Dáil Éireann debate -
Tuesday, 29 Apr 2025

Vol. 1066 No. 2

Unnecessary Hip Surgeries at Children's Health Ireland: Motion [Private Members]

Deputy David Cullinane

I move:

That Dáil Éireann:

notes with alarm the results of a clinical audit conducted on children's hip surgeries performed on children under the care of Children's Health Ireland (CHI), which:

— audited 147 cases across 14 surgeons across 3 institutions for the period 2021 to 2023, namely CHI at Temple Street, CHI at Crumlin, and National Orthopaedic Hospital Cappagh; and

— found that, of those audited, 60 per cent of the surgeries at Temple Street were not indicated, 79 per cent at Cappagh were not indicated, and 2 per cent at Crumlin were not indicated;

further notes that:

— not all of these surgeries were conducted through the public system, but that many were conducted privately with even less oversight of care;

— many parents sought second opinions and that there are cases where the second opinion considered that not only did the child not require surgery, but that the diagnosis was incorrect;

— this malpractice has occurred under the watch of several Ministers for Health, who have failed to properly oversee the effective delivery of children's healthcare in this State and have instead operated at arm's length; and

— a final report into this matter has yet to be completed nor published;

furthermore:

— considers that a surgery conducted in circumstances where it is not clinically indicated according to best practice standards is an unnecessary surgery; and

— acknowledges that any surgery can be a traumatic experience for a child and their parents;

recognises that:

— potentially tens of thousands of hip surgeries have been conducted at these institutions over the last decade, and that parents of children who had these surgeries are left in the dark and wondering whether their child suffered an unnecessary surgery; and

— condemns the fact that there was no disclosure of these concerns and incidents despite the Minister for Health being made aware as far back as May 2024 and until the publication of the clinical audit by the Ditch media outlet, and that these concerns were kept hidden from parents and Dáil Éireann;

further recognises:

— that these revelations come at the same time as the completion of the Health Information and Quality Authority (HIQA) investigation into the use of non-medical grade implants in several children, which found severe governance and institutional failures at CHI; and

calls on the Government to:

— conduct an extensive review of orthopaedic surgical practice at CHI to uncover the extent of unnecessary surgeries on children, and to determine why these surgeries were conducted and whether a profit motive was involved in any of these cases;

— provide certainty to all parents of children who have had orthopaedic surgical practice at CHI;

— hold those responsible for these failures to account, at an individual, organisational, and political level; and

— ensure that as we transition into the new Children's Hospital that it provides the best quality care with the highest standards of governance, management, ethics, open disclosure and communication between families and medics.

In our earlier debate, I said that trust was at the heart of our healthcare system and that people needed to have trust in all health services. They need to have trust in hospitals, in clinicians, in the people who run our hospitals and, of course, in the politicians who oversee all of that. When it comes to Children's Health Ireland, trust has completely broken down. It did not break down overnight. Parents have been dealing with years and years of long waiting lists and scandal after scandal. It has rocked people's faith in our children's hospitals. This is not to disregard the large amounts of good work being done by many people who work in children's hospitals, but look at the list of failures, the litany of scandals and all the reviews that are taking place. Despite all of the calls and demands that have been made by families and advocacy groups on the issues they raised over a long number of years, they felt they were met with a wall of resistance. They felt they were going up against a brick wall.

I thank Teachta Brian Brennan for the heartfelt contribution he made about his own experience in the earlier statements. Unfortunately, I have dealt with far too many families over the past weeks and months since the hip dysplasia scandal first arose after being published in The Ditch. Teachta Doherty and others have also been inundated with emails. Some of the people are parents of children who had surgeries. Obviously, they are the people we have to be most concerned about now because they do not know whether the osteotomies their children had were needed. They are still in the dark. This is going to be difficult.

As we and others have pointed out to the Minister, many people got second opinions. Dozens of such cases have been brought to our attention. When people got a second opinion, they were told that their child did not have the condition and did not need the surgery. When we read the letters - I am assuming the Minister received similar letters and we have sent some to her office - they talk about the procedure itself. Essentially, the surgeon must cut into the child's bone. It is very invasive surgery. To think that a lot of children did not need those surgeries is absolutely breathtaking. Obviously, culpability and responsibility has to be taken in the first instance by the surgeons. A report that will land on the Minister's desk - I hope soon - will point out where the failures lie. There has to be accountability in CHI as well.

We know similar issues arose where there were complications and children with scoliosis and spina bifida had to return for surgery. These are now under review in the Nayagam review. That still has not been published. It is the same people, it is the same culture and it is the same failures. There was also the unauthorised non-medical grade springs that were inserted into three children. Again, it is the same problems, the same surgeons, the same failures, and the same issues.

I was contacted by one of the advocacy groups today on behalf of one of the three families whose children had the springs inserted. They said they had reached out looking for a meeting with the Minister and that she had offered a phone call but not a face-to-face meeting. I implore the Minister to meet all of those families. It is important that there be a face-to-face meeting. If it is taking place, then I welcome that but I am just making the point that those engagements with families are important. We have to understand where those families are coming from. All of the reports I have seen - there have been many, including from the Ombudsman for Children - referred to failures in communication. In all of these issues, there is a pattern of failures. There is also a pattern where Children's Health Ireland has simply not communicated properly with families.

I have a number of questions for the Minister. She mentioned the audit, which covers from 2021 to 2023, but this issue goes back much further. I received an e-mail today from a family whose child had an osteotomy in 2010, yet they got a letter. How many letters were sent out? We do not know. Parents do not know. How long does this go back? Is the Minister now so worried about this that we cannot simply rely on an audit that looks at a random sample over three years when we know that this could potentially be a much bigger scandal affecting and impacting many more children?

I ask the Minister to consider our motion, look at what we are proposing, implement it and do everything that she possibly can to protect those children.

Deputy Pearse Doherty

I thank Deputy Cullinane for moving this motion on unnecessary hip surgeries in children. It is not one or two but, frighteningly, we now understand this could be a routine practice. It is staggering to have to stand here in the Dáil and actually say that, but that is potentially what we are looking at. We are talking about children as young as two years of age being put through invasive surgery - as Deputy Cullinane said, cutting into their hip bones followed by painful recoveries. It is a harrowing experience for any child, or family, to go through, but that is what happened to hundreds of children.

Since my colleagues and I raised this in the Dáil, family after family have been in contact with me. They are all similar phone calls. They are all similar conversations. The families are desperate for answers. These are parents who thought they were doing everything right and that they followed all the medical advice. Now they are left with a fear in the pit of their stomachs that they may have done something wrong. Well, they have not done something wrong. The State has failed them. The system has failed them. They are worried that the pain they watched their children endure was not necessary. One child had what is deemed an unsuccessful hip surgery. That child went from a walker and independence to needing a wheelchair. The child suffers digestive issues from not being able to stand. The challenges now faced by this family are made worse by doubt and not knowing if the surgery was ever justified in the first place. They do not know where to turn because their trust in the medical system, the system they once relied on, has now been shattered. Another family has contacted me about their daughter who suffers aches and pains that did not exist before the hip surgery three years ago. They recently received a vague letter about a further follow-up but nothing about their daughter's specific case. A mother told me about her three-year old having surgery in both hips. She was told that if they did not go for surgery, her daughter would be facing hip replacement surgeries in her 30s. She prays that she made the right choice.

