We are here today because the HIQA review has laid bare significant failures at Children’s Health Ireland, failures that I believe have put children at risk of harm. Children who deserved the very highest standards of care were failed in process, duty and responsibility. We must confront that failure openly, honestly and with a determination to make sure it does not happen again and to regain trust. Every year, hundreds of thousands of children, accompanied by their parents, guardians and other loved ones, walk through the doors of CHI hospitals. They come seeking and needing care and support. CHI aims to provide high quality paediatric care that is appropriate to the needs of these children so they have the best chance of reaching their highest potential throughout the rest of their lives. Across many disciplines and areas, that does happen.
Since 2020, the Children’s Health Ireland operational budget has increased by 52% to €586 million in 2024. CHI has also grown its permanent staffing cohort from 3,545 whole-time equivalents in 2019 to 4,464, a 26% increase. This additional funding supported the development of new services, including six new neonatal high dependency beds in preparation for an enhanced NICU service in the new children’s hospital and the opening of a fifth theatre in Temple Street. It also funds the current activity being provided by CHI.
The scale of activity in CHI is significant, with over 80,000 emergency visits each year, 50,000 urgent care centre visits, 50,000 inpatient or day cases and 140,000 outpatient appointments. However, behind every number or statistic is a child, with all of his or her care needs. It is our responsibility to provide that care and ensure it wraps around that child, integrating clinical excellence with emotional support, developmental understanding and a sense of real partnership with families. While we continue to provide services and drive reform, we need to address the failures of the HIQA review head-on, identify issues, rebuild trust and ensure that reform remains centred around putting the child and their family at the very heart of our paediatric services.
The HIQA report published three weeks ago was a stark reminder of what happens when safeguards fail. The report found that springs implanted in a small number of children during spinal surgery between 2020 and 2022 were not CE-marked. HIQA found that the controls in place within CHI for the management of the end-to-end processes did not provide adequate safeguards at each stage of the process. The report clearly shows that the use of non-CE-marked springs as surgical implants was clearly wrong.
Those children were not protected from the risk of harm, as they should have been. What happened to the children involved was wrong. It should not have happened and should not have been allowed to happen. I offer my deepest regret for the distress and anxiety caused to the families, and both the HSE and CHI have apologised to the children and families affected by these issues.
The chairperson of the board has stepped down from his role as chair. I have asked my officials to work with the board to ensure a new chairperson is appointed over the coming weeks. What we need now, for a number of different reasons, is stability to ensure CHI implements the recommendations from the HIQA review and also brings us to the opening of the new hospital. We need the underlying governance structures to ensure those things happen. We owe it to those children who were the subject of the HIQA review, and to every child in our care, to make sure that safety systems are not only strengthened but embedded even more deeply across every part of the organisation.
I assure everyone here and outside of this House that I am totally committed to dealing with these issues. When I met the board of CHI two weeks ago and again this week, after the publication of the report, as Deputies can imagine, I made it very clear to them my deep disquiet, dissatisfaction and unhappiness at what happened. Such gaps in governance and management are not acceptable and that is why the recommendations of the report must be fully implemented as quickly as possible. I expressed my clear expectations in terms of reform to ensure it does not happen again.
Both the HSE and CHI have accepted the recommendations in full and I have insisted on the full and rapid implementation of all 19 HIQA recommendations. The HSE’s CEO and his team are meeting regularly with the CHI’s CEO to ensure these recommendations are being implemented without delay. I received an update on the implementation of these recommendations on Friday, which I then discussed with the board yesterday. CHI advised that a quality improvement plan is in place to address the recommendations. This plan outlines 32 actions to address the HIQA recommendations. Eighteen of these actions are complete, which is 56%, and a further 12 are partially complete or in progress, including the development and implementation of a medical device management system. Overall, more than 90% of the actions are complete or in progress. CHI has advised that updates on the quality improvement plan will be published quarterly on the CHI website to ensure openness and transparency. Of course, as Minister, I will also be getting updates and I know CHI will continue to work with the HSE’s CEO to progress that.
I am extremely conscious that the Nayagam report is still under way. I understand that this has progressed and is now subject to the time required for due process and fair procedures, but I know everyone in this House expects it to be completed shortly.
Separately, as Deputies are aware, a clinical audit of surgery for children with developmental dysplasia of the hip is being conducted by an international expert paediatric surgeon. That audit, which is assessing surgical practice across CHI and the National Orthopaedic Hospital in Cappagh, is nearing completion. Both CHI and Cappagh are committed to sharing the findings of the audit once complete. CHI and Cappagh have issued letters to the families who may have concerns to provide information and reassurance as the final report is awaited. Currently, patient safety precautions are in place for any planned developmental dysplasia of the hip surgery through an enhanced multidisciplinary team pre-operative decision-making process across CHI and Cappagh. That team commenced work in the first week of March 2025.
