There were 233 children on a waiting list for spinal surgery at Children’s Health Ireland, CHI, hospitals at the end of February. Of those children, 43 who had been approved for surgery had been waiting more than six months and 15 of those had been kept waiting for more than a year. These children are in agony. It is a national shame on us all that they are kept waiting so long. This morning, "The Oliver Callan Show" radio programme heard from Louise and Alannah Collins, mother and sister to 14-year-old Daniel Collins from Tralee. Daniel has severe scoliosis. In the 14 months since he was told he needed surgery, his surgeon in Crumlin has not been able to offer him a single date. His back initially had a curve of 22 degrees. There is now a 95% curvature to his spine so he will need two surgeries and has no date for either of them. Advocating for Daniel on the airwaves is not something that Louise or Alannah should have to do. They painted a heartbreaking picture of the real-life impact of dysfunction in the health service.

The thought of a child in pain is appalling. Persistent pain or worsening health are the last things any of us want for our own children or for anyone’s child. We all know Children’s Health Ireland has important work to do to ensure the protection of children's health. It is tasked with ensuring our children receive the highest standards of care when they are sick. It is also overseeing the movement of three hospitals onto the new campus at St. James’s Hospital. We will now be wondering whether Children’s Health Ireland will ever fulfil its commitment to provide surgery to children like Daniel within four months. The publication of this latest HIQA report on spinal surgeries compounds these fears. The resignation of the board’s chair, Dr. Jim Browne, yesterday only further confirms the doubts and concerns. It reports so-called experimental spinal surgeries and unnecessary surgeries. We know about the lengthening waiting lists and doubts about so many aspects of the move to the national children’s hospital. Some commentators are suggesting since yesterday that problems at CHI start and end with the actions of one rogue surgeon. However, while the details of reckless experimentation are horrifying, clearly the problems at CHI go deeper than that.

The HIQA report is deeply concerning in indicating systemic failures at a broader level. With more reports to come, what is obvious now is that there is a dysfunctional culture and that trust must be restored. It is difficult for parents to hand children over to an institution that has been criticised, as CHI has been by HIQA. With this damning report, and more to come, it is hard to see trust being restored without robust action. Looking at how that robust action may now be taken, I ask, first, whether the Government will examine the model used following the cervical check scandal and how trust was rebuilt there? I am thinking of the important work of the 221+ Group, for example. Second, can the Taoiseach say whether the board of CHI now retains his confidence and that of the Minister for Health? I am thinking of all those families impacted by the use of corrosive springs, families waiting on a surgery date and of course thousands of children waiting for the opening of a world-class children’s hospital who are awaiting the Taoiseach's response on this.

There are a number of issues there and I thank the Deputy for raising them. I fully understand the trauma that the family of Daniel Collins is going through in respect of the delay in getting surgery carried out. I do not want to go into the background of every individual case in terms of complexity of the case and so forth. My understanding is that there has been engagement. The assistant director of nursing lead for the spinal surgery management unit spoke with Daniel's family on 2 April and discussed his plan of care. There was a further engagement on 7 April. I hope that his case can be progressed. As I said yesterday, it is now in the hands of the clinical team managing his case. A multidisciplinary team meeting will be held in respect of Daniel's case in terms of assessing and dealing with the issue. It is a matter for the multidisciplinary team to come forward with that and engage with the family in respect of timings and so forth.

In terms of the broader issue, there has been far greater activity in spinal surgery within CHI. That has to be said. There has been a reduction in waiting times and in the lists. Others have come forward. It is not where it should be. We are going to continue to press ahead. The Minister is very focused on the issue, to further reduce waiting times for scoliosis surgery and spinal surgeries more generally and also to increase activity levels there.