Every single mother and father I spoke to is hoping that their children needed that surgery because the thought of it having been unnecessary is absolutely devastating. They simply cannot understand why they are being left in the dark. The State first and foremost must be open and honest with parents. We need the answers to the questions. We need to know when they will know whether the children's operations were necessary and how many children we are talking about.

Deputy Mairéad Farrell

We can all agree that what has happened and what has unfolded is terrifying. The fact that children went through needless operations is terrifying for them, their families and wider society.

My heart goes out to the families and children involved but also to the families who do not know, who do not have the information and who are unsure. It is good that we are addressing this today. I hope the Minister takes on board the points we raise in our motion. The fact that we do not know the number of operations carried out unnecessarily is frightening. We have all been contacted by constituents who have found out that these procedures may have been unnecessary or who have received letters outlining that their children may have been impacted. That is not good enough. We have to make sure that the information is given to families and that communication continues to be at the centre of dealing with the families because many families are incredibly worried at this point.

Tá sé fíorthábhachtach go rachaimid i ngleic leis seo i gceart, go gcinnteoimid nach dtarlóidh a leithéid arís riamh agus go gcinnteoimid go bhfuil an chumarsáid cheart agus chuí ag dul go dtí na teaghlaigh ar fad, dóibh siúd atá fíorbhuartha agus iad tar éis a fháil amach nach raibh obráidí de dhíth ag na páistí atá acu agus dóibh siúd nach bhfuil cinnte go fóill mar gheall go bhfuil siad tar éis litreacha a fháil nach bhfuil soiléir faoin méid a tharla do na páistí atá acu. Caithfimid a chinntiú go bhfuil an chumarsáid sin ann agus nach dtarlóidh sé seo arís. Is minic i stair na hÉireann go ndúirt muid go bhfuil ceachtanna foghlamtha againn ach, i ndáiríre, léirítear dúinn arís agus arís eile nach bhfuil tada foghlamtha againn. Caithfimid a chinntiú nach dtarlóidh a leithéid arís.

Deputy Claire Kerrane

I will raise a number of points about all of this as a TD who has been contacted by a number of parents who have received letters informing them that the surgery that took place on their very young children may not actually have been necessary. I will refer first to the timeline. On Thursday, 13 March, The Ditch published an article providing details of what it said was the external report on hip surgeries on children. Six days later, on Wednesday, 19 March, letters were sent to parents - the letters I have are all dated 19 March - informing them of an audit that had commenced nine months previously. The parents who have been in touch with me knew nothing about this until they received the letter nine months after the audit commenced. One parent told me:

This is a horrifying situation to be in as a parent, I am not sure how well known this is, I only became aware today and I was sick in the stomach reading the letter and the report on the Ditch. I wonder could you ask the Minister for Health when will parents be fully informed as to whether the surgery on their child was or was not necessary based on the audit findings

Parents very much need answers and it appears they were only informed about the audit in writing after an article appeared in The Ditch. That is no way to deal with any such audit being commenced.

The calls in this motion are fair. I particularly point out the calls to hold people accountable and responsible for this. In many cases, we do not see accountability or people being held responsible. The Government should support the calls in the motion. We should work together on this issue to ensure we never again see letters like this and that parents never have to receive letters like this again.

Deputy Johnny Mythen

I am sure none of us would ever have envisaged or expected a motion like this being moved in the House. How do you explain to the parents, guardians and families the 147 cases of unnecessary hip surgeries carried out in the period from 2021 to 2023 in three institutions under the care of CHI? Hip operations were carried out on children as young as two and a half years old and there is a real possibility that hundreds more cases during the preceding decade may be discovered. The facts of the matter are of great concern to parents and guardians and to many children who are awaiting future hip surgery. There was no disclosure of concerns from the previous Minister for Health although he had been made aware of these serious allegations as far back as May 2024.

I recently had a visit from the father of one of the children who had hip surgery and who had received one of the generic letters from CHI stating that his child should receive follow-up care until her bones had fully grown and developed, contrary to what he was told after a first consultation in 2022, which was that she would be okay after a year. He went on to describe the impact this surgery had on his daughter. He spoke about having to leave his child of two and half years screaming and crying while he tried to hold back his own tears as he made his way down the corridor and about the days of watching her as she could not walk for ages. He then said something very poignant. He said that he trusted the experts, the surgeons and the social contract to look after his child's wellbeing but that they had been failed in all three categories.

Will the Minister commit to providing certainty to all parents of children who have had orthopaedic surgery at CHI? Can she guarantee that this will never be allowed to happen again? We are calling for a full investigation and comprehensive forensic review to be carried out and for any findings to be acted upon. Anyone found responsible for gross negligence and malpractice must be dealt with using the full rigours of the State. A full plan must be put in place to assist and help all families affected by this abject failure to protect their children. I will quote one of the mothers, who referred to:

the absolute scandal of huge sums of money being used on unnecessary hip operations, while children with scoliosis are left without their much needed lifesaving operations, there’s something very wrong with the system

I ask the Minister to support the motion.

Deputy Sorca Clarke

We all want to ensure that, as we transition to the new children's hospital, it provides the best quality care with the highest standards of governance, management, ethics, open disclosure and communication between families and medics. However, we simply cannot say that was provided to the children and families failed by the scandal of unnecessary hip surgeries at CHI. A scandal that goes back a decade or more and that happened under the watch of several Ministers for Health demands an extensive investigation. It also demands that those responsible for the failures be held to account. While the Government has known for about a year, parents tell me that they only became aware of the audit after The Ditch reported on it. They feel very strongly that concerns were hidden from them. That is wrong. No parent should feel like that after a child has had surgery. At the very least, those parents now deserve certainty and clarity.

There was a protected disclosure in September 2023 and the Department was notified in May 2024 but the audit that started in summer 2024 has yet to complete or publish a final report. I acknowledge the Minister's statements in the previous segment, however. A draft report on 147 case samples from 2021 to 2023 across 14 surgeons and three hospitals found that 79% of hip surgeries at Cappagh were not necessary, 60% at Temple Street were not necessary and 2% at Crumlin were not necessary. There is a question that now needs to be asked. What about those before 2021? We know that parents sought second opinions and that there are cases where those second opinions not only said that the children did not require surgery, but that the diagnosis itself was incorrect. We also know that some children were pushed towards surgery on both hips even though it was only required on one.

These revelations come as the completion of HIQA's investigation into non-medical grade implants in several children found severe governance and institutional failures at Children's Health Ireland. These failures cannot be carried over to the new children's hospital. These failures can never be repeated. Trust has been shattered. We have no confidence in the board or executive of CHI. Who could after this? The Government must appoint a new board to lead a major cultural and governance overhaul at CHI. That is the very least parents, patients, future patients and the good staff who work in our medical services deserve.

I will make a brief comment regarding the contribution of my colleague Deputy Brian Brennan during the previous segment. I do not think he quite realises how powerful his contribution was. I hope he will look back on the video because I believe he will then see it.

Deputy Joanna Byrne

There is a history of journalists in Ireland uncovering scandals, including the RTÉ payments scandal, the tracker mortgage scandal and the revelations in the Pandora papers. When questionable hip surgeries in CHI hospitals were raised by a whistleblower and an audit was conducted, this Government stayed silent. It stayed silent on the unnecessary hip surgeries until this scandal was exposed and publicised by the journalists at The Ditch. It is a scandal much worse that the kind the Government is usually embroiled in such as the waste of public money or misleading the public on housing delivery. In no uncertain terms, the children of this country were quite simply failed.

