Peadar Tóibín
Question:82. Deputy Peadar Tóibín asked the Minister for Health the number of persons on the scoliosis waiting list for surgery at CHI hospitals at present; and the steps she is taking to reduce waiting lists. [51548/25]
Ceisteanna Eile - Other Questions
Hospital Procedures
It is now eight years since the Minister's predecessor, Simon Harris, said that no child would be left waiting for longer than four months for a scoliosis operation. This time last year I asked him how many children had been taken off operation waiting lists without their parents knowing. He stated he would find out. However, as yet, there is no evidence that he has found out and let us know. Does the Minister know how many children were taken off the waiting lists without parents knowing, in a similar manner as to what happened with Harvey Sherratt?
I thank the Deputy. There is an audit going on into equity of access on waiting list management. I expect to have that audit at the end of November. I will have to wait until then to confirm any figures. At the end of August this year, there were 135 patients on the CHI spinal active waiting list, compared with 150 in August 2024. That is a reduction of 10%. Outpatient lists are also down, with a 45% reduction in the number of new spinal outpatients waiting on an appointment. While I recognise this progress, there is an awful lot more work to do to drive improvements in spinal services. I have met with families and advocacy groups, and it is important to listen to them.
The Deputy is more than aware that €30 million was allocated to reduce waiting lists in different areas. There is a ringfenced theatre providing dedicated capacity. There are additional outpatient clinics, in particular this year on Saturdays, which have seen over 800 additional patients, and which has reduced the waiting list for initial assessments. We are trying to maximise capacity through national and international outsourcing. As I said earlier, which I appreciate the Deputy was not here for, there is an awful lot more work to do there. I am trying to explore additional options.
Activity has increased with 342 spinal procedures completed so far this year, compared with 304 for the same period last year. This is a 13% increase, but at the same time we are seeing a growing need for those services. There are 370 spinal patients who have been added to the CHI active waiting list, which is a 10% increase compared with last year. While some of this reflects faster outpatient access and better referral pathways, we are also trying to do further analysis to understand some of the source of that demand, which is really important. The services remain an absolutely top priority and I will do everything I can to actively drive progress to address the challenges children face.
The Minister must admit it is quite shocking that it will take 14 months for a question asked in September 2024, about how many children have been taken off waiting lists without their parents knowing, to be answered. It points again to the dysfunction. I welcome that the Minister has met with parents about this. That is a good thing. The Minister mentioned money going into this section. Some €11.6 million was provided to outsource operations abroad for children who need it. As of now, there is no child scheduled for operations abroad. This shows that while money is being provided, it is meaningless if it is not making a practical difference to the lives of these children. The 2024 report of CHI has also not been published. That is scandalous. The 2023 report, in fairness, states that CHI is sitting on approximately €36 million at the moment. My understanding is that it is not spending it because that money has been assigned to fit out the new children's hospital.
Is that the case? The Minister might answer that.
I do not believe so. There is a separate portion of money to do that, so I do not believe that. I will check, but it is certainly not my understanding. I remain concerned about the number of children referred, or not referred, for international surgery. As I said earlier it is a source of deep frustration to me that those services are not being utilised. Part of the audit is an analysis of equity of access on the waiting lists, which is something we have not done previously. This qualitative assessment involves talking to parents and patients and asking them how they ended up in Blackrock, for example, and what the pathway was. I have spoken to parents who told me that the international option was not provided to them or was provided to them too late in the process. I am not clear on it, but I asked for an audit into spinal services, neurological surgery and another medical area in CHI precisely to try to determine that, such was my concern.
I think the Minister understands this perfectly well. Given that it has been so hard to get information from CHI over the last number of years, anything less than a statutory inquiry into the lack of care for children on scoliosis waiting lists is not going to get to the truth. The fact that there has been no information forthcoming from the individuals involved means that if we cannot compel people and papers to find out the truth on this, we are simply not getting to the facts.
I have been here for a while and I have heard of inquiries being announced in tandem with campaign groups, and it being said that the terms of reference will be agreed by the campaign groups. However, when it comes to the inquiry being set up there has been a separation from the actual campaigns. Will the Minister ensure there is no such separation from the families, and that the terms of reference of such an inquiry are fully in sympathy with the needs of the families when they are announced?
