Dáil Éireann debate -
Thursday, 27 Mar 2025

Vol. 1065 No. 1

Ceisteanna ó Cheannairí - Leaders' Questions

Deputy Pearse Doherty

Tá scannal eile ó thaobh cúraim shláinte do pháistí inár dtír. Chímid ó thuarascáil neamhspleách atá foilsithe in The Ditch go raibh obráidí déanta ar na céadta páistí sa tír seo agus é ráite anois nach raibh na hobráidí sin ag teastáil uathu. Tá sé seo scannalach agus cuireann sé isteach go mór ar thuismitheoirí na bpáistí seo.

There are serious findings that unnecessary hip surgeries were carried out on hundreds of children in the CHI hospitals at Cappagh and Temple Street. These allegations were originally made by a whistleblower and were reported in the media at the time. It was further alleged that these surgeries were conducted purely for financial gain. If true, that is absolutely shocking and a great scandal. We are talking about children between the ages of one and seven. It would be disgraceful for any medical professional to decide to put a child through the pain and trauma of surgery if it was not necessary.

Following whistleblower claims and a protected disclosure, an audit into paediatric hip surgeries at the three CHI hospitals was ordered in April of last year. The report has now been published in full on The Ditch website and can be read by everyone. It claims that hundreds of children on whom surgery was carried out did not meet the threshold for that surgery. They were subject to unnecessary surgery. According to that audit, 561 children went through these hip surgeries since 2021. The audit has found that 79% of those operated on at Cappagh and 60% of those at Temple Street did not meet the threshold for surgery. They were unnecessary. The report recommends that all of these children be recalled and independently assessed.

Will the Minister imagine for a second that he was the parent of one of these children who were operated on? Can he imagine the absolute horror of thinking that your child was put through the trauma of surgery when they did not need it? The daughter of one of the parents who made contact with us was only four years of age when she went through this operation. The parent received a letter from the hospital at Cappagh to inform her of the clinical audit into these surgeries just a couple of weeks ago. She is devastated. She says she is sick to her stomach that her daughter might have been operated on unnecessarily. She continues:

This is a horrifying situation to be in as a parent. My daughter was born premature and endured lots of challenges in her first few weeks of life. This was followed by treatment for hip dysplasia and now possibly resulting in a surgery that may not have needed to happen.

This comes less than two years after it came to light that unlicensed springs were implanted into several children at Temple Street children's hospital. That scandal is still ongoing. External reviews and HIQA reviews have been ongoing for 18 months now and we still have no answers. There is no sign of the interim report that was promised at the time.

This all raises some questions. When is this going to stop? What is going on at Children's Health Ireland? Why is the Government incapable of getting to grips with it when we hear of scandal after scandal affecting the children of this State? The allegations and the news of this audit were first put in train and entered into the public domain in July of last year. Surely, given the already established concern regarding practices at CHI, these allegations should have set off alarm bells in Government Buildings, in the Taoiseach's office and in the Department of Health. These allegations should have compelled the Government to step in directly to investigate and demand answers. It raises big questions for the Government. The families who have been in touch with us want those answers. What actions did the Government take when these shocking allegations first came to light in July? Has the Government established if the allegations are true? Was some of this motivated by profit? There are hundreds of parents out there who are living a nightmare of worry. Have all of those parents been contacted? The crucial question they are asking is when they will know if their children were operated on unnecessarily.

Minister for Finance (Deputy Paschal Donohoe)

I thank the Deputy very much for raising this very important matter. I am very conscious that before this report was made available, many families had very deep worries about surgeries their beloved children had undergone. They were raising questions about the need for and impact of these surgeries. They will at least have questioned their trust in our health service and health professionals. As the Deputy raises this very important issue, I am also conscious that our nurses, doctors and consultants work very hard to provide the best possible care to those with whose care they are entrusted. This is why it is so vital that when issues are raised regarding the need for surgeries or any other medical interventions, their impacts and why they occurred, those issues are taken very seriously and acted upon.

