Before I call the Opposition leader, I welcome back Deputy Holly Cairns. I also congratulate Deputy Emer Higgins who married her husband Brian Lawlor over the recess. Under Standing Order 38, I call the Opposition leader, Deputy Mary Lou McDonald.

I extend my comhghairdeas to both Deputies on very significant and joyous life events.

Harvey Morrison Sherratt died on 29 July. Last week I spoke again with his parents, Stephen and Gillian. They are heartbroken and shattered by the loss of their beautiful little boy, and we again send them our condolences and our love. Harvey had a very short life. He was only nine years old when he passed. As the Taoiseach knows he suffered from scoliosis and spina bifida. He waited years for spinal surgery as his condition worsened, and his dad Stephen said, "We watched him deteriorate, cry in pain, struggle to breathe and lose the sparkle in his eye." Harvey was born the year the Tánaiste, Simon Harris, was appointed Minister for Health. In 2017, when Harvey was just one, his parents were told that his ribs were crushing his lungs. That same year Simon Harris promised that no child would wait more than four months for spinal surgery. Over the last eight years that promise has been broken again and again. Harvey did eventually get his surgery last December, but he had waited far too long. He was badly let down. He was, in fact, failed by Government.

Harvey's story is not an isolated case. Such failures are shamefully a hallmark of the Taoiseach's Government. On Monday, Cork mother Antoinette Burke felt she had no choice but to challenge the Taoiseach publicly. Her daughter Katie has cerebral palsy. She has been left waiting 15 years for the surgery she needs. Antoinette said that she first contacted the Taoiseach's office back in 2010 but her pleas went without action. The Taoiseach said in reply, and I use his words, that Katie's case is not "necessarily emblematic" of what families go through in their fight for disability services and treatment, but in fact it is exactly that because Antoinette's hurt and anger is recognised very well by the parents of children with scoliosis and spina bifida. It is emblematic of what they have experienced.

It has been a litany of broken promises from Government. It promised it would do everything possible to end the scandal of children waiting and waiting for spinal surgery, but today that waiting list is growing.

As we speak, there are 135 children on waiting lists without a date for surgery, up from 108 since the start of the year, and 40 of these children have been waiting six months or more just for a date, mind you, not even for the surgery itself. Last year, the Government promised that children waiting more than four months would be given the option to travel for surgery but since then only seven children have had surgery abroad. It is shockingly low. The Government continues to fail these children.

Tá bás Harvey Morrison Sherratt tar éis solas a dhíriú ar theip an Rialtais i leith leanaí na tíre. Caithfidh an Taoiseach cur in iúl dúinn cad atá i gceist aige a dhéanamh chun cinntiú go bhfaigheann leanaí le scolóis nó spina bifida na hobráidí atá de dhíth orthu le práinn. Harvey's battle with scoliosis was a race against the clock. It is the same for each one of these children. The longer they wait, the more complex surgeries they will require. The risk of permanent paralysis is very real. The fear of becoming inoperable is very real. This neglect of children with scoliosis and spina bifida must end and must end now. I ask the Taoiseach directly today to tell those children and their families what he will do now to ensure they get the operations that they require urgently.

Hear, hear.

At the outset, I want to take the opportunity to offer my deepest condolences to Harvey Morrison Sherratt's family and his parents, Gillian and Stephen. No words of condolence or consolation to Harvey's parents are enough. It is an extraordinarily traumatic thing to happen to any family, but in these circumstances even more traumatic in terms of the experiences the family and Harvey had with the hospitals and the clinical world itself, and it is unacceptable. The Minister met with the HSE and CHI board and has been working on this issue non-stop since she was appointed Minister for Health. The Minister has asked for a multidisciplinary report on the chronology from CHI regarding its involvement in Harvey's care and the key milestones as recorded on the CHI's hospital records. The HSE CEO received this draft report in August and has shared that report with Harvey's parents as well as with the Minister for Health. My understanding is that the Minister for Health and the Tánaiste are due to meet Harvey's parents in the near future.