I updated the House earlier. They should be fully in sympathy. I also recognise that whoever is leading the inquiry will need to clarify the terms and make a final decision on what they need to be. I anticipate a comprehensive and transparent inquiry where the terms of reference are developed in partnership. The Government is one piece. The advocates are another piece, as is the person leading from both a legal and a clinical perspective on how that is best done.
I updated the House on some of my thinking about this. I am conscious that I spoke with regard to other forms of inquiry, where the public nature or the particular model of statutory inquiry precludes the information in that inquiry being used for any other purposes. We look in particular at Limerick, where for the first time ever in the health system, there are a number of serious disciplinary proceedings happening there, particularly in relation to the Aoife Johnston case and the circumstances of that.
There was a review done by Frank Clarke, which had significant powers. I have spoken with Mr. Justice Clarke since to ask if powers of compellability would have made a difference to him. He was satisfied with the model he had. It is my responsibility to scope out the different models and express the pros and cons of the different models. We will ultimately have to agree the nature of it in partnership, but I am conscious of the need for whoever is leading it to be able to do a good job and have their appropriate powers, the requisite timeframe, support and all of those different things. We just need to work out what model is going to work best for that.
Primary Care Centres
Peter 'Chap' Cleere
Question:84. Deputy Peter 'Chap' Cleere asked the Minister for Health for an update on the proposed new primary care centre for Graiguenamanagh; and if she will make a statement on the matter. [52193/25]
Primary care centres add huge value to communities across the country, including my own in Carlow-Kilkenny. There is a lot of excitement in my home town of Graiguenamanagh about our new proposed primary care centre. I would like an update on how that is progressing.
I thank the Deputy for allowing me to update the House on the new primary care centre in Graiguenamanagh, County Kilkenny. The need for that primary care centre was identified as part of the HSE’s overall primary care centre development programme. It is to be delivered via the HSE operational lease mechanism. As the Deputy is aware, the HSE has advertised for and identified a preferred developer for this new centre. I am pleased to advise that an application for planning permission was lodged by the preferred developer in July 2025. In response to this application, Kilkenny County Council requested further information on 1 September 2025. The HSE has advised me that the developer is in the process of preparing a response to that request.
The preferred developer will issue a construction programme once approvals of the relevant statutory procedures have been secured. Once that programme is available, the HSE will be able to provide further updates on the timeline of the project, including the date of commencement of construction works on the site. When it is opened, it is envisaged that a wide range of primary care therapy services, community nursing services and GP services will be delivered from the centre. It is welcome news that the development of the new primary care centre in Graiguenamanagh is progressing and nationally we are trying to make progress in developing primary care centre infrastructure. There is a total of 180 primary care centres operational across the country with 51 of those opening since 2020. I assure the Deputy that the Department is engaging with the HSE to progress the further development of PCCs throughout the country, including specifically in the Deputy's good county of Kilkenny.
That is most welcome news. I understand the new centre is planned to be a two-storey facility of approximately 20,000 sq. m, with accommodation for GP practices and community nursing, as well as dental services and therapies. However, the key thing about this primary care centre is its rural location, and the accessibility challenges a lot of people where I am from have in getting access to top-class care. Towns and villages like Skeaghvasteen, The Rower, St. Mullins and Borris will be able to feed into this brand-new primary care centre in Graiguenamanagh. It will be a game changer for the region. It is certainly a game changer for my town. While I know it is in its infancy, I have a concern about when the primary care centre is complete, in terms of getting bodies and roles to work in that centre.
There is a challenge in the HSE. I know the funding is there, but getting people to fill a lot of these roles can be a challenge. I want to get the Minister's assurance that she will do everything she can for Graiguenamanagh to ensure that once this facility is complete, those roles will be filled.
