I thank the Minister. Next up is the Rural Independent Group.

First, I cannot express enough to the children themselves, the parents involved, the aunties, the uncles and the grandparents, that when we are having this debate and this question-and-answer session with the Minister, we have to keep those lovely people and lovely children in mind. They are the most important thing in all of this. We can ask and answer all the questions we like, but the pain, the suffering and the turmoil those little children and those families have gone through should be the most important thing in every one of our heads. While CHI has refrained from commenting on the allegations regarding unlicensed implants and the suspension of spina bifida surgeries, we now know that one surgeon has now been suspended from the hospital since May of this year. Can the Minister say any more about that at this time?

What I can say is that he has not been suspended. There are clinical protective measures that have been put in place, including as part of the consultant contract. Some of them are contained in the reports. For example, having a second surgeon involved when there is complex surgery is one of them. The surgeon is currently not doing any clinical work, but it is important to say, and I do not believe any of us in this House are guilty of it, there have been no findings made against this doctor.

Okay.

It is absolutely clear, and we do not need any report to tell us this, that non-medical materials should not have been used. That is a given. The Irish Medical Council is in a formal process. That is a legal process when it comes to the review of clinicians. We have to let that process go through.

Yes.

So, we know the rate of complication is higher than would have been expected internationally. However, there have been no findings at this time that have been made against this surgeon.

Yes, that is a very important clarification. One troubling allegation is that the non-medical springs, which were made from low-grade steel rather than the required titanium alloy, were used in surgeries involving at least three young patients. These springs were not intended for medical use. Am I correct in saying that? This raises questions about their origin and intended purpose. This reminds me, and the Minister will be very well able to remember this also, of the situation of people who had hip replacements. The Minister will remember how low-grade materials were used in the hip replacements, and then there were all those cases, etc. I am comparing one with the other. Can the Minister give any clarification on that?

I thank the Deputy. What I can tell him is this: the springs that were used were not authorised for medical use, which is very serious. We do not know - the review is now establishing this - how that happened in terms of procurement and getting into theatre. There are protocols for checks on everything that is used in theatre. Exactly how all of that happened is being established right now, but we know that these were not authorised. Furthermore, we know there are processes in place through the Health Products Regulatory Authority, HPRA, which authorises the health devices, to be able to identify materials that can be authorised for medical use. This is obviously subject to a battery of tests and regulations.

Yes. I do not like using this analogy, but in the past hour I have spoken to a person who has been involved in the automobile industry. That person said to me that when a motor car is being made, there are awfully strict criteria about the materials that are used. How could this actually happen, when these are going into people’s bodies? It just does not make sense. I am not asking the Minister to answer me on that because I do not want to eat into Deputy Danny Healy-Rae’s time.

First, I, too, commiserate with the families involved and with the Carter family for the loss of their lovely child. It is so sad. So many people do so much good work, such as doctors, nurses and the health service. It has to be acknowledged that they do. It is sad to see that trust is being broken in a case like this. We see the same with the child and adolescent mental health services, CAMHS. I want to ask the Minister about who in the chain of command is responsible for what. This is a scandal. Is anyone going to be held culpable? Was there someone in charge of the surgeon? We do not know. What is the Minister’s responsibility? He is the Minister for Health. Should he be overseeing what has gone on here and have known more about it a lot sooner?

I thank the Deputy. It is a very fair question. The answer to that is that there are extensive patient safety and clinical governance mechanisms in place in all our hospitals to do with every procedure. In this case, two serious incident reviews have been kicked off. They will be reporting very shortly. They have done extensive work on what happened in two particular cases. Concerns were raised through the multidisciplinary team. That kicked off an internal and external review. A complaint has been made to the Irish Medical Council. The Irish Medical Council is now carrying out its own work.

Neither the chief clinical officer nor I was satisfied that the internal and external reviews sufficiently answered the questions. I agree with much of what has been said this evening about the reviews not identifying what went wrong. Those two reports are useful in terms of ensuring everything that should be happening is happening, but as Deputy Shortall alluded to, they did not call out what went wrong. As such, Dr. Colm Henry and I were not satisfied that the questions had been answered to the level they needed to be. That is why this additional review is being carried out.

This review was triggered by complaints from clinicians and staff last October about problems with infections and complications following surgeries. That was almost 12 months ago. It is frightening to think so many children were affected. I am not sure if the number is 16 or 19, but one has died. One is too many. This is serious.

We must narrow down who was responsible. The HSE is getting an awful lot of money, and it needs that money, but we must ensure something like this never happens again. We are told not to put spurious parts in certain vehicles, but to be crude about it, that is what happened in this instance. Who ordered what and at whose discretion was it to purchase these devices?

That is exactly what two reviews are looking at – an external review commissioned by CHI and an external review commissioned by the chief clinical officer, with the reviewer reporting to the chief clinical officer and meeting me regularly. This is exactly what we need to establish.