humanity of every individual involved.That is why Senators have brought this legislation and are focused on thisi ssue. More specifically, however, regarding risk management and clinical migration, I am, honest to God, really concerned about all of that and how it is done. The children who will be transferred from Temple Street and Crumlin hospitals will be the very sickest children in Ireland at that time. We will have discharged everybody whom we can safely discharge in the weeks leading up to that. That is why it is important not to do it over the clinical winter. I will test that and push it as far as I can, but we will not take any risks with it. We will be transferring the very sickest children, including children with congenital heart problems who are in intensive care and children with scoliosis surgeries. We will try not to do the scoliosis surgeries immediately before. We will try to approach it as intelligently as we can, but that transfer overnight in ambulances during that seven- to ten-day period has me awake already, never mind at the time. I am very sensitive to the risk management processes for it and I am thinking about it very deeply. The important point is that I am aware of it.

Senators Keogan and Duffy raised some really important, complex individual cases. Again, it is not for me, as a person who is definitely not a clinician, to be adjudicating or commenting on the individual cases, but I do hear the Senators. If they want to speak to me privately about them, they absolutely may do so.

I do not wish to read out speaking notes that Senators have heard before, but I wish to recognise that there has been considerable investment. On behalf of the people who are doing the work, I recognise the number of surgeries that have been completed and the number of interventions. I do so not on my behalf or the Government's behalf, but on behalf of the people working on this all day every day in Temple Street and Crumlin hospital. I was in Crumlin hospital yesterday and surgery was actively taking place, although, quite reasonably, I could not go to see it because people were working on it. I do not wish to have a sense coming from this debate that nothing is happening or that nobody is getting treatment, because that is simply not the case, as Senators are aware. It is out of respect to the people working in the system that we must recognise it is, in fact, happening.

We had a reduction in the waiting times for paediatric orthopaedics generally last year of approximately 15%, but it has increased in the early part of this year. I understand from speaking to the clinicians that there has been an increase in the acuity of some of the cases, which has meant that multiple surgeries or interventions have been necessary. That does have an impact on some of the times, lists and numbers. I am aware of that and I respect it, but I can certainly see, from my analysis of the numbers that are there and the investment that has gone in, that there is a trajectory that is moving toward reducing this in a planned way. We are nowhere near where we will want to be or any sense of removing the complete focus that needs to be there to ensure that children are getting the appropriate, timely interventions they need.