Mark Daly (Fianna Fail)
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I welcome the Minister back to the House. I was saying earlier that we could give her honorary membership because she has been here so many times today. I thank her for taking No. 2, Report and Final Stages of the Health (Scoliosis Treatment Services) Bill 2024.

I welcome to the Distinguished Visitors Gallery Tom and Eileen Ryan, and their son Sean, who also happens to be a councillor in Tipperary. They have come all the way from Tipperary, the home of hurling, I am told. They are here with their and our great friend, Imelda Goldsboro. A Sheanadóir, thank you for bringing Tom, Eileen and Sean to Seanad Éireann today.

Mark Daly (Fianna Fail)
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When is it proposed to take Fifth Stage?

Michael McDowell (Independent)
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Now.

Mark Daly (Fianna Fail)
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Is that agreed? Agreed.

Mark Daly (Fianna Fail)
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Would anyone like to make any comments?

Michael McDowell (Independent)
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I understand it is customary to allow a few words to be spoken on the decision that this House has unanimously taken to pass this legislation. I welcome the Minister, Deputy Carroll MacNeill, and thank her for her interest and co-operation in the whole process. As I indicated on the first day when this Bill was tendered for Second Stage consideration by the House, I am not here to score political points. The cross-party, united approach of this House is to see that work is done and that the commitments, which were doubtless given in good faith but which are difficult to render as concrete reality, are delivered from now on.

The purpose of this legislation is to put in place, in respect of this particular condition, which requires surgical intervention in many but not all cases, a programme and statutory duty for the Health Service Executive to ensure that it resources the process adequately, that it concentrates the resources which are necessary, and that it puts together a system which gives accountability and progress reports. As somebody said, while I am not in favour of artificial measurement processes, something where progress is not measured and reported on and where there is no accountability tends to slip down the order of priority in any political or administrative process. I noticed that today, at the health committee, the chief executive of the Health Service Executive, Bernard Gloster, was asked by my colleague, Senator Clonan, whether he had confidence that the Government's targets for spinal surgery, including spina bifida and scoliosis, would be achieved. He said he had confidence that the new chief executive of Children's Health Ireland, Lucy Nugent, would take this seriously and that that agency would deliver what its commitments amount to.

For the information of this House, there was a request at that committee for the number of patients on waiting lists with spina bifida. It was advised that patients are listed by need as opposed to diagnosis and there was a discussion about the differences between non-complex cases and complex cases, and the care paths, intervention paths and treatment paths required for each condition. Ms Lynam provided an update on scoliosis information. She said an information hub had been launched, a tendering process for educational videos is under way, the waiting list and activities report will be published on Friday, 11 July alongside a progress update from the spinal surgery management unit, that frequently asked questions and service updates about the HIQA report have been published, that the spinal surgery management unit will be presenting at the Irish General Practice Nurses Educational Association conference in September, and that CHI is working with the HSE to improve the healthlink pathway for GP referrals to be made more user-friendly. Those are the plans and they are admirable but I also want to raise with the Minister one point that was discussed at the health committee today, which was insourcing and outsourcing of medical services. It has been suggested to me, for instance, that only two children have been offered, and have accessed, surgery in Great Ormond Street Hospital for Children in recent times and only 14 have travelled to the USA. I am told, and I would like the Minister's response on this, that some CHI at Crumlin consultants are in a position to operate on patients with these conditions at Blackrock Clinic but that this is not a national pathway, with children and consultants at Temple Street not having the same facilities. Will the Minister indicate to the House how the National Treatment Purchase Fund operates in respect of the CHI outsourcing treatment for scoliosis patients since 2017, whether that oversight still exists and who is responsible for it?

I am very mindful of not putting individuals' cases on the record of the House in a way that would identify them, especially when they are underage. I have been contacted by parents who are very frustrated at being left in the dark and uncertain as to their child's situation or at being given the impression their child is about to receive badly needed surgery only to be then told it is not available or will not be delivered. It is very difficult for parents, who are the guardians and protectors of their children's rights, to feel confidence in a system where all the moving parts seem to offer hope only for hope to then recede.

This Bill will go to Dáil Éireann and I hope its Members pass it into law in due course, with whatever amendments they consider necessary. Its purpose is to ensure the missed targets and unrealised ambitions are addressed and that the political commitments that were given, doubtless in good faith, but were not realised are realised through a process of accountability and positive duty imposed on the HSE.

