We will move now to the question-and-answer session. The Minister, Deputy Donnelly, and the Minister of State, Deputy Butler, are with us. There are seven and a half minutes for each question-and-answer block. I take it we will do a bit of back and forth, if that is what suits Members. Our first seven-and-a-half-minute block is for Government Members.

There is a lot of uncertainty in the media coverage in respect of the consultants who are available in the hospital to perform these operations when one consultant is no longer available and a file has gone to the Medical Council. What consultants and teams are now in place to continue the work that is required? What effort is going to be made to recruit additional people with the relevant expertise to fill the void?

In 2022, €19 million was provided for current and capital expenditure to tackle the waiting lists in paediatrics. What progress has been made since then? Will the whole programme now be put on the back burner because of what has occurred?

I thank the Deputy. I will be able to provide colleagues with a list of the current workforce and consultants across CHI. As colleagues will be aware, we have paediatric orthopaedic consultants who work across numerous sites, including Temple Street, Crumlin and Cappagh hospitals. There is also some activity for which Blackrock Clinic is used. There are various surgeons involved there. While I fully appreciate there are broader questions around paediatric orthopaedics, what initiated the issue at hand was spina bifida procedures in Temple Street hospital. The reality is that there are only two surgeons who do complex spina bifida work in Temple Street hospital, one of whom is not engaged currently in clinical activity. I, the Department and the HSE are all engaged with CHI on this issue. It is being examined at the most senior level and at a variety of levels. Can we hire into these posts? Can we expand posts? Are there people who might come in temporarily? Can we bring in surgeons from abroad to do individual sessions or who might agree to stay here and work with the children over a period of time? Can we reactivate the programme where the care is provided abroad? I think we should where the patients and their families agree to it. That might be appropriate for less complex work where less follow-up is required. There is no getting away from the fact that when it comes to complex spina bifida care, there are two surgeons involved. Extensive work is now ongoing to find additional surgeons who can do the work.

The Deputy also asked about the progress being made. Next week and in the coming weeks, significant additional capacity will come online. I allocated €19 million last year in current and capital expenditure. I asked CHI to come up with a comprehensive plan, which it did. That €19 million was a big ask and the plan was fully funded. Since then, the workforce has increased, additional beds have been made available and post-operative supports have been put in place. Because of that, there has been a substantial increase in the number of surgeries performed, notwithstanding the fact that waiting lists have not come down, as we talked about earlier. A substantial amount of additional surgery has been performed. In addition, a fifth theatre is opening in Temple Street hospital this day next week. It is staffed and ready to go. There are many sessions reserved specifically for spinal treatment and orthopaedics. A second MRI is being staffed in Crumlin hospital and we believe it will be operational in November. Some 24 additional beds were funded under the plan, including nine acute medical beds and two orthopaedic elective surgery beds. Those beds opened in Crumlin hospital in August. Two more beds are due to open next month. Seven short-stay beds are to be fully operational in Temple Street hospital in October, along with four orthopaedic elective surgery beds that will be fully operational from November.

I do not need to tell the Minister the concern this issue has raised. I am aware he has been moving with might and main since this happened to address it but one of the main concerns which arises from this issue is the public's trust and confidence in the system. It is so important for preventative medicine, in particular, that we encourage the public to engage with services provided, be it for check-ups, scans, diagnostics, vaccines or all the different procedures and preventative treatments that are so important to having a proactive healthcare system. When these issues occur, it undermines and risks the confidence and trust of the public and makes it so much harder for all of us to collectively rebuild that and get the message and word out there that people must engage with the health system, go to their scans and check-ups and follow the procedures that people are advised to take up.

I have a couple of questions on this issue. How did it actually come to light? I believe the Minister has touched on it already but how did it specifically break? How soon after was it addressed by those actions being halted? I would have thought that there were sufficient checks and balances in a system which is high-risk and high-impact. If something went wrong in surgery, I would have thought there would have been a significant degree of oversight, be that from a monitoring consultant, from an audit or from sample reviews because it is difficult to understand how something like this could happen in what one imagines is a highly regulated, monitored, and managed system. I am struggling to come to terms with how that could have happened in the middle of all this.

When I have asked all of the questions, can the Minister then come back to me? Is that the best way to do it?

The Deputy has passed his 45 seconds.

It is five minutes, according to the roster that was given to me.

The Deputy can wrap up now.

I will cut to the chase. Were these patients or their parents invited to consent to these procedures? Did they consent and was there a discussion or a decision at some point where they were told what they were signing up to here and what was going to happen and were they then misinformed? Was consent given which was based on false information? What engagement happened between patient and surgeon for this to happen? How was that managed and was that then vitiated by false information?

What is the next step when the initial findings come out? I know there will be many different investigations but when are the initial findings likely to be available? I thank the Cathaoirleach Gníomhach and the Minister. I thought I had much more time and I was only warming up.

Before we go any further, I wish to make clear that this is a questions-and-answers session. There will be direct questions and direct answers, over and back, rather than statements. I ask the Minister, therefore, to give a summary-----

It is an important question. It is not a short answer. The Deputy is referring to a number of different children across a number of different surgeries, several of which have been identified as serious patient safety incidents and others which have not. I might come back to Deputy Lawless and to colleagues in writing to ensure that there is a detailed response to this.