Absolutely. When it is operational, it is expected that it will have GP, dental, community nursing, occupational therapy, physiotherapy, speech and language therapy, dietetics and psychology services, as well as diabetic breathanyl screening and outreach for chronic disease help, all of which are so very important. The Deputy is right when he says that recruitment is a challenge. We have vacancies in the system, notwithstanding having the funding for it. I hope the primary care centre model will be a welcome addition to counties Kilkenny and Carlow. The Deputy will be aware of the existing facilities at Kilkenny Ayrfield, Kilkenny city east, Callan, Thomastown, Ballyhale, Ferrybank and Shamrock Plaza in Carlow. There is a further primary care centre in the early stages of development or planning for Tullow. These centres are a really important part of our care network. As I said, we have 51 opened since 2020, with five opening in 2024 and others having opened this year, most recently in Dunfanaghy in north Donegal and in Newcastle West. The facility in Roscrea opened in quarter 1 of 2025. Another seven primary care centres are currently in construction, two of which should become operational before the end of this year. They are an enormous support to the community, and we want to continue to see them driven and staffed.
I thank the Minister. I know from my experience of dealing with other primary care centres around the constituency that there is a really strong, enhanced community and patient experience at such centres. Patients can build long-term relationships with their providers, which can lead to better communication and more personalised care, which is really promising. I am really excited about the various strands of care that are going to be available in my home town. It is absolutely a game-changer and something that is long overdue, and it is going to be a fantastic asset to the town. I seek assurances from the Minister that she will look favourably on two other health centres, in Freshford and Ballyhale, which are in the capital plan and are in the process of being upgraded. While the Graiguenamanagh centre will serve one part of the constituency, facilities in the likes of Ballyhale and Freshford also serve huge pockets of the constituency. I seek assurances from the Minister that they will be dealt with favourably.
I thank the Deputy. Clearly, we are trying to have a network serving counties Kilkenny and Carlow, and we need the staff. The vacancies are there. We are desperately trying to recruit and make sure the complete suite of services is there for the people of the county.
Hospital Waiting Lists
Paul Murphy
Question:83. Deputy Paul Murphy asked the Minister for Health when she anticipates that no child will have to wait longer than three months for spinal surgery; and if she will make a statement on the matter. [52561/25]
The Tánaiste made an infamous promise to parents in 2017 that nobody would be waiting for a scoliosis operation for more than four months. When are we going to reach that point? It seems that 226 children are on the CHI spinal surgery list. In August, 135 were actively waiting, ready to go. The numbers on the spinal outpatient lists are over 461. The CHI spinal surgery management unit said there are delays of months before children can even be seen. When will this promise be kept?
As the Deputy is aware, the Sláintecare target is 12 weeks for an inpatient procedure. That is how we measure performance across the entire health sector. Some 39% of the children on the active spinal waiting list in CHI were within Sláintecare targets at the end of August 2025, which is an improvement on 28% at the end of August 2024. Additionally, only 7% were waiting over 12 months, which is compared to 24% at the same time last year. There is, therefore, some progress being made in reducing waiting times, especially longer waiting times.
It is supported by a couple of different initiatives. The dedicated GP referral pathway supports the appropriate prioritisation of urgent patients. Children requiring non-complex procedures have pathways to Blackrock and Cappagh to maximise the capacity for the complex procedures that are happening in CHI. International outsourcing has supported 19 patients to have surgery abroad. As I said earlier in the House, I am disappointed with the figures this year and I am unclear as to the referral pathways to maximise that. There is a new orthopaedic surgeon adding some capacity since 11 August.
Crucially, the Mater hospital is now fulfilling its obligations in the adolescent transition spinal service to support seamless transition of care. I am trying to explore what additional measures can be taken. I have asked for a proposal from the Mater to see what more is possible in that regard. We are making some progress, but I acknowledge that it is too slow, and too many children are still waiting. I have met with the HSE and CHI board and executive several times over the past couple of months. I have made new appointments, in particular the appointment of Mr. Fergus Finlay to the CHI board, who will be an excellent advocate on the board working and seriously engaging with spinal services in particular. I have great confidence in him. I have also commissioned an audit of governance and equity in patient access and waiting list management, which has a very important qualitative element to ensure the patient and staff experience is also captured.
There are three issues. Does the Minister have confidence in the clinical lead of the paediatric spinal surgery management unit? This is the person who took Harvey Sherratt off the waiting list without parental knowledge or consent. How many other children were taken off the lists in that way?
Second, does the Minister have any knowledge of any other medical devices that have been used in an off-label fashion at CHI without parental consent?