Parents are still in the dark and worried that their children had unnecessary, traumatic surgeries. What did this Government hope to gain by not informing parents immediately?

Deputy Jennifer Carroll MacNeill

This is completely wrong.

Deputy Joanna Byrne

Who and what company, Department or hospital benefited from that silence because I cannot make sense of that silence other than a cover up of failures? The expert first appointed to conduct the audit, an NHS consultant surgeon from England, resigned over a lack of clarity and confusion about their work. Was that lack of clarity and confusion by design?

Deputy Jennifer Carroll MacNeill

Is this deliberate?

Deputy Joanna Byrne

The Minister has to understand that these are questions parents are asking us. Last year, a whistleblower was worried that some of these operations at Cappagh and Temple Street hospitals were purely for financial gain. The whistleblower was proved right when the audit my colleague referenced took a sample of 147 cases from 2021 to 2023 across 14 surgeons and three hospitals.

Deputy Jennifer Carroll MacNeill

It has not been published.

Deputy Joanna Byrne

The draft report found that 79% of hip surgeries in Cappagh were not necessary, 60% at Temple Street were not necessary, 2% at Crumlin were not necessary and all those operations cost about €1,600 each. Those figures are scandalous. We have heard about cowboy tradesmen but does this point to cowboy surgeons?

These revelations come at the same time as the completion of HIQA's investigation into the use of non-medical grade implants in several children, which found severe governance and institutional failures at CHI. With those levels of ineptitude and possible wrongdoing going on, and for how long we do not know, we cannot have confidence in the CHI board. The Government's amendment to this Private Members' motion does not inspire confidence, either. It has been a year since this was uncovered and thus far, nothing has been resolved. A year on we are waiting for a final report of the audit and it is just not good enough for the people who are affected.

When it comes to the Irish public, and in this case sick children, the Government is moving at a snail's pace. When it comes to creating housing tsars or new super junior Ministers, the Government can move heaven and earth at lightening speed to provide jobs for the boys. I ask the Minister to drop her amendment and back this Private Members' motion. It is the very least those children affected deserve and it is the very least parents and families can expect. These are children who endured life changing trauma unnecessarily. Just stop and think about that sentence for a moment. Our Proclamation of the Irish Republic declares a resolve to cherish the children of the nation. By God, these children were not cherished by this nation, they were not cherished by cowboy surgeons and they are not being cherished by those who will not stand up for them now.

Minister for Health (Deputy Jennifer Carroll MacNeill)

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"recognises that:

— Children's Health Ireland (CHI) was made aware through the protected disclosure process of a concern relating to the threshold criteria being used for surgical intervention in relation to development dysplasia of the hip (DDH) September 2023;

— the concern related to different indications for DDH surgery between CHI Temple Street, the National Orthopaedic Hospital Cappagh (NOHC) and CHI Crumlin, with a lower threshold for surgery at Temple Street and NOHC for children, this resulted in different practices across the sites in CHI and NOHC;

— the Department of Health was notified by the Health Services Executive on 9th May, 2024 that a clinical audit was to be conducted in CHI and the NOHC;

— the clinical audit is being conducted by an external international expert on surgery for children with developmental dysplasia of the hip performed during the 2021-2023 period across CHI and the NOHC;

— the Minister for Health is awaiting the final report of the audit, which is expected in the coming weeks, before any conclusions can be drawn on this matter, further details will be shared once the process concludes, respecting confidentiality and due process;

— patients and their families will have understandable concerns, and CHI and NOHC have issued letters to families to provide reassurance and information about the audit pending its completion;

— as a patient safety precaution, a single cross-site pre-operative decision-making process for any planned DDH surgery in CHI and NOHC has been implemented, all cases are being reviewed before any decision for surgery is made by clinicians from CHI Crumlin, Temple Street and NOHC;

— an action plan is currently being drafted, this plan includes identification of groups of patients not included in the audit sample but who may be affected by any findings of the audit.

— plans are also being put in place for patient follow-up as required in line with good practice and will consider any recommendations with regard to clinical follow up from the final report; and

— a communications plan is also being developed to support the publication of the final report and further communications to patients and families.".

I welcome the opportunity to address in this House the issues raised by the Deputies tabling the motion. However, I wish we could have this debate following the publication of the report. The reason the report has not been published is that it has not been finished and it has not been given to me. It is not a question of Government acting in silence. There is a clinical audit being done and it has not been completed. There is due process involved with its completion. That has not finished and therefore it is not finished. It has not been given to me. I cannot publish it. I have committed to publishing it.

On the remarks of the previous Deputy alluding to a silence or a cover up, it is factually wrong, and I have to say that. However, I wish we could just debate the issues and that will be better enabled when the report is published. I am very happy to do that when the report is published. As the report is not published, the motion is constructed based on reports in a media outlet that I cannot verify or stand over and that may be correct or may not be correct. Nobody on that side of the House knows the answer to that either. They do not know whether the facts they have asserted in this House are accurate. They may be and we will see that when the report is published but it is possible they are not or there are other things going on.

Given the seriousness of the issues, which everybody would agree with, I need to be careful that we handle that in an appropriate way going forward. I am very happy to have this debate based on the report when it is published because it is so serious and so important. I have to move an amendment to the motion because it contains details I cannot stand over factually. I do not want to do that but I do not have any alternative to that. That is a procedural point but, for example, were it to be the case that Deputies said the Government voted against their important motion on spinal issues, that would not be correct. It would not be procedurally or ethically correct. This is a debate we should have but I would like to have it when the report is complete and published. I would welcome that opportunity again.

As I said, I will insist on the report being published in full, save for the personal details. I am also very conscious that it is an audit in respect of a portion of time. I am very aware that it may be important to do something further but again I would like to reserve my own judgment on that until I have had the opportunity to see the report. I hope that is a fair reflection of the procedural element we are looking at this evening.

We have had a number of hours of debate on these very important issues, which I welcome. By far, the most important contribution to this issue over many years has been that of my Fine Gael colleague, Deputy Brian Brennan. I support other Deputies when they said it was a very significant contribution. I will not forget it and I do not think anybody here will forget it but it speaks to the complete humanity of the experience of families impacted in this way, the complete humanity of the decisions given to families or the complete humanity that is caught up in the diagnoses and treatment options. I have a child who had an emergency surgery in Crumlin that was completely appropriate and done on a Sunday morning at 10 o'clock, having been diagnosed at 7 o'clock. It was completely appropriate. In the previous debate, we talked about three categories and this was the correct response.

As Deputy Brennan expressed here this evening, to have a situation of being given a diagnosis, and Deputies described in letters that have come in to them, that was a wrong diagnosis, a treatment option that was incorrect, a treatment option that was unnecessary or a treatment option that was excessive on the bodies of small children for any reason, nobody here could possibly stand over it. It is so important that we get the correct information from this audit, reflect on the report that has been completed and make our next decisions together about what is next and what is appropriate. All of this is driven by genuine horror from us all, epitomised by Deputy Brennan's contribution of this own personal experience of this and we absolutely share this.