The learnings from these reviews are informing the development and improvement of services and, I hope, the building of confidence and trust. However, I know from my own instinct, and from discussions with Members of the House and with advocacy groups, that much more work needs to be done. I have, of course, listened to the advocacy groups and the Deputies who have raised different cases with me.
I thank them for doing so and for continuing to engage with me on a private basis to raise cases because it is so helpful. I greatly appreciate Deputies working with me in that way. I have listened to the historical experiences of advocacy groups and the members they more broadly represent, as well as to TDs. I met the chair of the paediatric spinal task force some months ago and attended its next meeting, which happened to coincide with the publication of the CHI report. At that meeting, I had the opportunity to speak to groups of advocates for people with spina bifida and scoliosis. I heard directly from them and was struck by the impact that the publication of the HIQA report had on their personal experiences over time, their trust in the system, and the hurt they had experienced over many years.
Yesterday and today, I again had the opportunity to meet in a deeper way with advocacy groups, in person and not online, like the task force, representing children, young people and families affected by spinal conditions such as scoliosis and spina bifida. I thank them sincerely for their time, their presence, their honesty and, above all, their unwavering dedication to improving services for those who need them most. During our meetings, I listened closely to what they said. They spoke clearly and powerfully, as Deputies will already know, about the impact that long waiting times, delays in treatment and, crucially, gaps in communication could have. These issues affect not only the physical health of their children but their emotional well-being, their development and the everyday lives of entire families. Their message was clear: more needs to be done and it needs to happen urgently.
I will state publicly what I said to them, which is that I am resolute in my commitment to addressing the issues raised. Every child deserves timely, safe and effective care. The stories they shared with me only strengthen my determination to drive further improvements in access, capacity and patient communication within our spinal services. We have seen progress in recent years, but I recognise that it is not enough progress. Nevertheless, progress has happened. I also recognise the experience of many children who have had surgeries in the past number of years. In that context, I am conscious that this is not about numbers. It is about children. It is about ensuring that no child or young person is left waiting. It is about making sure that every part of our health system, including spinal surgeries, meets their needs, respects their dignity and supports families at every step of the way. The voices of the families and advocates who spoke to me have left a big impact. I am determined to ensure that this service improves further.
One thing that was made very clear to me, which I will make abundantly clear to CHI and everybody working in paediatric services more broadly, is the importance of communication. The importance of clear, compassionate, proactive communication with families and patients cannot be overstated, including timely communication about changes, which can naturally happen for different reasons. The way in which these messages are delivered is important to families who are out of control in other aspects of caring for their lives. For example, I recognise the impact and cost of attending an outpatient appointment, including coming from a different part of Ireland and not Dublin, having to perhaps take a day off work to arrange childcare for other children, the cost of petrol, etc. There is also the emotional cost of planning for a particular outpatient appointment that does not happen, for some reason, and being told that at short notice. That is simply not forgivable. It must not happen. I have made it abundantly clear that communication must continue to improve.
There have been some improvements. For example, CHI has launched a scoliosis information hub for children and young people and there is a more focused communications plan. However, I will make one point clear in respect of communication. We have invested in theatres and surgeons, which can take time and can be difficult, but there is nothing difficult about picking up the phone correctly in a proactive way that supports families and does not add to distress. A new spinal patient advocate liaison co-ordinator has been appointed with a dedicated role to strengthen that communication. I have asked advocacy groups, and I ask them again, to continue to feed back on how that is going and on how we might further improve communication in those instances where it has not been good enough.
People have acknowledged that there have been some improvements in spinal services. In particular, I acknowledge the experience of people who have had surgeries. That has to be recognised. However, it is simply the case that we need to continue improving access to spinal surgery. That has been the focus of sustained and determined efforts over several years and we have seen tangible progress but, at the same time, too many children still wait too long, which is not acceptable. That commitment to improving access must remain firm. All children in Ireland deserve access to the care they need when they need it.
Scoliosis affects approximately 1% of children and adolescents in Ireland. While many of those children do not require surgery as such, for those who do, timely access to treatment is critical. The waiting lists are too long for children who need surgical intervention. It differs depending on the nature and level of complexity of the surgery but, nevertheless, they are too long. I am aware of the burden that places on young patients and the human impact behind that time.
On increasing capacity, at an operational level, the establishment of the paediatric spinal surgery management unit within CHI last year marked an organisational step forward. That dedicated team is responsible for co-ordinating spinal surgery services across CHI at Temple Street, Crumlin and the hospital at Cappagh. It works closely with multidisciplinary teams to ensure the efficient scheduling of procedures and appropriate prioritisation of patients based on clinical need. That is the intent.