As Deputy Doherty has already acknowledged, a clinical audit is now taking place with regard to this issue. I emphasise that this audit is taking place in recognition of the seriousness of this matter and what it means for families' trust and confidence in health services that are designed to look after them and to support their health. That audit is being conducted at the moment. As to where that process now stands, the report is now being looked at. Clinicians are providing final input into it. That final input will be available to the author of the report very shortly, if it has not already been shared. I am certain that when the process is complete, this work will be shared with the Department of Health, the hospitals and those who lead them. At that point, a number of further priorities will then become urgent. The first will be to communicate clearly with the families of children who may have been affected and to share with them, in a transparent and open way, the conclusions of this report, acknowledging the distress and worry that many face. The second will be to look at what further actions, if any, are needed to respond to the consequences of any operations that took place. The third relates to a core theme of the audit that will have taken place. We will need to understand if and why this happened in the first place and what the consequences of it are. The hospitals, the Minister and the Government will take this as seriously as the House would expect. It is important to emphasise that this work is under way. It is all about ensuring that any surgical practice that took place during that period was carried out in a way that was consistent with international standards and the care that any family would expect when entrusting our health professionals with a child's care.

Deputy Pearse Doherty

When my colleague, Deputy Cullinane, raised these questions with the Minister for Health a number of weeks ago, she said she had not seen or read the report.

It is only through The Ditch releasing the report that we can now all see it. That tells a story of the lack of urgency being placed on this issue by the Government that alarm bells are not ringing about something that was raised as far back as April last year and in the media as far back as July last year. We now know from the report published by The Ditch - the independent audit - that 79% of the operations in Cappagh did not meet the threshold and 60% in Temple Street. Potentially hundreds of children were operated on unnecessarily. A second family came to us and told us a consultant told them their young girl needed an operation on both hips. They thought something was wrong and got a private second opinion. They were told not only did she not need the surgery, but the child did not even have the condition. Let that sink in.

An Leas-Cheann Comhairle

You are out of time, Deputy Doherty.

Deputy Pearse Doherty

That is what is happening to the children of Ireland. There is not enough urgency in government which is allowing this to happen. It happens over and over. When will parents know whether their child was one of the children operated on wrongly?

Deputy Paschal Donohoe

The Deputy does not need to remind us of the impact this can have on families and those who have been affected by the issues now being raised. We know how important it is to maintain trust in our health services particularly for our very youngest who could be dealing with complex health needs. There is a need to ensure they trust those whose care and expertise they depend on. It is equally important in dealing with all of this is that we assemble the facts in a clear and authoritative way and that we are in a position to communicate to those who have been affected by it when there is greater clarity on exactly what happened. That process is coming to an end. The report to which the Deputy referred, which has been published elsewhere, has been assessed by the author involved in doing it. He sought further clinical input. When that report is then shared with the Department and the work is concluded, of course, contact will take place in as comprehensive and honest a manner as possible with all who fear they could have been affected by this. I underline again the seriousness with which the Government, hospitals and the Minister take this matter.

Deputy Cian O'Callaghan

Donald Trump has called 2 April "Liberation Day" because it is the day he plans to launch a global economic war. Ireland will inevitably be impacted but the extent had been unclear. However, last night we learned that Donald Trump has pharmaceuticals in his cross hairs. He said, "... we love Ireland, but we're going to have that," referring to our pharma sector. Trump’s toxic love affair with the country could cost us dearly. Given that pharma comprises approximately €100 billion or 45% of our goods exports this is hugely concerning. The pharma industry and the people who work in it are a critically important part of our economy. We know tariffs will have a negative impact on Ireland. However, the ESRI warned that the impact could be much worse if pharmaceutical products are targeted. Are we now veering towards the worst-case scenario the Government has modelled? That could mean the loss of up to 80,000 jobs and billions of euro in lost trade. Nobody wants to be alarmist or cause unnecessary worry but we must be prepared for whatever economic threat is coming. We must do whatever we can at home and through our engagement with the EU to cushion the blows.