We are awaiting further reports to be presented to the Minister. HIQA is the external independent body to ensure quality within healthcare settings in Ireland. It has produced a report in respect of the specific issue of the use of springs, which is absolutely unacceptable. We are all agreed on that. Then there are issues regarding the independent review being led by Mr. Nayagam. There are two parts to that, namely, the review in terms of the individual risk and then the independent review in terms of assessing the governance of paediatric orthopaedic surgery service to make findings on improvement in governance, quality, safety outcomes and performance metrics.

Meanwhile, the work has to continue in CHI. A new CEO has been appointed to CHI. The chairperson has resigned. A new chairperson needs to be appointed. The board needs to do that. Some have called for the board to be disbanded. That would not help the situation right now in any shape or form. It would weaken governance even further and could lead to further difficulties and challenges.

I thank the Taoiseach for clarifying that there has been engagement with Daniel Collins's family. However, I understand there is still no surgery date. We all wish Daniel and his family well. However, the reality is there are far too many families and far too many children still awaiting necessary surgery dates. Quite apart from the trauma all those families and children are going through, there is a broader issue. Our health spokesperson, Deputy Marie Sherlock, pointed out the broader issue of systemic failure highlighted by this HIQA report.

To return to that issue of confidence, there are three fundamental questions.

Is the Taoiseach confident that the board is capable of implementing the HIQA recommendations and can guarantee the provision of safe surgeries for children who need them? Can this board manage this complex transition to the new world-class children's hospital that we all so fervently hope will be available and accessible soon to the children across Ireland who need it?

Nobody is happy with this. I am certainly not happy with it and I know the Minister is not happy with it. The Minister is meeting with the board and the HSE regarding these issues. The two further reports, one of which is about dysplasia, need to come in. The three reports will be assessed in totality. We need - over time because we do not want to create any further disruption - to get to the bottom of this, and we will with these reports. The report about spinal surgery has been very clear and transparent about what happened and has outlined what happened. We now need to keep the focus on getting more activity within in the hospital. A lot of good work has been done within the hospital. That needs to be said. Many of the consultants have done very good work and have co-operated. We have significantly improved the level of activity in this area in terms of scoliosis in particular and spinal surgery more generally. In the medium to longer term, we need to look at the overall structures governing paediatric care. That is a point I would make and we need to reflect on and consider that.

Medical experiments were conducted on children in our major paediatric hospital. Corrosive springs were inserted into the bodies of extremely vulnerable children. No ethical approval was sought for the use of the springs and the families did not give informed consent for these procedures. This was not an isolated incident. The litany of failures raises serious questions about whether Children's Health Ireland is fit for purpose.

Despite this, yesterday in this Chamber, the Taoiseach ruled out a public inquiry into the enormous governance failures at Children's Health Ireland. The Taoiseach said previously that all the recommendations of the HIQA report will be implemented but families have heard that before. In 2013, a report into services for children with spina bifida found major deficits and a lack of co-ordination at national and local level. The recommendations from that report were not implemented. In 2017, a damning report from the Ombudsman for Children found serious and ongoing violations of the rights of children waiting for scoliosis treatment. In response, the then Minister for Health, Deputy Simon Harris, promised that no child with scoliosis would wait longer than four months for surgery. That promise was never kept. In 2023, the Ombudsman for Children published the Ivy report into the care of a child with scoliosis by Children's Health Ireland. That report found numerous failures of governance and communication within Children's Health Ireland. In 2024, a follow-up report to the Ivy report revealed that surgery was delayed for Ivy for so long that she was no longer operable. The latest damning report into Children's Health Ireland cannot be viewed in isolation. In fact, we know that two more reports into care at Children's Health Ireland are on the way, one of which will detail that potentially hundreds of children had unnecessary hip surgeries. Can one imagine the devastation felt by parents upon learning that their child has been put through traumatic surgery that was never needed?

The extent of the crisis at Children's Health Ireland and its implications for the care of children in Ireland are enormous. Last night, Úna Keightley from the Spina Bifida and Hydrocephalus Paediatric Advocacy Group said she had written to the Minister for Health three weeks ago but had yet to receive a response. Will the Minister meet with Úna Keightley and advocacy groups? Given the crisis at Children's Health Ireland, does the Taoiseach believe that ruling out a public inquiry into this scandal was too rash?