I will 100% debate this report with the Deputies once I receive it but I have not received it. It is not as though it is in my handbag, nor is the Nayagam report. I have not received them but when I receive them, in the same way as the HIQA report, we must debate these things. We will debate them again. We will also debate the different structural and recruitment challenges and all of the different challenges we all face together in trying to improve these different services which I, as Minister, am very clearly responsible for.

I recognise that the sequence of this is not where one would want it to be. We have a clinical audit and the clinical audit was public since last June or July. Of course, it is necessarily selective and anonymised because it is a clinical audit. Obviously, the best way for this to happen would be that the audit would be received, people would be contacted, there would be a natural sequence to these things and that it would be appropriate because I agree that families receiving letters in the post saying they might be impacted by something is just so worrying. When you go to get your post, you get your bills and something from Revenue but to get a letter like that about a surgery that your child had five or six years ago is so worrying. Those letters were sent in response to the fact that this issue came into the public domain - and I always respect the work of journalists, of course - prematurely, or earlier than I could control because the report has been completed or given to me. As a response to that, letters were sent to parents whose families were in this process where surgeries had occurred.

The clinical audit was to assess whether the indications and threshold used to select patients with DDH for pelvic procedures were in keeping with international standards of practice over a three year period between 2021 and 2023. The clinical audit was completed on a random and anonymised sample of patients aged one to seven years who had those procedures from 2021 to 2023 in both CHI and Cappagh hospitals. The purpose of the audit, and this is really important, is to assess whether the indications and threshold used to select patients were in keeping with international standards. Let us see what that report says.

The audit process is now in the final stages and, as I said, it will be published. I am told the audit process is at an advanced stage. Feedback on the draft report has been received by the expert who is authoring it and that is being reviewed.

In the meantime - and this is important - as a patient safety precaution, as I know some Deputies are aware, a single cross-site pre-operative decision-making process for any planned DDH surgery in CHI and in Cappagh has been implemented. All the cases are being reviewed before any decision for surgery is made by clinicians from CHI Crumlin, Temple Street and Cappagh. That MDT process, that multidisciplinary process, commenced in the first week of March 2025. An action plan is being drafted, and that plan includes the identification of groups of patients who may not in fact be included in the audit samples but who may be impacted.

I ask Deputies to allow me to come back to them once I have received the report and had the opportunity to understand what it means and what it looks like. I am very happy, for example, to immediately meet the health spokespeople and work through how we might best address that. I know they have been contacted by many people, as I have. I know that those people are worried and do not know whether they were included in the audit or were outside the period. I know that they do not know what has happened or how best to address it. However, I am here to try to do that with the Deputies and I ask them to do it with me. It would be so wrong of me to come in here and speak about a report I have not received. I think the Members opposite would rightly criticise me for that. Can we do this again once I have received both that report and the Nayagam report?

Deputy Donnchadh Ó Laoghaire

Tacaím leis an rún agus tréaslaím leis an Teachta Cullinane as an méid atá déanta aige. Is léir ón méid a tuairiscíodh nach raibh aon ghá le líon an-suntasach na n-obráidí seo agus go mbeadh impleachtaí fadtéarmacha agus dáiríre do na leanaí atá i gceist. The most common Irish phrase to describe an operation is "dul faoi scian", which is literally to say "to go under the knife". Whether or not that is always the most appropriate phrase, what it conveys is the fact that it is not something anybody does lightly. In the incidences we are talking about, some of these children are very young, and I think any of us would shudder at the thought of children being exposed to very serious, very significant operations that were not necessary.

I appreciate the points the Minister has made about waiting for the report and so on, but the percentages of surgeries that were not necessary - 79% at Cappagh and 60% at Temple Street - are so high it hardly bears thinking about. We would be concerned, I think, if that was 30%. If any operation were found not to be necessary, you would raise a question about it. Well over the majority of operations in those two locations were unnecessary. That is a huge concern and it falls once again into the questions that remain with Children's Health Ireland. At this stage trust, it is fair to say, has been shattered. It has been completely lost. We in Sinn Féin do not have confidence in the board of Children's Health Ireland and, in our view, there is a need for a new board.

These are revelations of the utmost seriousness. I cannot see into the future. The Minister says we need to wait for the report. Perhaps it is the case that she will, once she receives the report, do everything right. However, my experience very often in this place is that a Minister says, "We will wait for the report and we will see", and the actions that come after that can be very underwhelming and do not get to the root task or the root issue at hand. Obviously, I cannot see into the future; I do not know if that will be the case. However, I would caution against that. This is very significant, very serious stuff and it underlines serious flaws in terms of Children's Health Ireland. Our concern is that children are suffering on account of it.

Deputy Pat Buckley

We are back again. It is not easy to come in here and say what Deputy Brennan said, and I admire him for that. I think we all have our personal stories. Going back to age 16, I can remember my personal story. It was not easy either. It just goes to show that we are all normal in this House and we all have feelings.

This motion is about not having confidence in CHI. It is as simple as that. I suspect that the majority if not all the parents of those kids who are affected are probably sitting on the same bench as us.

I did a lot of work on protected disclosures, and one of the big things with protected disclosures was flipping the reversal of the burden of proof. I still feel that you are punished in society in this country if you tell the truth or try to help people. You get absolutely battered for it. That is how rotten this society is. What has happened to these kids is absolutely rotten. I will not spare my words. You would not do it to a dog. You just would not do it to an animal. We are on about who has confidence in what. Nobody is being held accountable for this. I can remember, going back a number of years, the same procedure, the double hip operation. It is called a hip spica. You are in an arched timber cast. The HSE had one hip spica chair in the country, so any other child who came out after that chair was gone got a beanbag. That is going back to 2016 or 2017. With the help of a friend, we sourced one at a cost of €800. We bought a child's chair so they could have comfort. We imported it from England, yet you can hire them for €40 a month.

A lot of things have gone wrong here. I genuinely have no words for why we have to discuss this, but somebody has to be held responsible for it. I just cannot imagine how parents are feeling. I am sick to the stomach, but it must be absolutely gut-wrenching that one second you are sitting at the steering wheel holding that wheel and your child is on your right and within a blink you are on the opposite side of that car and they are holding the steering wheel. Now you have no control. I plead with everybody in this House to work together to get this right.

Deputy Cathy Bennett

I ask the Minister of State and the Government to listen to the families. From a sample of classes, 79% of hip surgeries on children at one hospital and 60% at another were found to be unnecessary. There are cases where not only was a second opinion not considered to be necessary but actually found an incorrect diagnosis. Parents are outraged, but the overwhelming response from those parents I have spoken to has been worry and concern - concern as to the well-being of their children who, on the watch of Children's Health Ireland and potentially successive governments, may have undergone unnecessary surgeries. That worry and concern is compounded by uncertainty because they are in the dark as to whether they are impacted by the scandal they read about in the papers, another scandal in Irish society, a scandal in our health service, a scandal mismanaged by the Government from the get-go. Those potentially impacted are left uncertain. None of this is new. This State has a long and sad history of failing its citizens, especially children. We know the playbook: silence from the Government; another report commissioned, maybe followed by a review of that report; victims or those impacted forced to campaign endlessly for justice; and, perhaps, eventually, years later, an apology and a promise that "lessons have been learnt".