I do not think anything the Taoiseach said or did in Washington DC a few weeks ago could have changed this outcome. Donald Trump is megalomaniac convinced tariffs will turbocharge the American economy. He will not or cannot listen to facts, logic or reason. The Government is in no way responsible for Trump’s behaviour. It is, however, responsible for the reckless promises it made during the election. The country went to the polls just four months ago. It was obvious at that time from Trump’s election that there was huge economic uncertainty. Despite this, Fine Gael and Fianna Fáil spent the election promising tax cuts and large spending increases. The Social Democrats warned them this was a reckless approach. The Government has now admitted these tax cuts may never materialise. As a small open economy with huge trade with the US, Ireland is more exposed than most. How the EU decides to retaliate to Trump’s tariffs will have a huge impact on Ireland. The question is: as a small member state, how much input do we have into the EU response? As Eurogroup president, what is the Minister’s insight into this? Will he tell us about any plans for supports for impacted industries? Does he now regret making populist promises during the election which he is already rowing back on?

Deputy Paschal Donohoe

I thank the Deputy for, ultimately, during this week raising a serious economic challenge which this country confronts. I note he raised it in a very political context so let me respond first on that before I deal with the substantive issue regarding the threat and difficulty our country could face and our response.

I have in front of me the alternative budget of the Social Democrats. I attempted to see what reference or recognition the Social Democrats gave to jobs and the competitiveness of our economy. I looked at section 1 – I could not see it. I looked at section 2 – I could not see it. I had to go all the way down to section 15 of the Social Democrats’ alternative budget to find any reference to jobs and how we support our economy. Having scrolled all the way down through to section 15, I saw a reference to jobs – a simple, “increase funding for Enterprise Ireland”. I did not see any reference to the IDA, the organisation involved in helping us combat all of this.

I looked at the tax changes the Social Democrats proposed. I will remind Deputy O’Callaghan of them before I deal with the charges he made against us. It referred to the “Removal of the refundable element for unused R and D tax credits” – the very research and development tax credits that play a role in supporting businesses in our economy. It referred “Abolishing entrepreneur relief on capital gains tax” at exactly the time when we want our entrepreneurs to do more. It referred to phasing out the special assignee relief programme which many of the decision-makers who lead the companies based here are on. That is the political commitment of the Social Democrats. That is what it indicated.

On what I, my party said and the parties that make up this Government said, we were clear during debates and in our manifestos and crystal clear in the programme for Government that Fine Gael, Fianna Fáil and Independent politicians negotiated. It is laid out in black and white. We outlined what we would do in the event that we could avoid exceptional economic difficulties but we were honest in indicating what could happen. We went on to say that in this context – this was made crystal clear in a number of debates – the State and the Government would act to protect public services and our tax base and look at how we could support jobs in our economy. We showed honesty in answering that question. I wish the Deputy could show the same in putting his question to me.

Deputy Cian O'Callaghan

The Minister was crystal clear in the election that he was going to deliver tax cuts. He is now being crystal clear that they are off the table. We called him out on that during the election campaign that it was irresponsible and reckless.

Deputy Neale Richmond

The Deputy is twisting his words.

Deputy Cian O'Callaghan

I asked the Minister serious questions about the response on tariffs, which he has not answered. How the EU decides to retaliate to Trump’s tariffs will be critically important to Ireland. We are particularly exposed because we are a small open economy with huge levels of trade with the US. The Minister knows this. We are much more exposed than other countries. If the EU retaliation brings into the trade war industries and sectors important to Ireland and not already targeted by Trump, this will have a detrimental impact. Is the Minister confident the EU will take this sufficiently into account in deciding how to retaliate? This is important for the country. How will the industries most impacted by this trade war be supported?