Third, to refer as she did in a previous answer to the nature of an inquiry, the Minister mentioned that the person leading the inquiry would have a say. I do not really understand that point. The key people who should have a say on this are obviously the people affected. I urge the Minister to ensure that any inquiry is public and is satisfactory for the parents who have been lobbying and campaigning, especially those, like Gillian and Stephen, who have lost a child and continue to campaign on this issue.
Yes, that is my intention. It is a partnership approach. At the end of the day, some terms of reference are going to have to be settled and it is absolutely our intention to do that in a partnership approach. The person leading it, of course, must have some knowledge of how it is going to be done and some hand in how best it can be delivered as well. That is an important perspective. It should not be coming from me to impose it upon them. We are genuinely trying to deliver a partnership approach. We are some weeks away from trying to get the exact model in relation to that. However, I hear very clearly the Deputy's perspective. Yes, I have a concern in relation to medical devices, which I am referring to HIQA to do an investigation and get its perspective. I have a concern generally in relation to governance, equity in patient access and waiting list management at CHI, which is why in May or possibly June - I would like to confirm that; forgive me, please - I asked the HSE to conduct an internal audit specifically into waiting list management and equity of access. I hope and expect to have that back at the end of November or beginning of December.
So the Minister has confidence in the clinical lead, or does she not?
I did not make any comment on that. I said there was an audit-----
Okay.
-----so please do not put words with me because I did not say anything in relation to that.
I am sorry; I will clarify. Parents and advocates are asking about three particular issues in this regard. First, they want to know if the Minister has confidence in the clinical lead. Second, which I do not think she referred to either, is she aware of any other devices that have been used in an off-label way - parents have said this - and inserted into children? Third, we all know that it is not the best approach, obviously, for children of this nature to be going abroad. Why is it always that we cannot bring surgeons here or upskill enough and invest enough that the resources and equipment can be available here? It can be very difficult and expensive for children to go abroad in this way.
Yes, I would also like to do that, but we have to recognise that there are some children for whom it is suitable and who have had good outcomes.
I answered the Deputy's question in relation to medical devices. I said I was referring a concern that I had to HIQA.
In relation to the clinical lead, I said that I have commissioned an audit, which is a really important process. I do not wish to step across that. I am very happy to discuss the outcome of the audit with the House once I have it, but I cannot step ahead of that.
Deputy Brennan had indicated that he wanted to come in on a previous question; I am sorry.
I need an update on behalf of the people of Gorey on the new ambulance station and the primary healthcare centre. For too long, Gorey has waited on this issue. Gorey is one of the fastest-growing towns in Ireland. Come summertime, an extra 40,000 people move in between Courtown, Castletown, Ballymoney and these areas. We just do not have the medical infrastructure to cater for these people. We really need an update. At the moment, we feel the primary healthcare centre has been pushed down the line. The module at the moment is not fit for purpose. We feel that the money being offered per square foot is not enough for a developer to build. In terms of the ambulance service, the people who are running it are incredible workers, but at the moment, they are working out of a prefab. This is simply not acceptable in 2025. The people of Gorey really deserve an update on both of those issues.
I thank the Deputy. I know he has been a very strong advocate for the Gorey primary care centre, the need for which has been well identified. A tender process has been undertaken. As he is aware, a preferred provider had been selected, with a letter of intent issued in 2019. Unfortunately, that selected preferred provider encountered difficulties regarding economic viability resulting in the collapse of the process in 2024. To facilitate the readvertisement of this primary care centre, a full review was taken with relevant stakeholders. A number of stakeholders require accommodation in that centre and a scope has been established. That review is now complete and a tender process is under way. The stage 1 tender advertisement was published on 24 June 2025. Stage 1 expressions of interest were received and evaluated and letters have now issued to all parties. It is anticipated that stage 2 priced offers will be advertised on the eTenders procurement platform in the final quarter of this year. The readvertisement and retender process for the project are necessary under the procurement rules.
