Is é an príomhrud, agus an rud is tábhachtaí, ná na leanaí a fuair na hobráidí seo, agus na tuismitheoirí go háirithe. Is é príomhaidhm an Rialtais ná tacaíocht agus cabhair a thabhairt do na teaghlaigh éagsúla. Tá mé an-bhuartha ar fad faoin méid atá á shoiléiriú ag an tuarascáil seo a foilsíodh an Aoine seo chaite. Our overriding consideration will be the children upon whom these operations were carried out and their families. That is the number one priority of the Government and, indeed, of the Minister for Health. The findings of the audit are shocking and grave Our first thoughts have to be with the children and their families. In terms of the communications, I will make sure there should not be a limit of one parent being allowed to attend any meeting. In my view, parents, or at least a mother or a father, may require support at such meetings, and that should be readily facilitated. I make the point that the audit was external. It is unfair to cast aspersions on the Government's motivation and suggest that somehow this could be in-house. The audit was external, conducted by Simon Thomas, consultant orthopaedic surgeon at Bristol Royal Hospital for Children. On the figures, some 60% of procedures in Temple Street were not clinically indicated in accordance with the criteria established by the author. In Cappagh, 79% were not clinically indicated. That is beyond comprehension, but we need to find out why and how it happened. The most immediate priority has to be the follow-up for the families. In that context, individualised letters have been sent out by CHI and Cappagh. An expert reference group, with international input, is developing the criteria against which future multidisciplinary team assessments will be made. That will be in place within the next two months. In terms of the retrospective review, fundamentally, it has to be external. A separate process involving external experts is being established for this purpose by the HSE. The Minister has asked the RCSI to assist in bringing together a multidisciplinary external team to examine all cases going back over the period of time in question, which covers about a 15-year period in terms of skeletal maturity and so forth. The Minister for Health is expediting the establishment and engagement of external experts to review these cases, not just surgeons, but radiographers and other disciplines as well. The issues raise the most fundamental concerns about clinical performance itself, clinical governance and overall governance within CHI. The Deputy referred to other matters in respect of a report published in The Sunday Times. The Minister was notified of this on Saturday afternoon via a media inquiry. She had not been alerted to the existence of that report of an internal inquiry conducted by CHI. That also makes for shocking reading of the most profound kind, which not just goes to the heart of the misuse of NTPF funding but more seriously raises fundamental concerns at that time about safety for children receiving surgery.
Sentiment score: 0.06
The immediate priority is the clinical follow-up and care of patients who have undergone this surgery. This represents a very fundamental and serious breach of trust. As I have said, there will have to be further investigations as to why this occurred and how it was allowed to occur. I have said the retrospective look back will have to be externally done, involving multidisciplinary teams to make sure that independence and that confidence is in the process from day one. I make the point, of course, that 98% of the procedures and surgeries within in Crumlin were clinically indicated. I acknowledge there are many very good high-quality people working in CHI generally. There are very basic issues of clinical governance, clinical leadership and clinical performance. There are issues with overall governance of the hospital that are clearly raised and emerge from this situation.
Sentiment score: 0.31
First of all, there has to be accountability. I would agree with the Deputy in that respect. Also, one would have thought that the era of an individual consultant being an independent republic was long gone. That is clearly not the case in the context of these reports and the one from which the Deputy has been quoting, which is the subject matter of The Sunday Times articles, if I am correct. The imperative of multidisciplinary teams being in place across the entire system cannot be overstated. That report the Deputy referred to, which I had a look at late last night, is deeply worrying. It relates to a whole range of issues but the more fundamental one, in terms of the overall context of the language the Deputy used, really speaks to an environment that is, to put it mildly, not optimal for the safety of patients, and an absence of a proper team-based, holistic ethos within the CHI group and within the hospital in particular. The Minister said earlier that governance was an issue of fundamental concern to her also. We need an immediate clinical follow-up for those impacted by the hip surgery and pelvic surgery and then, in addition to that, we need accountability and to find out why and how so many children who did not require operations had operations. Third, the Minister has appointed or is in the process of appointing two members of the HSE board to the CHI board. We have to evolve the governance now of CHI, conscious that we are moving to a new hospital as well, which in itself will demand significant governance standards and capacity. We have to do so in a way that does not disrupt the thousands of procedures that are ongoing within CHI. A new CEO has come on board there. We have to work with the new CEO. I know the Minister and the HSE will work closely to buttress and underpin governance now in the short term within CHI. We will have to look at a sensible evolutionary pathway to change governance. I would make the overall point that, in health historically, institutions have been too strong, to the detriment of patients. In education, the big revolution was that the learner became central to education, not the institutions. In health, the patient must be central, not the ethos of any particular foundation, any particular historic hospital or whatever else. Invariably, new structures get formed to accommodate the historical background of certain hospitals. That is what has happened essentially in terms of CHI. We need to move on and evolve this into a proper governance framework.