Deputy Paschal Donohoe

I stood up and was willing to defend my record. I notice the Deputy was not willing to do the same in his points to me. That is very clear.

Deputy Sinéad Gibney

The Minister did not answer the question.

Deputy Paschal Donohoe

The Government laid out last week our analysis of what the impact could be on our economy.

On many occasions, both in the Dáil and elsewhere, we have outlined three priorities. Our first priority is how we engage with the United States of America and we acknowledge - as does Deputy O'Callaghan, in honesty - the difficulty of that engagement. Second, what we have made very clear is that engagement is now under way between Ireland and our partners within the European Union on what an appropriate response could be. Third, what the Government has been doing for many years, and will continue to do, is look at the measures that can be put in place to strengthen our budget, our jobs and our enterprise economy. I can only say that we approach all of this with budget surpluses, which Deputy O'Callaghan's party was always against, the set-up of funds and the use of those funds-----

Deputy Cian O'Callaghan

The Minister has not answered what I asked.

Deputy Paschal Donohoe

I answered the Deputy's question very clearly regarding what we would do.

An Leas-Cheann Comhairle

Minister, I ask you to conclude please.

Deputy Paschal Donohoe

I welcome the Social Democrats finally recognising the value of an enterprise economy.

Deputy Seamus Healy

When is the Government going to stop failing children with additional needs? Over 14,000 children are waiting for a needs assessment and 41,000 children are waiting for therapies, including speech and language therapy, occupational therapy and physiotherapy. Hundreds of children have no school place for next September. Day and residential services for children transitioning to adulthood are almost non-existent. The Government is breaking the law every day of the week. Children with additional needs are entitled to an assessment of need within six months of referral but that is not happening. Thousands of children are waiting for far in excess of two years. If a member of the public was to break the law like that, he or she would be prosecuted. When is this Government going to be prosecuted for breaking the law each day of the week?

There are hundreds of children without a school place for next September. Families have taken to the streets in Dublin, in Cork and all over the country and have contacted Members of this House in opposition and in government on this issue. I stood here a month ago and raised the case of Michael Joseph Barrett from Cahir who is five years of age. His parents were at their wits' end because he had received seven rejections at that stage. I spoke to his mother this morning. Now he has 16 letters of rejection and no school place for next September. There is another constituent of mine, a young boy called Neil Darmody from Ardfinnan, who has a profound disability. He made his confirmation on 13 March but there was not even 24 hours of happiness in his house because on the following morning he was refused a school place in a special school. His teenage sister is a well-known and well-respected disability rights campaigner. She extracted €10 million from the Tánaiste prior to the last election and the Minister can take it from me that she will be on the Government's case. Indeed, the family has already commenced legal proceedings against the Department. When will these children get a school place for next September and when is the Government going to stop breaking the law in this regard?

Deputy Paschal Donohoe

I hope I get this right; I think the Deputy referred to Michael and Neil in his question. I am very conscious that they are very young children who are very special to their families and communities and who need additional help in getting the start they need in life. All of us, whether in government or in opposition, are aware of those within the communities that we are lucky enough to serve who have young children who need better support as they begin a journey in life in which they will face more challenges and in which their needs are additional and more complex.

The Deputy asked a question about prosecution and action that could be taken against the Government. That does happen but I can assure the Deputy that we do not need the threat of prosecution to do more or to act more. Our urgency to do that is driven by an appreciation of the needs that young children have and by an appreciation that we need to, and want to, do better by them. The Deputy asked what actions are being taken by the Government in relation to this. From a healthcare, therapist and staffing point of view, the number of health and social care professionals now employed by the HSE has increased by nearly 4,784 whole-time equivalents, that is, people who are doing the equivalent of a full-time role, which is up 28.5% on where we were in 2020. I am really conscious that when I stand up and talk about figures, it feels very hollow at times in comparison to the individual experience of a child and their family but the people I am referring to, who have been hired, are making a difference to families and children. That is why we need to continue in our efforts to put in place the therapists, special schools and special classes these children need.