I commend my colleague and Sinn Féin spokesperson on health, David Cullinane, TD, on bringing forward this motion, which comprehensively sets out what the Government must do. If there is to be a break from all the scandals of the past, there must be transparency. All who are potentially impacted must be provided with certainty because it is not acceptable that today, nearly 18 months after a protected disclosure that was made to Children's Health Ireland, so many remain uncertain. If there is to be a break from all the scandals of the past, there must be accountability at an individual, organisational and political level. If there is to be a break from all the scandals of the past, this needs to happen now, and the Minister can change this when her audit is complete.

Deputy Conor Sheehan

I was not in the Chamber for Deputy Brennan's moving contribution but I did listen to it from my office. It made me stop what I was doing.

I was born with a congenital dislocated hip. I have a weakness in one of my hips. I went through some stuff as a child and may have to have more treatment on my hip. Orthopaedic surgery is an especially physical form of surgery, an especially invasive form of surgery and the thought of vulnerable children having surgery they were not supposed to get and that some of them may have had car parts, essentially, inserted into parts of their body does not even bear thinking about. I am glad to hear the Minister commit again to the publication of the report. We really need to come back and look at this again because there are some concerns – the families have concerns – about the audit.

The systematic failures of governance and management at CHI have been repeatedly highlighted by the Scoliosis Advocacy Network and the Spina Bifida Advocacy Network. I did a lot of work with them when I was a councillor and they feel like they are constantly knocking and knocking and nobody is giving them any answers or accountability. It is very clear we need a public inquiry. We can tease out exactly what that will look like but perhaps Scally could serve as a model. There are so many questions we do not have answers to. There are huge issues of concern about this hospital and especially around uninformed consent. Many parents have told me the last thing they want is to have to bring children who are very unwell here to the Dáil to protest. It is really vital we restore clinical confidence here because we have a situation where Tusla now has to mediate between families and doctors because families are terrified of their children having surgery in case the surgery is unnecessary or is the wrong surgery.

We need to be very clear as well that this is systemic rather than a one-off issue. The fear, given the figures quoted in the audit report that looked at a sample of 147 cases over two years, is that they will have to be looked at again and that many more will have to be looked at. There is a fear this problem is more widespread than the media reports we have heard. Like many Deputies across the House, I have people coming to me who are literally terrified. They have, for example, very young children and do not know whether the medical advice they are getting about the treatment their child needs is right for them. That, in 2025, we do not have clinical confidence in an organisation concerning a form of surgery so people can get the treatment their children need is shocking and disgraceful but not surprising given what different advocacy groups have raised, especially about CHI over many years.

Deputy Pádraig Rice

I thank Sinn Féin for bringing forward this motion, which provides Members with another opportunity to raise our concerns about the yet-to-be published audit into hip surgeries at CHI as well as the long-standing failures in the organisation.

I first raised the issue of hip surgeries with the Taoiseach on 1 March yet almost two months later we still have no more information. Were it not for the reports in The Ditch we would still be in the dark about the latest scandal at Children’s Health Ireland. Last July The Ditch reported CHI was conducting an audit into hip surgeries at three hospitals following a whistleblower’s claims unnecessary surgeries were being carried out on children. The report said the audit was due to be completed in the autumn of last year, but as we enter the summer parents are still anxiously awaiting its publication. Last month The Ditch published a leaked draft of the audit that measured each case against the indicators normally required for surgeries to go ahead. In total 147 children’s cases under the care of 14 surgeons were audited between 2021 and 2023. According to The Ditch, a staggering 79% of cases in Cappagh did not meet the required threshold for surgery. In Temple Street it was 60% while in Crumlin it was just 2%.

Since these findings were published last month a number of parents have contacted me to express their deep concerns about their children’s surgeries. A parent said she received a letter from CHI stating Crumlin, Temple Street and Cappagh may have been using different criteria to determine whether surgery was required. Given the audit results leaked last month that would certainly appear to be the case. It also echoes the findings of the recent HIQA report into the use of unauthorised springs that found procedures were not standardised across CHI sites. Again and again we see the same issues in CHI, but nothing seems to change. Another parent whose child’s case has already been raised on the floor of the House was in touch with me recently. His daughter was a patient in Temple Street in 2016 and the parents were told she required hip surgery despite the lack of symptoms. The surgery they were told she would need involved sawing into her hip bone and reshaping the socket to hold the ball in the joint more securely. Fortunately, this girl’s parents sought a second opinion north of the Border and the second consultant found there was no need for the surgery. This is a really horrifying case. This girl narrowly missed an unnecessary surgery and I wonder how many children were not so lucky. Another parent contacted me recently to say they were shocked at the findings. They described the day of the surgery as a day they would never forget and that their child would never forget. To think that many may not have needed the surgery makes me sick to my stomach. They spoke also about how they put their faith in professionals.

On the scope of this review, the Social Democrats fully support the motion’s call to conduct a more extensive review of surgical practices at CHI. The scope of the current review is too narrow and must be widened. How many parents, over the years, understandably accepted the advice of surgeons or simply were not in a position to seek a second opinion?

The motion before us also refers to profit, which was initially reported as a possible motive in the The Ditch articles. This is a rather alarming claim and it needs urgent clarification. There is no mention of it in the leaked report. We must know if the potential presence of this motive was assessed in the review and if not, then why not.

I wish to raise another set of allegations that have been levelled at CHI. I am sure the Minister has seen the reports in the Mail on Sunday regarding CHI’s IT failures. Just two weeks ago it reported surgeons had commenced operations on children without the help of vital X-rays to guide them on a number of occasions. According to the whistleblower, IT workers had to be summoned into theatre midway through operations on children and in one instance a pregnant woman. On one occasion in Temple Street, a whistleblower stated they witnessed what appeared to be a child’s intestine during a live operation while trying to resolve a medical-grade PC issue to enable the surgeon to see the child’s X-ray. That operation should not have commenced without the visible X-ray on the medical-grade PC. Last Sunday another report stated children’s chemotherapy procedures are being cancelled in Crumlin because of a totally inadequate IT system. According to the whistleblower Crumlin’s chemotherapy department is entirely reliant on Wi-Fi, with no wired connection on site. This has been called a dangerous oversight for a critical department. The whistleblower alleges chemotherapy appointments were routinely being cancelled because the Wi-Fi system is plagued with disconnections. This, they say, has resulted in numerous occasions where quality-controlled and safe doses of high-risk chemotherapy medication could not be administered to children. To add insult to injury, it was reported it would cost only about €12,500 to ensure the hospital had a more reliable, glitch-free system. That is a barely a drop in the ocean in the context of the overall health budget. I accept this is another reason the new children’s hospital is so urgently needed, but we have to deal with the IT issues in the meantime. It is unsafe and entirely avoidable. I thank the brave whistleblowers who have come forward to expose the mounting problems in CHI. There is an ever-increasing evidence base the culture in CHI is a major factor in the failure of patient care and the poor levels of accountability. A 2023 report by experts from Boston Children's Hospital stated CHI "... needed to create a culture where all members of the care team are encouraged and comfortable sharing safety questions and concerns". Nothing to date would suggest there has been any change in the culture. CHI may claim there has been but report after report suggest otherwise. Lessons never seem to be learned.