In the Minister's opening statement he said that in November 2022, his Department was notified that two serious patient safety incidents had occurred in Temple Street hospital and that he was informed around that time, sometime in November. In the CHI report, which was prepared for 8 August this year and which is a composite of a number of reports, it states that in July and September two serious incidents in spinal surgery were reported at CHI in Temple Street. If it was July when the first incident took place, and the Department was not notified until November, that is a period of four months. Is that accurate?

I thank the Deputy for his question. I note the CHI report states July and I believe it is November for the two patient safety incidents. I will check the exact timing but the process which will have been followed is that when those incidents were notified, the Department will have been notified. Importantly, I have also checked that the parents were followed up, close to when those serious patient safety incidents were notified.

I accept that but the point is that if it was the case that in July, CHI first became aware but it was not until November that the Minister and the Department became aware, that is serious. When the Minister became aware in November of these two incidents and other related issues, did he inform the Taoiseach at that point?

No, I did not. As per the opening speech, we would be notified of perhaps 20 or 30 of these incidents in a typical year. We deal with them, the Department engages with the HSE, I am updated on them, and then I interact as appropriate.

When did the Minister inform the Taoiseach?

There would have been communication between my Department and his Department previously rather than-----

Addressing this question to the Minister, this is a very serious issue. He has accepted in his opening statement that there is much trauma in respect of the families involved and I do not dispute the Minister's sincerity in this. Given the seriousness of these issues, people will want to know whether the Minister did his job right and whether he informed the Taoiseach and others in government as to the seriousness of these issues. This is not about communication between his officials and, yes, that would be helpful to get that information, but when did the Minister inform the Taoiseach?

I will check exactly when that was but the Deputy may understand that there is official communication. That is how I am informed and how the Taoiseach is informed. The Taoiseach and I spoke in detail about this last week but there was previous communication in August, and, potentially, before that with his officials and his Department.

These are questions we will put to the Taoiseach to discover what exactly his recollection is of when he was informed.

In relation to the non-CE spring implants, the Minister stated in his opening statement that this first came to light in August. Is that when the Minister was informed?

I believe the exact date when I was informed was 4 August.

Did the Minister inform the Taoiseach or anyone in government of that issue?

That would have been communication with the Taoiseach's Department through July and August and I can check as to exactly what communication may have included information on the springs.

Given the short time and the fact that we have Children's Health Ireland appearing before the Oireachtas Committee on Health on Thursday, I believe there are also serious questions for Children's Health Ireland on that particular issue which has been referred to by many colleagues in their statements.

The big issue for the Minister at the moment is to ensure that the external investigation has the full confidence of the parents and the advocacy groups. He has acknowledged today that he will meet with these groups and with parents, and the Taoiseach has also done so. They will want to know whether these will be serious and meaningful discussions and whether the Minister is open to changes to the terms of reference to ensure that we can get the buy-in and the support of the parents and the advocacy groups in respect of those terms of reference.

The short answer is "Yes". It is also important to say that the reviewer will meet directly with the families and groups. In fact, it is specifically within the terms of reference which includes consultations with patients' families and staff. The intention was that Mr. Nayagam would meet with them and he has full discretion within the current terms to adjust them according to what he hears directly from the families.

I also want to say that with the benefit of hindsight, I believe the draft terms should have been not just shown to the families and groups - they were shown to them but only just before publication - but there should have been a deeper consultation with the families and groups on the terms. I reiterate that the review was set up such that the reviewer himself would meet with the families and groups and not hear via me or anybody else, but would hear directly from them as to what they want. He then has full discretion to adjust the terms as appropriate.

It is important that the Minister acknowledges that because many people looking at this issue, me included, will be wondering how is it that a Minister for Health, when a scandal like this happens with all of the trauma that it involves for families, crafts the terms of reference which the HSE had input into and which we understand Children's Health Ireland had input into, but that the families and the advocacy groups had no input into. Nobody can stand over that, nor can the Minister. I just want to follow that up where I have a question-----

In the spirit of questions and answers, and I appreciate that the Deputy has a question, I will be short. I hear and agree with the Deputy and say that should have happened but it is important to state that it was and remains the intention that would happen, but that it would happen directly with the reviewer. In addition to that, yes, it should have happened with the Department and with me ahead of that as well.

The reason I say that is that I spoke earlier about all of the reports that have been published. I am asking the Minister now whether he can give a commitment to publish the report into Crumlin. That should be published in the interests of transparency.

On the Boston report, the advocacy groups are angry about the fact that they had input into that report but there is not a mention of that anywhere in it.

That adds to the scepticism they have over the terms of reference of the review, which is why that is so important. Will the Minister publish that report on Crumlin? What services are not happening in Temple Street? There is considerable speculation on it. It is really important for that to be clarified also.

I am out of time, but may I take a-----

Briefly.

The Crumlin review will be published. The families are being engaged with tomorrow. Crumlin hospital did this review off its own bat given the concerns raised in Temple Street. The very clear advice I have from CHI is that that review did not show higher return rates or complication rates than would have been expected internationally. Yes, we will publish the broader review. We will not be waiting a year. I will expect interim reviews and I will publish those interim reviews. Both Bernard Gloster and I intervened directly to ensure that the reviews - the internal review and the Boston review - were published in full. I never agreed to their not being published. I do not agree with the position taken by CHI and that is why Mr. Gloster and I intervened directly such that they were published.