I thank Senators for their support for this measure. I thank the Minister and her Department for accepting the Bill and accepting that accountability and measurable progress are something that, if they are put in place in statute, will result in delivery, explanation as to how delivery will take place and accountability for when delivery does not take place. The beginnings of this issue, which predate the Minister's tenure, were when there was a controversy as to whether funds specially allocated for scoliosis ended up being dissipated elsewhere in the HSE's activities. The Bill is designed to focus attention on this problem and ensure the HSE realises it must address it clearly and unequivocally, set out plans, report on its progress and account for its successes or failures in delivering what are vital medical services, including surgery in some cases, for people whose lives will be blighted by delay and underperformance. I am glad the House has accepted the Bill. It is now open to, and up to, the Members of Dáil Éireann to bring it into law by having it enacted as a measure approved by both Houses.

Mark Daly (Fianna Fail)
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I welcome to Seanad Éireann Ronan Cullen, who is an American intern working with my fellow county man, Deputy Cahill.

Tom Clonan (Independent)
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I welcome the Minister. It is great to see her here in the context of this Bill not being opposed, for which we are very grateful. I commend my colleague Senator McDowell on his drafting of the legislation. I thank my colleagues in the Independent Group and others who cosponsored it.

The Bill deals with an issue that is very personal to me because of my family circumstances. The Minister met my son earlier who has had spinal fusion surgery. He is an example of someone who had that surgery very late. It was quite complex surgery that involved a very pronounced anaesthetic risk. It was traumatic, and unnecessarily so, because of some of the issues that have been well ventilated in this Chamber, at the health committee and elsewhere in respect of not just the spinal wait list in CHI but also the urological wait list.

After last week's health committee meeting with CHI, where we talked about both of those wait lists, I was contacted by a lot of very anxious parents. One lady who came to Leinster House on Tuesday and sat with me in my office for half an hour set out the manner in which her beautiful child was negatively impacted by the issues that persist at CHI. She made the interesting comment that she does not want any more apologies and for everybody to just keep saying how awful everything is. What she wants, she said, is action. She asked what we can do to help the cohort of children, teenagers and young adults who have been impacted by these issues.

I very much welcome that the Bill is being allowed to progress because it is a pathway towards that necessary action. I thank the Minister for not opposing it. I hope she and her colleagues in the Cabinet will support it in the Dáil and get the measures it contains up and moving. I know she will do everything in her power as Minister to that end. She is the type of person who has the energy, integrity and the motivation in the public interest to drive it forward. What these families need now is action and this Bill is a step in that direction.

Maria Byrne (Fine Gael)
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I thank the Minister for her attendance. I compliment the colleagues sitting to my left who drafted the Bill. We are all in agreement across the Chamber that we are here to ensure delivery of better healthcare for all. I acknowledge the Minister's dedication and commitment in this regard. I pay tribute to her and her Department.

When I was first elected to this House, scoliosis and spinal treatments were happening less and less, with many cases being outsourced. We have come a long way. The fact people are now predominantly being treated within the recommended timeframe is a great compliment to the amount of work that has been done by the Government and by the Minister and her team. Most of the procedures are now being done in Crumlin, with the rest done in seven or eight other hospitals. Previously, that activity was confined to one or two hospitals. A lot of work has been done but we would all agree there is always improvement to be made in any area. I compliment the Minister and all involved. This is a good news story.

Nicole Ryan (Sinn Fein)
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I thank the Independent Group for bringing forward this Bill and the Minister for accepting our amendment to put a timeframe around the provision of care. We heard at the health committee about the horrors that occurred in respect of CHI. Many of us are on the committee. We know what has happened. I echo what Senator Clonan said, that the time for action is now. We have done a lot of talking and there are a lot of reviews and reports. I am sure more things will come out, but this is a really welcome step in order that children and teenagers in the health system get the care they deserve and need and that the action is being taken. I commend all Senators in the Independent Group on bringing this forward, Senator McDowell on pushing it through and the Department on accepting the Bill.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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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.

Michael McDowell (Independent)
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I thank the Minister. I note what she says about the apparent concentration of some surgical procedures in Blackrock. I ask her, the Department and the HSE to ask why that is happening and whether there is a differential between patients who have insurance and patients who do not in being seen in that context.

Mark Daly (Fianna Fail)
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I thank everyone for their contributions and the Minister for taking Report and Final Stages of the Health (Scoliosis Treatment Services) Bill 2024.