Efforts to expand capacity within CHI are also progressing. The implementation of ring-fenced theatres and dedicated orthopaedic beds has helped ensure that children requiring spinal surgery are seen more quickly. I note the impact of additional outpatient clinics, which are being run to assess new patients more promptly. Since April 2024, more than 600 new patients have been seen in those clinics, thereby reducing the time children wait to be seen by a consultant. A dedicated referral pathway for GPs has been introduced for urgent cases. Alongside that, national and international outsourcing arrangements have been expanded. For non-complex spinal procedures, pathways to Blackrock and Cappagh hospitals are being used to free up capacity in CHI for more complex cases, which is important. More than 20 children have used those pathways since the beginning of this year.
The National Treatment Purchase Fund continues to support diagnostics and a wide range of procedures that enhance capacity for spinal surgery. Internationally, partnerships with Morgan Stanley Children’s Hospital in New York and Great Ormond Street Hospital in London have provided care for 16 patients since April last year, with more scheduled to travel this year. I met the team from New York when they were here in the past number of weeks to meet patients, get a sense from them of how much more could be done, how that was working and how we might improve it further. Regarding the families for whom it is clinically suitable and who choose that option, if it is offered and accepted - it is not suitable for every child to engage in international travel depending on the different pressures he or she faces - we try to fully support those children in accessing the pathways. There is also the matter of the transition from paediatric to adult services. CHI is now collaborating with the Mater hospital on the development of a transitional adolescent spinal service. Joint outpatient clinics have begun supporting patients as they shift to adult care pathways with more continuity.
On investment, the House is aware that in 2024, 52 new full-time equivalent posts were approved to strengthen paediatric spinal services, including surgeons, anaesthesiologists, nursing staff, allied health professionals and administrative support. Twenty-two of those staff are already in post and recruitment is ongoing for the rest. I wish to see that recruitment progressing as quickly as it may. I am aware that in order for a recruitment process to be successful, applicants are needed and the process needs to progress. I am watching that closely. Those who have been put in post include four additional orthopaedic consultants. In addition, €11.6 million has been allocated to international outsourcing initiatives.
This investment builds on funding previously committed under the waiting list action plans. As Deputies will be aware, a multi-annual approach is taken through the national waiting list action plans, which combine immediate capacity-building with longer term structural change. The 2025 plan, published in February with a budget of €420 million, again prioritises as best it can scoliosis and spina bifida services. Under these plans, additional posts have been funded and new infrastructure has been completed, including a fifth theatre in Temple Street, an additional MRI scanner and 24 beds.
This investment and these initiatives have delivered some tangible results, although I recognise this was against a backdrop of very considerable need. I make these points to recognise those people who have had surgeries and whose experiences have improved. In 2024, for example, 513 paediatric spinal procedures were completed. This was a 10% increase compared with 2023 and a 35% increase compared with 2019. However, I recognise that this number needs to be higher this year. In addition, in 2024, the total number of children actively waiting for spinal procedures reduced from 127 to 108, a decrease of 15%.
I say this to recognise the work that has been done, to recognise some improvement in it and, very seriously, to recognise the considerably expanded work that needs to be done to meet the need that is there. What matters more than the number of children waiting is the time they are waiting and I make this point repeatedly. What we want to achieve, of course, is the Sláintecare targets of no more than ten weeks for an outpatient appointment and no more than 12 weeks for further intervention in an appropriate way. Those should be our collective targets because that is what we have in Sláintecare but I realise that we have a figure of four months, which has been a metric for some time, that we have used. In 2024, the number of patients waiting more than four months dropped by 37%. Those waiting more than 12 months dropped by 59%. As of March 2025, 68 children had been waiting more than four months on the active waiting list. This is a 22% reduction compared to the same period in 2024 but let us not let any of those numbers mask the ongoing reality that too many children are still waiting. The expected impact on the waiting times through increased activity has been offset in some ways by a significant increase in demand and referrals compared to previous years. The additional outpatient clinics seeing new patients are resulting in an appropriate increase in referrals and up until the end of March this year, 110 children have been added to the active surgical waiting list, which is an increase of 43% on the same period last year. That reflects a growing need and a growing population, but also the outcomes of a faster outpatient access and more targeted referral pathway. My focus will always be on the time, not the number, because as population increases and as correct referrals increase, that number should increase.
I acknowledge that there is an increased complexity of cases presenting at CHI. That is because in many ways the less complex or more straightforward cases are being referred to other hospitals to free up capacity in CHI. CHI is managing children who require much more complex, and also multistage, surgical interventions. For example, those children may undergo several procedures that may not result in a reduction in waiting list numbers. That is not important, the point being that some of those more complex cases are now being centred in CHI. They may result in multiple surgeries and 513 surgeries do not necessarily correspond to 513 children's cases; it is more complex than that.