The Deputy will also be aware of the work that the Minister for Education is doing with the aim of making more special classes in schools available across the country. The plans that we have in place to do that recognise that the last thing families and their beloved children need, on top of everything else they are confronting in life, is not knowing what school their lovely child, the child they love, will be in. We recognise the huge anxiety that can cause and we know that September after September, this is an issue for too many families. In the time that is available to us, we will work hard to make those classes available and to continue to build on our efforts to have the right number of therapists available in the right places and settings to provide the support we know is needed.

Deputy Seamus Healy

That is a live horse and you will get grass answer. It is an all talk and not enough action answer. The Minister has not answered the two questions I asked. When will these children get school places? When will the Government stop breaking the law? On Monday last the Minister for Education said she would use legislation to force schools to open special classes, which gave the clear impression that schools were refusing to open classes and were responsible for the lack of school places. There are very many schools around the country that are willing and able to open special places, including Bansha National School in County Tipperary, which is ready, willing and able to open special classes. It has engaged with the local SENO and the Department but is still awaiting sanction. When will that school get sanction for the unit?

Deputy Paschal Donohoe

The opening line of the Deputy's answer was glib and does little justice to the importance of this issue. I stood up and gave the Deputy the best answer that I can-----

Deputy Seamus Healy

The Minister did not answer the questions.

Deputy Paschal Donohoe

-----to the two questions that he put to me.

Deputy Seamus Healy

No, he did not answer the questions and he is being glib.

Deputy Paschal Donohoe

He asked me two questions.

Deputy Seamus Healy

I ask that the Leas-Cheann Comhairle would ensure that Ministers answer the questions.

Deputy Paschal Donohoe

He asked me a question in relation to prosecution and I answered that question. He asked me a question about what we are doing in relation to schools and therapists.

Deputy Seamus Healy

No, I did not. I asked when they will get a school place -----

Deputy Paschal Donohoe

Again, I answered that question.

Deputy Seamus Healy

-----and when the Government will stop breaking the law.

An Leas-Cheann Comhairle

Deputy Healy, please.

Deputy Paschal Donohoe

If the status of an individual school mattered enough to the Deputy, he would have let me know about that individual school before I came into this Chamber. Deputy Healy knows that I cannot be aware of the status of every school in this country.

Deputy Seamus Healy

On a point of order-----

An Leas-Cheann Comhairle

Deputy Healy, please resume your seat.

Deputy Seamus Healy

-----that school engaged with the SENO, the Minister and the Department.

Deputy Paschal Donohoe

If it mattered to him in the way he suggests it does-----

Deputy Seamus Healy

The Minister and the Department know all about the school. They know all about it.

An Leas-Cheann Comhairle

Deputy Healy-----

Deputy Paschal Donohoe

-----he would have let me know so that I could have, for both Michael and Neil, given them the justice of the answer they deserve.

Deputy Paul Nicholas Gogarty

Additional Government policy is needed to encourage the use of electric vehicles. One of the principles in the Government's own EV charging infrastructure strategy is that for the majority of EV users, home charging will be the main solution. However, in new, more densely populated housing areas in my constituency such as the Adamstown strategic development zone, the SDZ in Clonburris, parts of Newcastle, City West, Saggart, Rathcoole and Palmerstown and in fact, in any modern urban or suburban housing development, this principle is not being adhered to.

In fact, home charging is being actively discouraged due to a lack of support for underground cabling installation. This also means the Dublin local authority EV charging strategy is not currently fit for purpose.

We need a legal mechanism to force management companies, especially those in apartment blocks, to proactively facilitate residents who wish to charge their vehicles using their own domestic tariffs. The Sustainable Energy Authority of Ireland, SEAI, apartment charging grant provides an 80% subsidy towards works to facilitate home charging in apartment car parks. However, it has not been backed up by legislation. In many cases, management companies do not have the interest or guidelines to facilitate it. We need an amnesty for those who have proper underground cables installed to charge points near their homes and are then told they must remove them. There must be a new policy to permit licensed chargers to be erected or retrospectively applied for in order that homeowners whose parking spaces are on the far side of a footpath, for example, can erect a charge point so long as it does not cause an obstruction.