On the ambulance service, HSE capital and estates, in collaboration with the National Ambulance Service, has identified and agreed a suitable facility for use as an NAS ambulance base and is in the process of securing approval to purchase same, subject to planning approval being obtained. The facility will require capital investment to fit it out as a purpose-built ambulance base. The NAS and HSE capital and estates have completed the necessary documentation to facilitate the progression of the project in quarter 4 of 2025, which I hope is a good update for the Deputy. The HSE is working to appoint a design team in this quarter, with the aim of developing and submitting a planning application in early 2026 to progress the project. Those are two important updates for Gorey.
Hospital Investigations
Darren O'Rourke
Question:85. Deputy Darren O'Rourke asked the Minister for Health for an update on the investigation into unnecessary hip surgeries at CHI; the supports available to those affected; and if she will make a statement on the matter. [51162/25]
My immediate priority following the publication of the Thomas audit on 23 May 2025 was to ensure there was clinical follow-up and care for patients who had undergone pelvic osteotomy surgery. This is a once-off review to assess any complications that may exist and to determine the current clinical state. After this, patients then enter the recommended normal follow-up process. These multidisciplinary team, MDT, clinics have been under way since 6 June for clinical reviews of patients who had osteotomy surgery in CHI at Temple Street and Cappagh. As of Tuesday, 21 September, a total of 196 patients have had clinical reviews as part of the MDT clinics in both CHI and Cappagh.
In relation to retrospective reviews of cases to determine the indications for surgery, as the Deputy is aware, the HSE is establishing a separate process involving external experts. Work to establish that external expert panel is advancing. It is expected that panel will be established this month and the review of individual cases will commence in January 2026. These are international clinical experts. We are trying to establish them to have the availability to do the work here - it takes a little time simply to have their availability - and for them to agree a robust and scientific methodological framework for conducting the review, which will be designed by them between September and December this year, by which everything can be measured.
The HSE has also committed to the involvement of parents and patient advocates in the terms of reference for the review. We had a workshop to discuss the external expert panel with them on 14 August. A further workshop took place on 13 September, with a further workshop planned for today.
Separately, it is my intention to communicate with all of the parents who are not necessarily part of the advocacy group representing parents, recognising that they may not wish to be part of it but also to make sure they have the opportunity to feed into perspectives, should they wish.
I thank the Minister for that update. I have a few follow-up questions. On the initial cohort of 196, does the Minister have an indicative timeline on when that full cohort might be completed? It was a significant number and in excess of 196. Is the Minister close to appointing a lead for the membership of the external review? We are only at the start of the month but there is keen interest in that. There was lots of disappointment that it has taken until January to get the review up and running. Is there a commitment that there will be a six-month timeframe for it to conclude its work?
We are imminently close to appointing a lead. I would have preferred to be in a position to do that today, but I am not. It is imminent, essentially.
I appreciate what the Deputy said about January. It is for this group of experts to determine their process and not for me to step across that. I expect and hope it would be done within six months but, again, if independent clinical experts tell me differently, then I will take their clinical perspective on it, as I am sure the Deputy would. I remain committed to updating the House, when I have the information, at any stage.
I am sorry that I do not have a timeline for the complete group of patients, but I will look into that to see what is possible and come back to the Deputy. Again, it will be an estimated timeframe. I am somewhat pleased that close to 200 patients have had that clinical review. Of course, that has been prioritised for those who might be expected to have complications, as I understand it, but I will look at that further.
I welcome that the Minister outlined a series of dates for engagement, including today. There is some emerging and serious concern about the scope and potential terms of reference for the external review. One area is how it will specifically relate to Crumlin hospital and surgeons operating there, as well as at Cork, Galway and elsewhere across the State and, related to that, how it will apply to children with complex additional comorbidities or needs. Will the Minister commit to ongoing engagement with advocacy groups and representatives on the development of those terms of reference?
Yes. We are having the third meeting today. I will meet the hip dysplasia advocacy group on Tuesday, 14 October in Leinster House. I will also make clear to all parents who may not wish to be part of an advocacy group, or be connected to that, I am here to hear from them at any stage as well.
It is also important to update the House that a meeting was held with the DDH advocacy group and the HSE on 24 September regarding mental health supports. It has been an enormously traumatic experience for many parents, as well as patients, to learn that surgery on their child may not have been necessary. A business case for funding all of the elements on this issue, including counselling, has been submitted as part of the Estimates process. I do not want to lose sight of that element of it too.