A lot of progress has been made and that does not get acknowledged. The HIQA report is a good report insofar as it clearly lays out what happened. What happened was wrong. It was incomprehensible. I said that yesterday. It is beyond belief that one would insert devices into a child that are not CE approved. It is very hard to comprehend that. That is unacceptable.

In terms of spinal procedures more generally, we are increasing activity year on year. There has been a 35% increase in activity compared to 2019 but we need to do more and that means recruiting more qualified surgeons and entire teams to enable that level of activity to increase. There has been a decrease of close to 20% in the number of those waiting over four months and a 59% reduction, as it should be, in the number of those waiting over 12 months but it is not enough in itself. We set up the dedicated paediatric spinal surgery management unit in 2024. There is a ring-fenced theatre in Crumlin. A lot of things have happened to enable a greater throughput and more consistency in terms of getting surgery done.

I spoke about public inquiries during Questions to the Taoiseach yesterday. Up to five public inquiries are being sought on different matters. I told the entire Dáil that we need to reflect on that. Is it the best model to investigate issues of this kind? Public inquiries are costing millions. Since 1998, €500 million has been spent on inquiries. There is an ethical question as to whether resources should be targeted at existing services for children living today across social, healthcare and education services. Inevitably, victims who seek inquiries do not get closure from them and are not happy with the outcome of inquiries. Many of these inquiries are taking years and costing millions. This is a serious issue. I have been in opposition so I am not casting aspersions on anybody but the easiest thing to do is to call for a public inquiry. It is a case of "that's done, we've called for it, so let's have it". Judges are taken from courts, reluctantly now because very few judges are coming forward. As an Oireachtas, we need to examine this.

My view is that we have agencies we have statutorily established to investigate issues. That is what HIQA is for in terms of healthcare. That is why it was set up. The Health and Safety Authority was set up for accidents while Fiosrú, which was GSOC, was set up for An Garda Síochána. These agencies need to do their jobs effectively and properly. I am not sure whether having public inquiries or calling for public inquiries or commissions of investigation that go on forever, cost millions and where people are not happy at the end of them is a sustainable model.

Government has a role here when report after report shows that recommendations are not being implemented. Government has a role to ensure that those recommendations are implemented. If that had happened in this case, we would not be in this situation. If the Government will not set up a public inquiry into the cases of the families affected, who are calling for that, what is it going to do to sort this out? I asked the Taoiseach whether the Minister will meet with the families affected, as they have requested. Could the Taoiseach answer that question? I agree that the surgeon bears huge responsibility in terms of their unacceptable actions but in terms of the wider issues, it is the families who are saying that there is a gaping hole in governance at Children's Health Ireland. They have been ringing alarm bells about this for years and feel they have not been listened to. If they had been listened to, we would not be in this situation. What will the Government do to sort this out?

First, we will implement the recommendations of the HIQA report. Second, there is a task force on the broader issue of paediatric spinal surgery headed by Mark Connaughton with which the Minister will meet tomorrow. In terms of governance issues, we will engage with those from now on. Instead of waiting for further investigations we will proactively look at the structures and governance framework there and respond to that. We all know that the big issue in paediatric medicine more generally is the transition from the existing hospitals to the new children's hospital. This will be the big issue. Whatever we do, and we have to implement all the recommendations, absolute focus must be on that transition to ensure it is as optimal as possible in terms of resourcing and staffing the hospital. It will be transformative, even in terms of the physical conditions at Crumlin and Temple Street hospitals compared to those at the new hospital.

Will the Minister meet them?

We will meet and the Minister is open to meeting and engaging with the advocacy group. We would like to work through these issues with the advocacy groups and give our perspective as to what would lead to more immediate and quicker results that everybody wants in relation to all the issues the Deputy outlined in the question.