It seems to be system-wide failure after system-wide failure. I wonder where the accountability lies. The Minister mentioned the possibility of changing the legislation that underpins the board. Will we see those changes? Is it possible to amend the legislation? Can the structure around governance be changed? Can that be looked at in a more holistic manner? This month's report from HIQA is just more proof that a culture that supports the asking of questions does not exist in CHI. It is time for a major overhaul. In this instance, continuity is not what is called for. If anything, continuity is the very thing that is causing the instability.

Deputy Ruth Coppinger

Previous speakers referred to obesity, screen time for children, children not getting enough sleep and the importance of playing football. That was quite incredible in the context of a debate designed to deal with a succession of ongoing failures at CHI.

I do not want to partake in hyperbole, particularly as health workers are the absolute salt of the earth. Everybody who has any experience of our health service knows the dedication, hard work and stamina it takes to work in such a system, particularly one that is overstretched and overloaded. There are great people working in CHI. However, it does not surprise me that scandals are happening in children's health in particular because this is no country for children. They are treated appallingly by the health service. These things would not happen in adult health. There are obviously problems in adult health but not of the scale we are seeing with CHI. We have all had experience of trying to get treatment for our children in the health service. It is not pleasant, I can tell you, being sent out of Temple Street hospital with a child who has been vomiting for weeks.

This is why it is so surprising to hear about doctors performing unnecessary surgeries. Why would a doctor carry out an unnecessary surgery? You cannot get a blood test or a procedure in the health service unless you are dying in front of them. This matter is worthy of examination. I have spoken to parents about why they think this is happening. Let us look at what happened. A massive number of surgeries that were not necessary seem to have been carried out. That fact was brought to light by whistleblowers. We have to ask why that was the case. Is it one doctor or a group of doctors? It is very hard to get any procedure done in the health service. Does the Minister think doctors are experimenting on disabled children? She may think that is hyperbole, but I have just spoken to parents and that is their feeling. It is either that or there is a financial element involved.

The issue of disabled children being used to practice on has been raised with me. Parents of children with spina bifida have told me about their experiences generally in the health system, such as in the context of care often not provided by consultants but registrars. They feel it is such a high level it should not be done. There is competition - even unhealthy competition - between the different hospitals. There is a huge rate of failure of procedures. I really wonder why doctors did the surgeries in question and what the Minister thinks was the reason for their being carried out. The hospitals are now being brought together under one board. From talking to parents who have been to different hospitals, I am aware that they all have different systems and that there is competition between staff in some cases. How will they work together? Does the Minister seriously think this board, which presided over these catastrophes, will be able to move forward?

non-medical grade devices, the springs, have already been spoken about quite a lot. Does the Minister feel any other devices have been used in children which have not been ethically or properly tested? I have been told about urology devices - peg-feed devices into children's bladders, which parents say were not ethically checked out, are not normally recommended and that this information was only brought to the attention of the Minister yesterday. Does she have concerns about devices being used on children in other ways throughout the health service?

I also raise infection rates. The Boston report and internal CHI report on children living with spina bifida showed that Crumlin and Temple Street hospitals had infection rates of 55% and 75%, respectively. In the UK, theatres in several hospitals have been shut down for having a 7% infection rate. How could the infection rate be ten times greater in these hospitals without anybody shouting stop? It is incredible. The X-ray and Wi-Fi issues have been brought to light by whistleblowers. One spoke about being called into operating theatres where operations were under way and the X-ray had not been used. How is that in any way safe? What is the Minister's feeling on that? We are now hearing about chemotherapy which is reliant on a Wi-Fi connection rather than a hard-wired connection in Crumlin hospital.

It beggars belief how children are treated by the health service in this country, particularly disabled children, who seem to pay the highest price for an underfunded health system. Anybody who has been in Temple Street hospital or Crumlin hospital will know that they have been in an absolute state for years. They are also suffering because of staff shortages due to the housing crisis in particular. People cannot afford to make a decent life here. There is also the workload and conditions people are asked to operate in. All of this has happened while there have been booming budget surpluses in the coffers of this State. There are multiple issues - infection rates, Wi-Fi, IT, staffing, non-medical grade devices and unnecessary hip operations. Is it not time for the board to resign? It is not in the motion but it is beyond belief that this would not be called for now. There should also be a public inquiry. There are so many issues - it is systemic at this point. Parents are demanding it. We all know it will happen eventually because that is what always happens. People have to push and push for years before it is conceded. I urge the Minster not to delay any longer on these issues. We need a new board to bring forward the children's health services in this country.

Deputy Ken O'Flynn

We are facing not just a mishap or a misunderstanding but a national scandal that strikes at the heart of the public trust and exposes yet again the rotten foundation of the Government management of the health service. Innocent, vulnerable, trusting children were subjected to unnecessary surgeries. This is not a statistic; lives and futures have been irreversibly damaged under the supposed guardianship of this State. As this unfolded, the Government was yet again asleep at the wheel, blind to the warning signs and deaf to the cries of parents who dared to question the system. This Government's response has been shameful, slow, evasive and dripping of the cowardice of those more concerned with covering their own backs than defending the welfare of children. The truth is hard but clear - this Government cannot manage, supervise or protect the health of those who need it most. When the health service descends into negligence and children's lives are treated with reckless indifference, more than just reviews are needed. The full board must resign. We must stop the spin and start the sacking. The excuses must stop and there must be consequences.

We are governed by men and women who will move heaven and earth to save their reputations but who will do nothing when it comes to the suffering of innocent children. That is a hallmark of successive Governments that have grown bloated, tired and indifferent to the people they have been elected to serve. We need a health service where patients come before bureaucracy, where accountability is real and where failures are not rewarded by promotion but punished by removals. Our children deserve a health service built on care, not yet another cover-up. The people of Ireland deserve leadership built on courage and not cowardice. This Government again stands condemned for its incompetence, and not just that but by its indifference to the people it serves.

Deputy Richard O'Donoghue

I am again speaking with the Minister. I thanked her for visiting UHL. Everyone has spoken about the surgeons who have made mistakes and all the rest of it. It is not always the surgeons. I can speak about a personal issue. My son had kyphosis. He underwent an operation. He had 136 staples and two rods inserted in his back. Some 12 or 14 months later, the rods snapped. That was not the fault of the surgeons, but rather the materials used. It is not always about the surgeons. I cannot thank the surgeons enough for what they did for my son at that time. He had to undergo the operation a second time during his leaving certificate, but he got through it. Thankfully, he is okay. What happened was the result of the rods that were put in his spine snapping.

I have mentioned UHL and other hospitals where if somebody does something wrong, we should not fight that. Those involved should put their hands up and say they got it wrong. Why are we fighting legal battles for five, ten or 15 years when wrong has been done? We should instead say there was a learning, we got it wrong, we do not want it to happen to the next child or person in hospital and we want to get it right.

Not everyone is perfect, but if people own up to their mistakes at the start we can then put measures in place so that people can be helped. I have spoken on numerous occasions about the case of Jessica Sheedy - I have permission to speak about her - who died in Limerick hospital. The case has gone on for years, something of which the Minister is aware. There has been investigation after investigation. The issue is that the people who are carrying out the investigation know the person who carries out operations and then asks what they can do. There has been cover-up after cover-up. That puts the heat back on the Minister in terms of trying to do the right thing when she does not have the full information in front of her to diagnose the problem. We are now at a point where people say this should never have happened. How many people have gone through the same thing over many years, where there was cover-up after cover-up?

