"Children were not protected from the risk of harm." That is the line that really sums up the HIQA report into governance failures at Children's Health Ireland, CHI, published this morning. The investigation was commissioned following revelations that non-approved springs were implanted in three children during surgery at Temple Street Hospital. My first thought today is with those children and their families.

This report is a damning litany of failure: failure of governance; failure of management; abject failure by Government to act and Ministers to do their job. This is, after all, the body that runs the major children's hospitals in this State and the failures were widespread and systemic. Children's Health Ireland failed abysmally to keep children under its care safe - in fact, it put them in harm's way. These failures cover every area - management, governance, risk assessment, ethics, informed consent - and happened because Children's Health Ireland is not fit for purpose and was allowed to carry on in that way.

There was no overarching framework for governance; different doctors were working at different hospitals under different rules; there were separate procurement processes across each hospital; and there were no proper checks or oversight of process. Parents were kept in the dark about the true nature of the surgeries carried out on their children and there was very poor follow-up care for the children involved. These are all the hallmarks of an organisation playing by its own rules, outside of normal practice and with zero consequences.

It is the responsibility of Government to ensure the most robust, effective and safe practices are in place at all our hospitals. The failures at Children's Health Ireland were known for years and known to Government and yet nothing was done. We are now witnessing this pattern of behaviour, dysfunction and scandal repeated again with regard to unnecessary hip surgeries on children. There must be accountability all round, including political accountability. These failures span seven years and two health Ministers and were raised many times at the very highest level and were raised here in the Dáil. Government stood back and allowed this disaster for children's healthcare to happen and to go unchecked. Caibidil cháinteach eile atá sa tuarascáil seo i dteip leanúnach an Rialtais ar leanaí le scolóis agus spina bifida. Cuireadh leanaí i mbaol in áit iad a chosaint mar ba chóir.

The trust of children and their families has been shattered. It was a case of all promise and no action from Government. Yesterday the parents of 14-year-old Daniel Collins went to the media to call for an end to their child's suffering. He has been waiting so long for surgery that he now needs two operations. He lives with pain so severe and chronic, he is forced to sleep upright and cannot lie on the flat of his back. Daniel is not alone. Despite a litany of promises, there are 233 children still waiting for spinal operations that could change their lives.

Today's report must now act as a catalyst for real and meaningful change.

The Government must, of course, commit to ensuring that all of the report's recommendations are urgently implemented. The Taoiseach must account for the Government's and the Ministers' failure to act. I am aware that the chairman of the board of Children's Health Ireland, CHI, has stood down. However, in relation to the remainder of the board and the executive of CHI, has the Taoiseach confidence in them?

Tá sé dochreidte an méid atá laistigh den tuarascáil seo, go raibh dochtúir ann a bhí sásta springs den saghas seo a cheadú in obráid do leanaí. Ní raibh aon cheadúnas ann. Tá sé dochreidte an méid atá tar éis tarlú. My thoughts are with the families, the three children and the trauma they have gone and are going through. It is beyond comprehension that springs which are not permitted were used in surgery. The consultant concerned used springs that were not CE marked. That is the fundamental issue here.

Then there is the culture within the hospital that facilitated that. There are procedures but they were not followed, either in the procurement of or the use of these springs or in terms of any ethical considerations. This was not put before any ethical research committee. For example, if a consultant wants to engage in innovation and research regarding techniques around particular surgeries or difficult surgeries, normally that would go through an ethics committee within the hospital. That did not happen here either.

This matter was raised in a parliamentary question to the Minister of the day by Deputy Murphy and an inquiry was established. That is why the Health Information Quality Authority, HIQA, was established. I established that many years ago to make sure there was an external independent body to investigate and to ensure quality within our healthcare setting.

Let us be very clear. I understand where the Deputy is going in terms of wanting to say it is ultimately the Government's fault. There is a limit to what anyone in this House can do in terms of how people conduct procedures in operating theatres. Let us call a spade a spade here. We can be political about these matters but there are fundamental issues here that happened and should not have happened. There has to be individual responsibility. There has to be accountability in that respect. There has to be management accountability in terms of CHI and the board and so on, why the governance procedures were not followed and why they were essentially bypassed.

All of the recommendations will be implemented. I note that the chairperson, who has been in place since 2013, has tendered his resignation. The Minister will first ensure the implementation of the different sets of recommendations for the CHI, the nine recommendations for the HSE and the one recommendation for all services providers and all hospitals throughout the country. She will also, over time, evaluate structures in regard to these issues. Equally, it has to be said that much progress has been made on the other side. No one wants to hear that today but very substantial focus has also been made on a number of fronts.

In regard to Daniel Collins, my understanding is that the clinical team is engaging with him and the family in respect of his situation. I am not at liberty to go into too much detail on that. However, it is my understanding that there is engagement with the clinical team. It will decide about the clinical decision-making around Daniel's particular case.

Dúirt an Taoiseach go bhfuil an méid atá sa tuarascáil dochreidte, ach níl sé seo fíor mar bhí a fhios ag an Rialtas agus bhí a fhios ag na tuismitheoirí an méid a bhí ar siúl i CHI. The Taoiseach said this is incredible. It is certainly shocking and deeply unacceptable but it is not incredible. This was known. Parents knew it. Advocacy groups knew it and raised, again and again, wide-ranging systemic issues around governance, a lack of management and issues around informed consent.

Deep ethical concerns were raised again and again and were ignored. Families and advocates met a brick wall. That is the truth. I do not know if the Taoiseach has studied the report in any detail but this is not simply a matter of clinical decisions made in discrete circumstances in an operating theatre. Of course, the clinicians need to be accountable. This is profound dysfunction - a pattern of it within the fabric of this organisation. The chairman of the board has resigned. Does the board and the rest of the executive need to follow him?

If I want to be blunt about it, it actually is fundamentally about decision-making within the hospital setting and within the operating theatre. Too often within this House and across the political world, we immediately go to the political domain. There comes a time when we equally have to stand up for what is right and proper, and I know the Deputy wants to, but let us call a spade a spade here. What happened should not have happened. An individual decision was taken to use springs that should not have been used on any child. We are almost the biggest medical device manufacturer in the world and Europe. There are set procedures and quality controls over medical devices that go into any patient. The idea that one would use springs outside that entire protection framework is beyond belief and responsibility lies with the individual in the first instance.

The Taoiseach is missing the bigger picture.

The Taoiseach has not read the report.

People talk about well wishing. It is as plain as night follows day. One does not use unauthorised devices on any child. That is at the heart of it.

That is not in dispute.