When Emilia was three years old she had osteotomies on both hips at Temple Street hospital. Her mother felt unduly and inappropriately pressured by the surgeon. It started out with the possibility that she might need one hip done and then it was an absolute necessity to get both done. Emilia was six before she could walk property. She was the slowest to do a cartwheel and the last to ride a bike. She still has pain when she climbs stairs. Her younger sister Hannah was then later in Temple Street with an unrelated eye condition. The same surgeon spotted her and insisted on checking her for hip dysplasia. The mother said that was not necessary as she had been checked at the Coombe hospital and everything was fine, but the doctor insisted.

He logged into the CHI database, looked at the scan and said Hannah needed to get both hips done. The mother did not trust the doctor at this stage. She went back to the Coombe, where the doctor said that was a load of nonsense and that she did not need either hip done. No hip was done. It is a chilling example of what this scandal looks like to parents.

What it looked like inside the hospitals is illustrated by an email sent by then clinical director of Cappagh in November 2023:

Recently, it has become apparent that many children listed for pelvic osteotomies are being cancelled or are having their surgery deferred at short notice, thereby causing inefficiencies on surgical lists. Following a meeting today, I have decided that patients listed for pelvic osteotomies will no longer be discussed at the MDT [multidisciplinary team]. It will be up to the patient's individual consultant to review the X-ray and decide if they wish to proceed.

Surgeries are being cancelled because other surgeons thought they were unnecessary. Instead of saying something was wrong, the clinical director said we will stop discussing them at the MDT and it will be fully in the hands of the original surgeon to decide what he or she would do. That is incredible. What was the motivation for this? If Hannah had been operated on, because they had private health insurance, the surgeon would have made €1,500 for the first hip and another €750 for the second. That is what they would have made for Emilia's two hips. This is an example of the poisonous role of private profit in what should be a public health system.

I have three questions for the Taoiseach. First, why are the surgeons who conducted hundreds on unnecessary surgeries still operating on children? One of them could do an osteotomy tomorrow. Surely they need to be suspended, or, at the very least, stopped from performing osteotomies until the audit is verified. Second, the Government and CHI have publicly committed to independently reviewing all of these osteotomies, but the clinical director of CHI has emailed staff saying, "it is acknowledged that some patients and parents may request a retrospective review of their case to determine the indications for surgery". Does the Taoiseach agree that the onus should not be on parents to request that their cases be reviewed? Finally, does the Taoiseach agree that the review should not be limited to patients from 2010 onward, as is clearly indicated in CHI's statement? The operations started in 2002 and all of them need to be reviewed.

I thank the Deputy for raising this issue and the cases of Emilia and Hannah. Will the Deputy confirm that Hannah did not get the surgery?

Correct.

Okay. I do not want to put too much of a burden on the parent, but the issue should be formally referred to the Medical Council, for example, or to the authorities in CHI. It is important now that the Medical Council takes a role here in terms of the professional regulation of its members.

Hear, hear.

There is an onus on the Medical Council to be proactive in respect of this issue. I am conscious that it is a random, anonymised sample, although, to paraphrase, the author says there is a preponderance to a smaller number of surgeons in this context. I do not know who the clinical director at Cappagh is, by the way, but I know who the clinical director was at that time. That in itself is a serious issue because that seems to be a shutting down of the multidisciplinary team. The multidisciplinary approach is a safeguard against wrongdoing, poor practice or ill-informed decisions because the collective can inform. I have met many consultants who say they use a collective approach as to whether they will do surgery or not. Medicine is not an exact science. That is why the collective is important. I would be very worried about that email in terms of the suspension of the MDT in respect of assessing the necessity of operations in this area.

I have to be careful what I say. One further report, the Nayagam report, is coming. We do know, on a different case in terms of springs, action was taken with regard to a consultant being put on suspension. There is an issue for CHI as well in that it now needs to satisfy itself as an employer and satisfy prospective patients that there is no danger to any future patients and that the environment is safe following the publication of this report. I acknowledge what the Deputy is saying, that, by definition, the publication of the report creates issues with regard to a small number of consultants. That needs to be bottomed out fairly quickly. Obviously, the follow-through and the onus should not be on parents; the Deputy is correct. We now need to do an exhaustive examination. The Minister has already set about that, but has to put an external multidisciplinary team of professionals together to do that review of cases. That would then shed more light on the broader issues in terms of what has already been discovered in the audit with regard to veracity and verifying-----

Sometimes, when people are discussing this issue, they talk about culture in a disembodied sense, that a culture that was bad existed. Clearly, there was in this case. However, the culture was created by individuals and carried on by individuals. The top surgeons in question were a really big part of this. The question has to be asked in terms of what the motivation was. Was the motivation financial? I heard the figures, on top of salaries - that consultants receive €1,500 for the first hip and another €750 for the second. These are relatively easy operations for the surgeons to do. The Taoiseach can see how that may have a significant distorting effect on what is happening in our hospitals and proves the basic point that we need to have a proper public health system. I make the point that the email which suspended the MDTs, which was incredible, was cc'd to the senior management at Cappagh. It should have raised a red flag. Clearly, it did not because it then proceeded to happen and the MDTs were suspended.

Thank you, Deputy.

Does the Taoiseach agree that these surgeons should, at the very least, not now be conducting osteotomies? That can be done immediately and needs to be done immediately. The CHI statement is clear-----

Deputy, your time is up.

----- about operations from 2010 onward being reviewed.

I have said that-----

It needs to go back to 2002.

The Taoiseach to respond, please.

That is when these operations started.

The Minister has said already in response to that the last evening that she is not ruling out going beyond 2010, but that the priority right now has to be followed through-----

I do not want "not ruling out"; I want a commitment.

Let us be sensible about it. The Minister has to deal with those where skeletal maturity applies in terms of the cases that have been the subject matter of the external review, which is about 15 years. For those over that, they are in a transitional programme of care already as they transition to adult care. However, the Minister has said that this can be looked at in the context of getting the first phase done initially.

I wish to make one cautionary note that private healthcare does not mean unethical. Many people who operate and engage in the private sector generally are not unethical. I do not know the reasons as to why this happened. We need to inquire further into the how and the why. Different factors could be responsible for that. I raise the fundamentals. There is an ethical framework to which every doctor is meant to adhere. That has to be the key issue for us to explore.