I said that the Minister has come into office with a new lease of life in her Ministry. I asked her to come to UHL unannounced and she did so. No matter who makes a mistake in a hospital in this country, I ask that they put up their hands and fix the mistake. The real mistake is not fixing the situation and things going on for years. People do not fix what they have done. The family is not fixed. There is no protection for the next cohort of people who have the same type of surgery and face the same mistakes. That is what we are here for. We are not perfect.

Deputy Paul Lawless

I welcome the opportunity to speak on this motion. I first want to acknowledge the pain and heartbreak that this has brought to so many families and children, particularly children who went through unnecessary and needless surgery. I cannot imagine the pain and suffering that those families have gone through. We think of medical professionals as people we can trust and we entrust our children to their hands, yet we see such a failure for so many families.

A protected disclosure to the Department of Health happened in September 2023. If it emerges that unnecessary surgeries continued beyond this point, there are serious questions that need to be answered. Did the surgeries continue, for example, beyond the time that the former Minister, Stephen Donnelly, was informed about what was happening?

The external report outlined that over 150 cases were assessed, 2% of which involved unnecessary surgeries in Crumlin. Incredibly, 60% of the surgeries carried out in Temple Street were not necessary. Almost 80% of the surgeries that happened in Cappagh hospital were not necessary. A draft report was delivered to CHI management in January. The families impacted are still none the wiser. Does the Government not think that transparency and communication are important for these families? These were unnecessary surgeries involving needless pain. Children went through unnecessary recovery periods.

Patients deserve answers and certainty about what is happening. We cannot allow this situation to continue without any accountability. CHI will receive the keys of the new national children's hospital in the coming weeks and months. Are we allowing this to continue without any accountability? It certainly seems, from reviewing the board in terms of its experience, that there is a real lack of medical experience on that board. I urge the Minister take immediate action to ensure that this never happens again.

Deputy Paul Nicholas Gogarty

I thank colleagues for tabling the motion. This is an important issue. It was good to have a wider contextual debate on what went on in CHI earlier. To recap, I take on board what the Minister said during her contribution. I did not get a chance to come back to it during that debate but I will do so now. We need accountable and deliverable movement in the next couple of months due to the fact that this has been going on for so long. I take in good faith what the Minister set out to do, but I hope that will end up happening.

The Minister said it could be anyone standing here, which I take on board. Successive Ministers have had to face what came at them. It is not the job of the Minister to micromanage. Therefore, it is more about what the response is when the information comes out. That is why the Minister has an opportunity on this occasion.

On hip surgeries, in some ways it is slightly different in that specific hospitals seem to have been worse than others. This relates to a fundamental lack of oversight of the individual practitioners and management structures in those particular hospitals. It ties into the wider debate about corporate governance in CHI.

My colleague, also named Paul, mentioned that of the 147 cases the majority related to Cappagh, which has a smaller cohort of operations. A number of cases relate to Temple Street. The fundamental point is that no matter what hospital was involved, parents and children suffered unnecessarily as a result of the opinions that were given. Despite experts telling them that there was not a need for operations, individual practitioners overruled that and said, "Doctor knows best. You have to listen to me." If root-and-branch reform of how these types of operations are managed does not take place in the next couple of months, there will be serious consequences.

The motion mentions what happened prior to 2021. As Deputy Lawless asked, has anything happened since the information came to light in 2023? We need to find that out because we are talking about potentially tens of thousands of surgeries, as the wording of the motion states.

Deputy Mattie McGrath

I, too, want to speak on this motion. I thank Sinn Féin for bringing it forward. Again, it is a saga concerning the HSE. As the Minister stated, she is constrained in what she can say and must wait for the report. We have so many reports and so many investigations, but they are all inside investigations. It is wrong for anybody, but a child especially, to have an invasive procedure that was not necessary or was in error. It beggars belief that this is going on. As we know, it came to light in 2021 and prior to that. The report asks why the pace was so slow. This is for every person who had an incorrect or unnecessary procedure. Children have parents, siblings and wider families. It is a shocking indictment that in 2025 this is being allowed to continue and that nobody seems to be accountable.

I have wished the Minister well. I hope she does well with the HSE, but so many Ministers have made promises. As has been said, we have been waiting for the children's hospital; it is a saga. There was a campaign to prevent it being built where it is now located. The Minister's former party leader and former Taoiseach, Leo Varadkar, chose the site. The current leader tried to deny he signed the contract. Why would there be accountability on the part of officialdom when Ministers are not held accountable? The buck has to stop somewhere for the people who are watching this debate to see what goes on here and what goes on in Departments in terms of the lack of accountability.

I remember when the Secretary General moved from the then Department of Public Expenditure and Reform to the Department of Health. He got an extra €60,000 or €70,000 to move. For what? Where is the accountability? Somebody - including Secretaries General in Departments - must be held accountable. The Minister is ultimately responsible, but they are the people under him or her. There must be accountability, and there is not.

I said this earlier, and I will be repetitive. The HSE was set up with the single purpose of taking accountability away from the political heads. We have no accountability now. We do not have it from the political heads or the heads in the Department. Many good people work in these hospitals, in the HSE and in the different organisations. They do their best, but they are embarrassed by the situation that these are standard procedures, and rightly so. Why should they not be?

This motion will, I am sure, be dealt with in the same way as many other motions. The Minister stated that she cannot accept it because she is waiting for a report. There is always some excuse. We must start taking accountability and provide the services.

In the context of money, when I came here first, there was €6 billion or €7 billion for the Department of Health. The amount now is €26 billion or €27 billion. While we have a lot of good outcomes, we have less accountability - practically none.

Minister of State at the Department of Health (Deputy Kieran O'Donnell)

I wish to begin by thanking everyone for taking part in this very important debate. I echo the Minister's opening remarks. She stated that she is awaiting the final report of the clinical audit into surgeries for DDH in the coming weeks before any conclusions can be drawn on the matter. The Minister has gone on record as saying she would welcome a debate once she has received the report and it is published. Obviously, confidentiality aspects will have to be taken into account, but it is important to have a really meaningful debate based on a report compiled by an expert international surgeon. We have to have that clinical audit completed. Further details will be shared once the procedures process concludes. It is correct to respect confidentiality and due process.

As the Minister indicated, this is an important issue, especially for the families involved and particularly their children. This is about children. As a parent, I know the impact that has on children and, in particular, parents. We all value our children. I imagine it is very difficult for the parents. It is a very worrying time for children and their families. The Minister has committed to ensuring they will be kept informed as we move through the process and that the final HSE data will be shared with them once completed.

CHI and National Orthopaedic Hospital Cappagh have written to families in recent weeks and provided contact details for queries that patients or their families may have in advance of the final report. As the Minister stated, pending completion of the audit, all DDH cases are being reviewed through a single process before any decisions in respect of surgery are finalised. This process includes clinicians from Crumlin, Temple Street and Cappagh. Plans are being put in place for clinical follow-up in line with good practice and it is required to consider any recommendations to the final report. It is really the basis for that meaningful discussion out of respect for everyone, particularly the parents and their children, and have that debate in the House to have a meaningful structure based on a final report. A communication plan is being developed to support the publication of the final report and further communication with parents and families.