That is why I have made it clear to those responsible that we all, including me, as Minister for Health, but, specifically, the CHI board, the CHI CEO and, indeed, the orthopaedic teams more broadly, need renewed urgency on this. I have made that point repeatedly through my meetings in the past number of weeks since my appointment. While the ongoing development is important, it is part of a broader journey that will lead to a different model of delivery at the new children’s hospital.
As the House will be aware, the new children’s hospital is one of the most significant investments in the health and well-being of our children. I recognise, today, for example, that Sinn Féin has introduced a Bill that recognises the naming of the hospital at some time. I am very much looking forward to that day when we get to celebrate that together but, meanwhile, we have a significant body of work to do to make sure that happens.
While the new hospital stands as the most significant health infrastructure development since the foundation of the State, it is also setting a vision for how we want services to be delivered in the most efficient way. This state-of-the-art hospital is central to that reform of children's health services. It is aligned with the ambitions of Sláintecare where everything comes under one roof, including clinicians but also researchers, educators and care teams working side-by-side in a single facility. I hope that the impact of the hospital will extend beyond its physical walls, but why not discuss that when it is open rather than in advance because there is so much work to do to get it open?
Crucially, what is really important in getting the new children's hospital open is that this will be a digital public hospital with an integrated care experience enabled and improved by supported technology. There will be 473 beds in total, as Deputies will be aware, including 380 in-patient beds and 93 day beds. It will expand our capacity to meet clinical demand, including, crucially, the fact that it has 22 theatres and procedure rooms, which is a 47% increase over current provision, ensuring, I hope, faster access to surgery, more efficient surgery co-ordination and reducing wait times for life-changing interventions.
Appropriately, the hospital will also deliver a major expansion in critical care, with 60 critical care beds, 20 paediatric, 18 neonatal and 22 cardiac care, which is an 88% increase on existing capacity. That is absolutely crucial. Of course, there are 20 dedicated child and adolescent mental health services beds, which is an important part of children's broader health.
As Deputies will be aware, one of the hallmarks of this new hospital is the enhanced comfort and dignity that I am absolutely certain it will offer for families. Every inpatient will be cared for in a private room, with an en suite and space for a parent or guardian to stay in more comfort. Critical care and CAMHS units will also offer en suite rooms, with nearby accommodation to support families during some very difficult times.
The digital piece is at the centre of the hospital's design. Every child will have a digital health record, and that shared record enables better co-ordinated access between radiology, cardiology and respiratory services. This is absolutely central to how we move forward. Every child will have a digital health record. Families will have secure access through a dedicated app that allows them to view records, manage appointments and receive more timely updates. It will be lreland’s largest electronic record deployment to date.
As we focus on this renewed infrastructure, it is important to remember what the hospital represents. It is not merely a building; it is intended to be a transformative development in how we deliver care. We are already seeing this new model of care come to life through the two satellite centres in Tallaght and Connolly hospitals, which are open and successfully delivering ambulatory care to children across the greater Dublin area. Those centres, there is no question, are easing pressure on emergency departments and proving the value of ambulatory care.
Delivering the hospital remains a top priority for the Government. In October 2024, BAM Ireland and its parent company, Royal BAM, committed to the goal of a substantial completion date of mid-year 2025.
I personally sought confirmation that the key areas to enable early access for CHI would be completed to the necessary standards and when they would be made ready by BAM. I sought reassurance that all necessary resources were being deployed by the contractor to support our shared ambition to get that hospital open as soon as possible.
Once substantial completion is achieved, the hospital will be handed to CHI for operational commissioning. This is a complex and critical phase that will involve the installation of more than 36,000 pieces of clinical equipment, integration with the electronic health record and the different training in the hospital of more than 4,000 staff from three existing hospitals. There are 4,600 clinical spaces to prepare and it is a task of some scale. CHI is in the pre-commissioning phase and progressing. Yesterday, I met again with the CHI board to discuss the transition to the new hospital and its plan for the commissioning and the issues and how they might be sequenced all of the time to deliver the most timely safe opening of this hospital.
I acknowledge the work that has been done to date but our focus together, without any question, is simply the delivery of this hospital and supporting the staff and the people who work within the health services in moving into that hospital, making sure that the digital records work well, and making sure that it is opened in a timely and safe way. I reiterate to this House, and to the children and families listening, my commitment to improving services, in spinal surgeries, in particular, for children and young people by reducing waiting times and ensuring that children receive safe and high-quality care.
