Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)

I thank all Senators who have spoken. I know that many more spoke on earlier Stages of the Bill and that there is a very strong interest among them all, correctly, in making this the easiest pathway for children to get the surgery they need when they need it. I really welcome the Bill. It is fantastic to have this collaboration here, and I totally appreciate the purpose, logic and intention behind it. At the end of the day, however, the Bill should not be necessary. Unless the surgeries are actually performed, the Bill will not make a difference to that. It is our job, it is my job, to make sure the surgeries are performed and that the resources are there. I will set out a number of concerns I have about this.

There has been some good progress - there is no question about that - but there is a very significant body of work to be done yet, and I want to be very direct and very honest about that. Senators will have seen that, over recent months, I have tried to systematically go through productivity and activity in different hospital settings. This area of spinal services generally deserves every light shone on it. There is no question that there is good progress. At the end of May of this year, 60 children were waiting over three months, which means that 46% of the children on the active waiting list are within the Sláintecare targets. Obviously, I would like it to be 100%, and we have to work to get it to 100%, but that is a very significant improvement from August 2024, when 108 children were waiting over three months, which means that, at that time, only 28% were within the Sláintecare targets. That is a very considerable difference between August 2024 and May 2025, and I recognise that. However, as a new Minister coming in and looking at the resources that have been put into this area, the sheer level of effort put in by my predecessor, his predecessor, my departmental officials and right across the board, I am not yet satisfied with the efficiency of this system. While I will always mark improvements that have been made, I am still not satisfied at all.

It is important to me to note a couple of things. Senator McDowell noted the report on insourcing that I published yesterday. I apologise that it was published so close to the committee meeting, but the reality is that I got the report on Monday and I wanted the health committee to have it. I can either keep it in my desk, in my drawer, or publish it. That is the way the world works. You have to publish these things and make sure that everybody has sight of them as best you can. The insourcing report shines an important light, and this came up in respect of earlier conversations about CHI, although it is by no means confined to CHI, that the centralised mechanism for referral is absolutely essential in managing waiting times and managing the balance between any incentives broadly to hold patients here or there rather than making sure they are being managed in the most efficient way. That is something that has been introduced in recent weeks and that I think we as a group and the health committee more broadly should keep under active review to see what difference it makes.

It is frustrating to me to observe the scale of additional resources that have gone into this area: the hiring of more healthcare professionals in Crumlin, Temple Street and Cappagh, the details of which I have set out; a fifth theatre in Temple Street; additional MRI scanners; 24 beds; further activity at Cappagh; and an additional 52 full-time equivalent posts to enhance spinal services, approved at a cost of €5 million. Recruitment is ongoing for the latter. I appreciate that it can be difficult to recruit to consultant positions. If a consultant position is advertised, there may be a range of people who go for it. Perhaps some people are not qualified, perhaps some people do not have the correct experience and perhaps some people withdraw and take positions elsewhere. I appreciate that consultant recruitment is difficult. Nevertheless, significant additional capacity and resources have been put into this area over several years and I do not see a commensurate jump in activity. I definitely have more questions and more analysis to do in that regard.

Bernard Gloster and I, working together, have started an internal audit into some of the practices around waiting lists in CHI broadly, in Crumlin and Temple Street, in three areas in particular. Two of those are to be surgical; one is to be medical. Obviously, one of them has to be this because this is what Senators have identified as an area of real concern. I will supplement that audit with my own perspectives on making sure that the resources that have been put in are being used in the most efficient way. There is a measure of appropriate insourcing and outsourcing going on in this field. It has been identified that there are children travelling to hospitals abroad. In 2024, 513 spinal procedures were completed. That was a 10% increase since 2023 and a 35% increase compared with 2019, so for sure activity is increasing. Of those 513 in 2024, however, ten were sent to New York and five were in Great Ormond Street. There are some restrictions in that regard. Children have to be suitable, by which I mean medically suitable, to travel. Not every child is capable of making that journey. Then there is an important element of parental decision-making as well. It is not for every family. We have to respect all those different things that are involved in any of these different calculations. Nevertheless, there is quite a lot of activity in Blackrock, for example. There were 48 procedures done in Blackrock this year, but as I look at this year's projections I see that, to my mind, they seem to be higher in Blackrock and not as active internationally. Those are the sorts of things that are important to monitor and to interrogate, and we need to do that together.

We have shared goals as regards meeting Sláintecare targets. There is no question about that. This Bill is an important legislative underpinning of the Sláintecare targets in respect of this medical field and of our shared intent to make sure that children are treated appropriately. Notwithstanding the legislation, it is also important that the reforms I am trying to push through the public hospital system of maximum productivity, the use of the public-only consultant contract, the working of five days over seven, the maximisation of all capacity, and I mean diagnostic capacity and theatre capacity, and doing that in a greatly enhanced way are all important for delivering services to children in a timely way. I would welcome Senators' help in making sure we are seeing what is happening, improving what is happening and really assessing it in a granular way, which is the only way anything will be managed and improved on a sustained basis. In that sense, I would welcome their support and help in driving that forward. Second, we will have the outcome of this internal audit. I suspect it will take between four and six months to do this correctly, so we will come back to this. I do not know what that will throw up but it is an important test of the system and it is appropriate at this point. We need collectively to articulate every time the need to have a public system working in the public interest and that this is the absolute emanation of the State delivering public services for the public in public hospitals. We need to drive that as hard as we all can together in the spirit of Sláintecare.