I welcome Deputy McDonald.

Go raibh maith agat, a Cheann Comhairle.

The shocking revelations regarding paediatric surgery at Temple Street Children's Hospital have been met with huge anger and disbelief. It is hard to wrap one's head around the pain and damage experienced by the children and families affected, with 19 vulnerable children harmed, traumatised, in what was a catastrophic, unfathomable breach of care and trust, and too many other children still languishing on spinal procedure waiting lists and their parents left living in fear.

Yesterday I met with parents and advocacy groups and they are very angry. They say that Children's Health Ireland and the HSE have not been upfront with them and are seeking to dodge accountability for the scandal. They say that if the external review is to command their confidence, there is no way Children's Health Ireland or the HSE can play any part in drafting terms of reference. They say that if the terms of reference fall short of their needs, they will boycott the review and not allow their children's files to be accessed. They have expressed deep frustration that this scandal is portrayed as involving one consultant at one site; they say that it is much wider than that. Their experience is one of systemic failure of clinical governance, a deep-rooted failure by the State to resource the system properly and a failure to prioritise their children for life-saving and life-changing operations. The parents are angry about inadequate operating theatres and a frightening lack of intensive care capacity and angry that their children's doctors are forced to beg for necessary resources.

At the weekend it was reported in the media that, far from being in the dark about these experimental surgical techniques, meetings on these matters in fact took place at a very high level and included the head of Children's Health Ireland. This morning I shared with the Taoiseach a letter that came into my possession. The letter seems to confirm that such meetings were happening as far back as 2020, suggesting that the head of Children's Health Ireland was involved in these meetings and was even asked by surgeons for guidance on the use of these techniques. This raises very serious questions for Children's Health Ireland, and those questions require urgent answers. Did these meetings happen? What guidance or advice, if any, was given to surgeons and clinicians by the head of Children's Health Ireland? Does the Taoiseach have answers to these questions? Does the Minister, Deputy Donnelly, yet have answers to them? These facts need to be established urgently because this information is fundamental, I believe, to the drafting of any terms of reference. Certainly, these issues add weight to the call from parents and advocacy groups that Children's Health Ireland can have no hand, act or part in drafting terms of reference and certainly cannot be the body to which any of these reviews report back. Tá doimhne níos mó ann leis an scannal seo. Tá ceisteanna tromchúiseacha ann do CHI. Ní féidir ról ar bith a bheith aige i ndréachtú théarmaí tagartha an athbhreithnithe.

It falls to the Taoiseach as Head of Government to ensure that any review is truly independent and holds the full confidence of families and advocacy groups. The letter to which I refer raises fundamental questions of fact that need to be answered urgently and directly by Children's Health Ireland. The Taoiseach can secure these answers and I urge him to do so. I also ask him to guarantee that Children's Health Ireland will not be involved in the drafting of the review terms of reference.

I acknowledge once again that this matter is a cause of great anxiety to many patients and many families attending these services, and I am determined that we will get to the bottom of it. As the Deputy knows, an Irish Medical Council complaint is being considered at the moment and an independent review is being established under the guidance of UK expert Mr. Selvadurai Nayagam. The terms of reference, as is always the case for any review, will of course be done with consultation - consultation with the reviewer himself, who will of course want to meet the interested parties, advocacy groups and families, of course in consultation with the families, and with the advocacy groups. They will not just be written by the HSE or CHI. The review will be independent, but we do need to bear in mind that any review into CHI and the hospitals concerned will be achievable only with the co-operation of the hospitals concerned, and I would expect their full co-operation with the review.

Last week I appealed to politicians on all sides, the media and the public not to come to any conclusions about what happened here until we know the facts. I want to reiterate that now because I have read the letter that Deputy McDonald sent me this morning. It puts a new complexion on this, as she says. I do not know if it is genuine or if it was ever actually sent. I do not know if it was received or acknowledged, and I do not think the Deputy knows those things either. However, it does indicate that there was a level of knowledge at management level about what was happening, and that a multidisciplinary team, MDT involving nurses, doctors and therapists was consulted. It also claims, perhaps correctly or incorrectly, that the families and parents involved consented to what were essentially experimental procedures in a very difficult case, where patients were not fit for any other surgery. That puts a very different complexion on what we have heard to date and is very much at variance with the impression created by some of the stories the Deputy and I read on online media. It is exactly why we should not jump to conclusions. We need to come at this from a sensible, level-headed, calm, considered approach, ensuring that nobody jumps to conclusions until we know all the facts. Of course, the review, therefore, has to be thorough and independent.

I absolutely agree with the Taoiseach that nobody should jump to conclusions. What I am asking him to do, and this is a necessary precursor to getting the terms of reference for the review right, is simply to establish, as a matter of fact, whether a meeting or meetings occurred involving clinicians, and also the head of Children's Health Ireland, CHI, in which these experimental surgical techniques were discussed, whether guidance was sought and if it was given. The establishment of those basic facts - not conclusions, but basic matters of fact - creates a very different complexion and framework for the work of the review. I urge the Taoiseach to do that.

I know the Taoiseach is going to meet with advocacy groups, parents and families. However, I have to reiterate the fact that, according to families, the idea that CHI or the HSE would have any hand, act or part in designing the terms of reference is just an intolerable proposition, given the profound failure of their children and the very big questions that arise. I ask the Taoiseach to address that question again please.

I can assure the Deputy, the families and the advocacy groups that the HSE and CHI will not be writing the terms of reference for this review. It will be independent. Of course, they will have to be consulted at some level about what is going to be in the terms of reference. It would be improper not to do so, and absolutely, the advocacy groups and the parents will need to be consulted too, and the reviewer who is going to carry out the review. That will be done. It might take some time, therefore, to come up with terms of reference because I know the reviewer will want to meet the Minister for Health, Deputy Stephen Donnelly, and the Minister will want to meet him. The Minister for Health obviously has political responsibility for this, as we do as a Government. Beyond that, the reviewer is going to want to meet with the advocacy groups as well. It is absolutely right that the terms of reference are done correctly, even if it takes a bit of time for them to be agreed, and that the external review is fully independent.