Hundreds of parents are today living the nightmare of the prospect that their children were operated on unnecessarily. On foot of whistleblower allegations, an audit was carried out into paediatric hip dysplasia surgeries at three Children's Health Ireland hospitals. The audit, which has been published in full on The Ditch website, found that hundreds of children who were operated on between 2021 and 2023 did not meet the threshold for this surgery. It recommends that 561 children be recalled and independently assessed. This is very serious.

We have received dozens of emails and phone calls from parents since my colleague an Teachta Pearse Doherty raised this scandal in the Dáil on Thursday last. Parents are at their wits' end having received letters from Children's Health Ireland to inform them of the audit. The parents were provided with an email address in those letters, but many are telling us that they are emailing and getting no response. They are also ringing but getting no answer. This is heaping stress on top of stress.

One mother contacted us to say that she had received two letters because her twin daughters were three years of age when they had surgery in 2023. She stated:

It took them months to recover, to learn to walk again, not to mention the agonising pain each of them were in and the sleepless nights crying in pain. We want to get to the bottom of how they could put vulnerable children through this.

A second parent wrote:

One of my daughters had both hips done and we have received a letter. I am sick with nerves at the outcome of this. Families deserve to know sooner rather than later.

Another mother states her daughter had the surgery in 2023, days before her third birthday. She wrote:

I am heartbroken to think I put my little girl through so much pain if there was never any need for it. She had to be lifted and carried for over a week after the surgery. She was afraid to go to the toilet the night and day after surgery, she was in so much pain.

We know of cases where parents sought a second opinion when their child was scheduled for surgery and, incredibly, were told that not alone did their child not need the operation but also that they did not in fact have hip dysplasia at all. Parents of children who had operations a decade ago are also receiving letters. There is now a genuine fear that these practices were going on long before 2021. I would like to know how many letters have been issued. I want to know how many children have been affected.

Parents are angry that Children's Health Ireland will conduct the follow-up assessments because they have completely lost confidence in that organisation. Who could blame them? Children's Health Ireland is an organisation mired in scandal. The controversies pile up and the Government sits on the sidelines incapable of getting a handle on things. Tá na céadta tuismitheoir buartha gur chuireadh a bpáistí tríd obráidí tromchúiseacha gan ghá ag CHI. Ní mór don Rialtas na freagraí atá ag teastáil ó na dtuismitheoirí seo a fháil dóibh. The Government needs to get on top of this. What action has it taken to uncover the full extent of this scandal? For how long has it been going on? How many letters have been issued? How many children are affected? Crucially, when will parents be told whether their children were operated on unnecessarily?

It is very traumatic for any young child to go through surgery, irrespective of the gravity of that surgery. Equally, it is very traumatic experience for parents. In that context, to have a clinical audit established at CHI and Cappagh hospitals on the surgical management of children with the condition known as developmental dysplasia of the hip is deeply traumatic and compounds the original trauma. It is extremely worrying for patients and will lead to anger if it transpires that operations were carried out that were not required at all.

People should remember that, first and foremost, this is a clinical issue insofar as the decision to take the step of surgery is a clinical one. It is predetermined and it should be done through multidisciplinary teams that decide whether a child needs surgery for a specific condition. It is extremely serious that the assertion is that quite a number of operations were carried out unnecessarily, notwithstanding the fact that we are talking about clinicians involved in surgery of this kind.

A clinical audit is being conducted by an external international expert on surgery for children with developmental dysplasia of the hip across CHI hospitals and at the National Orthopaedic Hospital Cappagh. I believe the Deputy knows the condition. It is a problem with the way a baby’s hip joint forms, and some children with it may require surgery. The purpose of the audit is to establish that surgical practice was in line with international standards and practices. The audit is close to its final stages. It makes sense for us to await the completion of the audit in order that we will have an informed, evidenced-based approach to the issue.

Letters are being issued to the families by CHI and Cappagh hospitals, and they will be writing to them to provide further information in respect of this. I expect the details of the audit to be published and fully shared with the parents before publication.

My understanding is that concerns relating to different thresholds of surgery being applied in CHI hospitals and National Orthopaedic Hospital Cappagh were initially raised internally in CHI under protected disclosure arrangements in September 2023. The Department of Health was notified about this matter on 9 May 2024.

The audit process, as I have said, is at an advanced stage with clinicians to provide feedback on the draft report to the expert author by Friday, 21 March. Patient safety precautions are being put in place and a multi-disciplinary team is looking at all of this in a comprehensive way.

This is deeply worrying for the patients. We have to wait for the completion of the audit and the presentation of the findings to the parents, and then take what action is required also. It goes to the very heart of the clinical practice and standards that applied.

It is important to acknowledge the trauma to any child undergoing a surgery but the very idea a child would be put through that unnecessarily is doubly traumatic. Parents are now faced with the scenario of not knowing. The audit may only be in draft form but the letters have been issued. They are arriving to families. This stress and distress is very real in the here and now and the Taoiseach's argument that we simply need to wait and wait will weigh very heavily on those families who want answers now.

The Taoiseach says the HSE was made aware of these matters in May of last year. Can I ask when the Minister for Health was made aware? It seems to me an extraordinary thing that a year later parents are being told, and they are being told again to wait and wait. Can the Taoiseach tell us how many letters and how many children there are and how long was this scandal in the making? Was it, as we now suspect, not simply between 2021 and 2023? Does it go back as far as a decade?

First of all, no one is being asked to wait and wait. There has to be a proper audit done of this and then there has to be a proper look back to cover as many children as possible who would have had this surgery to have completeness and to do a comprehensive look back on the specific surgery. In my view, that is the correct thing to do. Yes, correspondence is going out to parents; that is important as parents have to be contacted. I will discuss this, obviously. Once the audit is done, there has to be full transparency in respect of not just the audit but all aspects of how the case, or this issue, will be dealt with from here onwards. It is very worrying that an audit has been found necessary in the context of standards of clinical care.

When did the Minister know?

I do not have the precise timelines on that.

He does not know when the Minister knew.

I gave the Deputy the date in terms of the Department. Tá sé dochreidte ar shlí. Níl aon amhras ann go bhfuil tuismitheoirí ar fud na tíre an-bhuartha faoin méid atá tar éis tarlú. Caithfidh muid dul i ngleic leis agus tuarascáil chuimsitheach a chur os comhair na dtuismitheoirí agus an phobail i gcoitinne.