Sentiment score: 0.09
I agree, although I note that, maybe not Deputy Bacik, but others last week were looking for the resignation of the board or something tantamount to that. That was put to us. A drip-feed of resignations is not the answer, obviously. The Minister has been clear on the number and series of steps. The immediate one is clinical follow-up that will be external, independent and give the necessary reassurance to parents, what could be young teenagers now and children in respect of the surgery they went through. They could have that external look back and it would be independent. Within CHI, there has to be a fundamental commitment to a multidisciplinary team-based approach across the entirety of all disciplines in CHI, including surgical disciplines and all other areas of medicine. That is absolutely critical. The Minister has said that governance is a key issue. I agree with the Minister. I think there has to be a fundamental look at governance as well in the immediate time ahead, but we must avoid-----
Sentiment score: 0.10
I am sorry. It will involve the HSE. We have to do things in a way that does not disrupt urgent procedures that children require today and next week.
Sentiment score: -0.08
Again, I reiterate that this is a shocking report into hip operations. For example, there is the variation between Crumlin at 98% that were clinically indicated - that has to be stressed - to only 60% in Temple Street and 21% in Cappagh. This variation alone, from an external independent author, sends all sorts of alarm bell ringing. We have to find out how that happened and why it happened. Why were children operated on who did not require any operation? It is incomprehensible and unethical. It is just unacceptable. We have to get to the bottom of this because it goes to the heart of trust and confidence in our health system and in clinical judgment and clinical performance. It goes to the heart of clinical performance, whether people like us saying it or not. Equally, if we look at the report on the springs, I found it very difficult to comprehend how something that was not certified or CE standard was inserted into children. We get various communications, anonymously and so on, saying we misread it and we were too harsh on the individual consultant when we said certain things in the Dáil but it is a basic. We have a very sophisticated medical device industry in Ireland where the standards are the highest in the world. We produce hips in this country. We produce all sorts of orthopaedic products. Everything is about quality assurance and quality control, yet in one of our tertiary hospitals – I am sorry, but it is an orthopaedic hospital, not tertiary - springs were inserted into a child with no one making the assessment on whether they had gone through the proper process. It is incomprehensible this would happen. To answer Deputy O'Callaghan's question, it does raise the most fundamental questions about the entire programme of clinical directorship and whether it is working, and it does need to be reviewed. The idea was a good idea. It is actually a good concept and a good idea but it does depend on everybody working as a team. We have had the dysplasia report on the hips. We are awaiting a further report on the operation of the paediatric spinal service, the Nayagam report. Now we have the internal enquiry that surfaced via the media, and which was not sent to the HSE or the Department from what we can establish and verify. Therefore, that report raises a series of issues also in terms of the governance question, safety questions, atmosphere and so on, which Deputy O'Callaghan has referenced. Taking all of this in its totality, one has to state the obvious that we need to look fundamentally at the governance of CHI and we have to move quickly in the short term, as the Minister is, in ensuring two HSE board members are on the board but then, how do we evolve that further?
Sentiment score: -0.00
As I said, to be fair, the audit was external, which means, in anything we do will have that reassurance for families in terms of the independence of any external review. There will be a retrospective review of every case. The Minister has acted and the Government fully supports her in this series of actions. The first priority is clinical follow-up for all those who had surgery and supporting their families in the process of the retrospective external review of their cases. In addition, the Minister is taking immediate steps to strengthen the board of CHI and to provide for stronger support from the HSE in its engagement with CHI. There will have to be accountability on all these issues. The Irish Medial Council is there, but we also have HIQA and others. We will pursue the matter on that basis but the first priority is to work on making sure we follow up comprehensively on behalf of the children involved and their families.
Sentiment score: 0.35
I thank the Deputy for raising the issue. He made a number of fair points. When a widow loses her husband or a husband loses his wife, the cost of running a household does not go down. The costs are similar, if not additional in some respects depending on age and so on, with having to look after children if the parents return to work. It creates enormous challenges. It is also a very lonely journey for quite a period. I will ask the Minister for Social Protection, Deputy Calleary, particularly in the context of the next budget, if he could examine the points the Deputy has raised and the various anomalies that potentially exist. The social protection is broad and has many different payments. Some of the policies are interrelated. If we move in one area, there is a ripple effect across the entire social protection system, although the status of the widow is worth considering, apart from the breadth of social protection payments that people receive. Generally, Departments are always worried about making exceptions for one particular category of person in receipt of payments in their systems but the Deputy has raised a number of important issues. I will ask the Minister to engage with the Deputy on this because he may have other examples, particularly on the sick pay argument. I will ask the Minister to pursue this. I will also engage with the Deputy in the context of the budget to see if there are other sensible or practical things we can do to alleviate the pressure and pain people go through in such circumstances.
Sentiment score: -0.01
There is a complexity to the social protection system and if you move in one area, it can affect others. We are all familiar with meeting pensioners when knocking on the doors, who will say they lost their wife last year and found it very difficult because they still have the same heating bills, running expenses, rent or mortgage.
Sentiment score: -0.31
Their expenditure had not gone down at all but their income had been halved in many instances. I will ask the Minister to look at this and we will revert to the Deputy on that.
Sentiment score: 0.00