I understand fully the anger and the absolute frustration felt by the parents and by other families who do not receive surgical intervention at the right time for their child. I have spoken to Antoinette Burke since I met her earlier this week. We have arranged to meet. I do not want to get into discussing individual cases here in public, but clearly the issue there is one of clinical decision-making and the judgment made by clinicians. Clinicians, it seems, have taken a decision not to do surgery over many years in that case on a clinical basis. Obviously, any parent wants to do the very best for their child. It seems to me that the interaction or engagement between the clinical decision-making and the position of parents is one that has to be improved. Certainly, however, the question was put to me about the use of the word "emblematic", and I made that point in the context that if we look at, and I have read, the case in relation to Katie and Antoinette, there is a very clear disagreement in respect of the clinical judgment that consultants have made in that case. That said, I am going to pursue this. We have spoken to the CEO of the HSE in relation to this case also.

On the broader issue of scoliosis, very significant resources have been allocated by Government to CHI. There is no point is saying there have not been; there have. The issue is that the translation of those resources to outcomes and outputs is a key issue for us.

There have been a number of reports into CHI. All Deputies are aware of that. We are not happy with everything that has happened in CHI. We have an issue in that one consultant has been referred in respect of the utilisation of devices that did not meet the quality mark. We are awaiting a report on governance in CHI. The Health Service Executive has strengthened its service level agreement with CHI and is giving stronger supports to it. That process will continue in terms of underpinning, supporting and creating additional capacity in CHI in the immediate future and the time ahead. That is the direction of travel in respect of services, in particular spinal services, at CHI.

As Harvey waited for the surgery that he required, the curvature of his spine deteriorated from 75° to 130°. I do not know if the Taoiseach saw him. The poor wee child was literally doubled over. He struggled to breathe. He waited and waited, and he is not unique. He is unique now in as much as he is emblematic of the wholesale manner in which many other children have been failed.

TJ Coughlan from Tullamore in County Offaly is a great young man. He is 20 and was told at the age of nine that he needed surgery. He was left waiting until he was 13 and when he turned 13, it was too late. He is now inoperable and is wheelchair bound. That was catastrophic for that young man's life.

The Taoiseach said this is unacceptable. I agree with him. He is reluctant to discuss individual cases in public. I understand that, but we must remember that these families have no option but to present their pain in very public forums. The Taoiseach pointed to clinical judgment. It seemed to me he offered every excuse under the sun, but he has not answered my question. What is he going to do about it now? This is not about treading water. What decision will be made now? Can the Taoiseach explain to us how it is that the waiting list is now growing and only seven children have availed of treatment abroad, for all of the fine words and promises from this and successive Governments?

I am not applying my reply to the two cases the Deputy mentioned, for example. There is a fundamental question we have all faced if we are honest, whereby people come to us and say that as a parent they believe their child should get a particular intervention or surgery. If a doctor or clinician does not believe that is appropriate at that time or believes that the outcomes may not be optimal at that time for the child concerned, what is Deputy McDonald suggesting? This is a reality on an ongoing basis. It seems to me that we have to examine that relationship further, as well as the level of advocacy for the parents in these situations.

That is why I think there is a weakness. Politicians cannot and should not arbitrarily intervene and say something should happen irrespective of what a clinical expert has said. We need some degree of consensus on that point. How it transpires and the advocacy for parents in that situation is something we should examine, in terms of stronger advocacy for parents in respect of clinical decision-making.

In terms of what we are doing regarding the treatment abroad scheme, we have provided resources and there is an instruction to CHI and clinicians to refer, and I believe they should be referring patients on a continuous basis.

I want to welcome everyone back to the House, in particular Deputy Holly Cairns on her return from maternity leave. I congratulate Deputy Emer Currie.

Higgins.