We also need to cater for other residents. By this I do not mean the provision of commercial chargers on the streets. In Adamstown, an array of on-street chargers near Shackleton have been out of order for about a month. The company that owns them, EC Charging, has not bothered to get back to me on this issue, which does not inspire confidence. These types of chargers will not cost the same as a home charger. They are only suited to people using nearby sports facilities or visiting relatives. This is not the solution. We need a hybrid on-street model to fill the remaining gaps. What could help - I am sure the technology exists - is subsidised chargers, either stand-alone or at lamp posts, that allow users to charge using their own home tariff with a login password or fob. Policy guidelines could be put together in a matter of weeks. Laws could be enacted in a matter of months.

I hope the Minister and his colleagues will take this on board. There is a lot of misinformation about EVs, including regarding how quickly their charge dies and that they cause more pollution, which they do not. In fact, EVs reduce overall carbon emissions and emit less on-street pollution. We must continue to encourage EV usage. The newer areas are the leaders in this field but they are, in effect, being penalised.

Deputy Paschal Donohoe

I thank the Deputy for raising this very important matter. He probably knows better than I do that there are challenges in regard to the emissions from private transport. This is one of the really big issues we have in ensuring our country can move closer to the climate commitments we have to each other, not to mention those enshrined in law. Public transport and its greater availability will play a big part in that but the question of how we can change how private transport is used and how car journeys can be made in a way that reduces their carbon emissions is critical.

The Deputy corrected some of the misinformation that is out there. Electric vehicles have an important role to play in our efforts in this area. As their technology improves, we must look at what we can do in regard to the charging network. The local and regional electric vehicle charging networks are rolled out through the local authorities and are funded by zero emission vehicles Ireland, ZEVI. A lot of important work is being done in this area. For example, a contract has been awarded to deliver an additional 200 charge points at 50 different locations across Dublin, the majority of which will be located in local authority public car parks and will be rapid in nature.

That sets the background for the Deputy's question. He asked where we stand in regard to apartments and underground charging lines. He referred to the apartment charger grant and the kinds of changes we need to make. Work is under way on a regional and local EV charging network plan, which is currently at draft stage. I will ensure the Minister, Deputy O'Brien, is aware of the specific but important issues Deputy Gogarty has raised with me and ask him to look at whether or how they can be included in the plan that is being prepared.

Deputy Paul Nicholas Gogarty

I thank the Minister for agreeing to take my points on board. The roll-out of fast chargers is really suited to commuters, taxi drivers and others who need a quick top-up. The mid-range 7 kW to 22 kW chargers are supposed to charge over a period of four to eight hours. They are suited to a different cohort, namely, people going to the supermarket, going to play a five-a-side game or watch a GAA match. As an EV user for the past eight years, I know home charging is the cheapest, most effective solution. Unless we encourage people to home charge, we will not get the mass take-up we require. It is a no-brainer. Charging an EV at home is a quarter of the price of petrol or diesel. However, if people are forced into using on-street chargers, that differential decreases. I thank the Minister for his commitment in this regard.

Deputy Paschal Donohoe

The Deputy's point about home charging is important. Another really important feature of home charging is convenience and certainty. If people know they can charge their car at home before beginning a journey, that will give them the confidence that is needed. There must be confidence that a charging network is in place if we are to facilitate a change in how cars are used. There are lots of other issues in regard to the use of EVs, including their costs. We have had debates regarding the supports the State makes available to their owners. I take on board the issue of confidence in the charging network as an important one. I will make sure the Minister, Deputy O'Brien, is aware of the issues the Deputy has raised to see whether they can be accommodated in the charging network plan that is being drafted.