The Government will continue to work to improve services for children and young people. The Minister will work to continue to raise standards and instil confidence in patient safety among the public. The key focus now is on getting the report finalised, which is due to the Minister relatively soon. She has given a commitment on the floor of the House that she would very much welcome a debate on the final report with everyone involved in order to do justice to the families and their children.

An Ceann Comhairle

I thank the Minister of State. We now move back to Sinn Féin, beginning with Deputy McGettigan.

Deputy Donna McGettigan

There is the possibility of hundreds of children having had unnecessary surgery for hip dysplasia just in the period 2021 to 2023. That is hundreds of children who were put through the pain of surgery and the difficulty of recovery. Hundreds of sets of parents, guardians and wider families who were put through the anxiety of having their child operated on. They had to watch their children suffering and they now find out that it may all have been unnecessary. It must add further heartbreak on top of what they have already endured. Many parents sought second opinions, and then these cases were diagnosed as being incorrect. These cases may just prove to be a snapshot of a wider problem. The scale of this and similar scandals is likely to be far greater than has been revealed so far. There may be thousands of children who have been operated on unnecessarily.

The Government should change the terms of reference of the inquiry to allow for the investigation of cases far earlier than 2021. These were life-altering surgeries carried out on vulnerable children, with parents who put their faith in the so-called medical professionals cruelly manipulated and betrayed, and not in one hospital but in Cappagh, Temple Street and Crumlin. Where were the oversight, scrutiny and accountability? It is appalling that there were no supervision mechanisms capable of uncovering this and putting in place effective measures to bring the practice to an end. It fell to a whistleblower to make a protected disclosure. Even then, the Government response was slow and marked by empty promises and hollow reassurances. According to media reports, there were concerns among hospital staff for years. What did previous Governments know, and when? The families deserve answers, and we demand them.

Parents whose children actually require surgery must be terrified that they may be putting them through operations they do not require. Trust has been squandered or lost. Rebuilding that trust will be a monumental task. It must start with full disclosure and real accountability. We all need assurances that the full scale of this scandal will be disclosed, that all parents whose children were involved will be informed and that sufficient oversight mechanisms will be put in place to ensure that nothing like this can ever happen again. There have been too many medical scandals already, whether it was the CervicalCheck crisis, when my party's warnings were ignored with disastrous consequences for hundreds of women and unbearable stress and worry for many more, or the scandal involving spinal springs, to give just two examples. When the latter scandal in Temple Street hospital was revealed, we were told system failures were to blame. That cannot be the case this time. We must see real accountability and real reform of the oversight systems and mechanisms in order that something like this can never happen again. Currently, it is hard to have any confidence in this regard.

Deputy Paul Donnelly

As a parent, I cannot recall the number of times that my wife and I brought our children to the children's hospital for various accidents or illnesses. Never for one second did I think I would not implicitly trust the doctors and consultants. One cannot but be shocked at these cases involving children, where parents have sought second opinions. In some cases, the second opinion has suggested that not only does the child not require the surgery but the diagnosis was incorrect. As we have heard, there might be thousands of cases similar to this. We can only imagine how parents are feeling and how angry and shocked they must be.

Constituents of mine received two letters, one for each of their children. They contacted the hospital immediately on that day, 19 March, and are still awaiting contact from the hospital. I read the first line of the last paragraph of the letter that was sent to the parents. It stated that CHI's priority was always the safety of its patients, ensuring timely access to quality care, and that it had engaged in a clinical audit. CHI's priority is always the safety of its patients, ensuring timely access to quality care. It speaks volumes that CHI sent that letter to those parents, and inserted that line, when we consider the situation that is going on at the moment. Everyone will take what was inserted in that document with a pinch of salt. We need action. If people need to be held accountable, we must ensure they are. Tens of thousands more parents will be bringing their children to a hospital in the weeks, months and years to come and we need to ensure they have confidence in the doctors and consultants when they talk about serious operations such as those these children have undergone.

Deputy Ruairí Ó Murchú

I had an opportunity earlier to discuss this issue and I discussed my constituent, who luckily got a second opinion for his daughter who was at that stage three years and three months old. She had been engaged with Temple Street since 2016 when she was 14 months old. I put some of this information on the record earlier. At the end of 2018, the doctor recommended proceeding with a Salter osteotomy bilaterally. That is one of the brutal operations we are talking about with the cutting into the hips and all that goes with that. There are long recovery times and enormous impacts. The child in question now does gymnastics, which I doubt would have been the case had the surgery that arose from that particular diagnosis gone ahead.

The doctor gave the diagnosis in April 2019. Luckily, the father and mother sought a second opinion. That second opinion stated there was no significant dysplasia in their child's hips and did not recommend any surgical intervention. In fact, the second opinion stated that to do so would only be potentially meddlesome. That is fairly clear. I know this issue and some of the other issues I have raised have been brought to the attention of the Minister. We need clarity on the audit and beyond, because it must extend further than just the period of 2021 to 2023. We need to ensure that we detail all of these cases.

I will give slight detail of the case of a man who contacted me. It is an historical case. He contacted me after I did an interview on a local radio station, LMFM, about CHI. The man's mother died when he was six months old. He had meningitis at 16 months old and as a result, began having problems with his hip. He had osteomyelitis, which is an infection that affects the bone, and needed treatment.

An Ceann Comhairle

Thank you, Deputy Ó Murchú.

Deputy Ruairí Ó Murchú

This relates to 1970 and 1973. The man was kept there for a considerable amount of time-----

An Ceann Comhairle

Thank you. I call Deputy Cullinane.

Deputy Ruairí Ó Murchú

-----and it relates to those particular issues. I will pass the information to the Minister.

Deputy David Cullinane

We have now been here debating Children's Health Ireland, children's healthcare and, in particular, the children's hospitals for five hours. That says it all about the failures we have seen in children's healthcare at those hospitals. The Minister is right when she says that the report into hip dysplasia has not been published. She is waiting for the full report to be published, but a draft report was leaked. It is out there and has been for some time. That draft report raised serious concerns. As bad as it is, it cannot be seen in splendid isolation because, as we know, it comes on top of the HIQA report into the use of unauthorised springs. It comes on top of the Nayagam review, which is still ongoing, and the very high levels of returns to surgery and infections that children had. Those incidences were out of kilter with European averages and there were concerns about the quality of the surgeries and the care given to children. The draft report also comes on the back of years of struggle for children and their parents to get the surgeries they need for their children with scoliosis and spina bifida. It is ironic that we are having a debate about surgeries that were carried out unnecessarily on children when other children are waiting for their scoliosis treatments and their spinal curvatures have, in some cases, got to the point where they are inoperable. It is unbelievable and difficult for parents to try to get their heads around that. One set of children is waiting for surgery, in pain and agony, when other children have been put through unnecessary surgeries and are now in pain, neglected and failed by the State.

There is culpability for clinicians and the people who must be held to account. However, the previous Minister for Health knew last May about what was happening in respect of osteotomies, yet action clearly was not taken. I accept, as the Minister said, that a full report must be published. We know for certain at this point that these issues will go beyond the period from 2021 to 2023. That is the main point we are making with our motion. There will need to be a deeper dive into these procedures because I have no doubt, unfortunately, that this will be a massive scandal. We should not be talking about this today but we must because of what happened.

Amendment put.

An Ceann Comhairle

In accordance with Standing Order 85(2), the division is postponed until the weekly division time on Wednesday, 30 April 2025.