2026-03-04

I welcome the opportunity to address the House on a number of important inquiry processes that have been established or are in the process of being established by the State in the health sector, and to update Members on progress to date. I also want to put these updates in the context of the human experiences that underpin them. We must always remember that long before any inquiry is agreed, before any terms of reference are drafted and before any report is delivered, there are lived experiences at the centre of these issues. Children, parents, families and survivors are all people with very deep memories of the things that have happened to them. These people's voices and experiences must shape our work and their needs must remain central to the process. I will begin with the Children's Health Ireland, CHI, inquiry scoping exercise and the Dignity4Patients scoping exercise. I do so because on Tuesday I had the opportunity to update the Cabinet on the progress with both of these and it is important that I update the House. Both exercises are at an early stage and I will address them in turn, before moving on to the non-statutory inquiry into the historical licensing and use of sodium valproate in women of child-bearing potential in this State. First, the scoping exercise into potential terms of reference for a public inquiry into spina bifida and complex-----

Minister, I hate to interrupt but is your statement ready to be distributed?

I nearly never do that because I often deviate from it.

Okay. We will have to continue on that basis.

As an initial step, the Government agreed that a facilitator will be appointed to consult stakeholders on scoping the content of potential terms of reference for an inquiry. This scoping exercise is designed to ensure that when a public inquiry is established, it has structures and parameters that reflect the needs of children and families of patients, are grounded in evidence and avoid duplication with existing statutory or clinical processes. In this regard, I have engaged with the Attorney General, considering the requirements for this facilitated exercise, to identify a suitable independent person of appropriate stature, experience and willingness to undertake this role. It was on his recommendation that I have appointed Mr. Remy Farrell SC as the independent facilitator to conduct this scoping exercise. I wrote to the following groups earlier this week to inform them of this step: Spina Bifida Hydrocephalus Ireland; Scoliosis Awareness and Support Ireland; the Cerebral Palsy Foundation; the Scoliosis Advocacy Network; the Spina Bifida and-or Hydrocephalus Paediatric Advocacy Group; Scoliosis Ireland; Orthokids Ireland and the hip dysplasia advocacy groups. I informed all of these groups that Mr. Farrell would be commencing his work on 3 March, which was yesterday, and that the exercise would run for up to 16 weeks. This marks a significant and much-anticipated step forward. I am pleased that this work is now under way. I thank the families and the various groups for their feedback to me and the Department on the appointment of Mr. Farrell. I know that many of them have been waiting for this announcement for some time. I would also like to acknowledge the work of the paediatric spinal task force, in particular the contributions of the three advocacy groups that have represented patients, as well as the chair, Mark Connaughton SC. The Tánaiste and I met the parents of Harvey Morrison Sherratt in September and agreed to work in partnership with parents and advocacy groups across the board on the structure of an inquiry into spina bifida and complex scoliosis services at CHI. Following those engagements and engagements with the broad advocacy group, I brought a memo to the Government where it was agreed that a public inquiry into spina bifida and complex scoliosis services should be established. Mr. Farrell, who is a highly respected senior counsel with extensive experience in sensitive and complex matters, will now lead a structured programme of engagement designed to ensure the voices of families, patients and the different advocacy groups with enormous experience of these issues are central to the process. While Mr. Farrell is known for his expertise in complex legal matters, what is most needed here is his proven ability to approach sensitive issues with great humanity and great respect. I hope everybody will feel able to engage meaningfully with him and with this process. I strongly encourage full engagement with Mr. Farrell. The lived experiences are vital to shaping an inquiry that truly reflects the needs and realities of the children and families affected in so many different ways by spinal and orthopaedic services in CHI historically. Once this scoping exercise has been completed, further Government approval will be sought for the final terms of reference and the nature of a statutory process. It is of course for the Government and the Minister to take the advice of Mr. Farrell on the structure, content and form of the inquiry, recognising that different forms of inquiry deliver different sorts of processes. The purpose of appointing Mr. Farrell in that facilitated way is to try to give us the best advice in relation to that. I now want to turn to the Dignity4Patients scoping exercise, which was initiated in response to requests from survivors, victims and advocates of those harmed by Michael Shine. At the outset, I would like to recognise the many individuals impacted by Mr. Shine, some of whom I have had the good fortune and opportunity to meet. I recognise that the number of people impacted is reported as being in the considerably high hundreds. This is an enormously significant moment for this group. Mr. Michael Shine, a former surgeon, worked in Our Lady of Lourdes Hospital in Drogheda from 1964 until 1995. In March 1995, the CEO of the hospital was made aware of a complaint of abuse against Mr. Shine by the North Eastern Health Board. Mr. Shine took leave while the complaint was being addressed and subsequently retired in October 1995. By the time of his retirement, he was already the subject of multiple allegations of sexual abuse going back to the 1970s. Dignity4Patients has been campaigning on behalf of the victims for many years. The organisation has long sought a full inquiry into the sexual abuse of patients and in the past year has sought a commission of investigation. I recognise that many people and families across Meath and Louth, in particular, will be impacted by the very fact that these statements are being made in the Dáil today. I acknowledge that. It is also the case that on 26 November, the Government agreed that a timebound scoping exercise be undertaken by an independent person in response to requests from Dignity4Patients on behalf of victims and survivors of Michael Shine. For decades, victims and survivors of Michael Shine have carried trauma and have sought recognition and accountability. Their strength and willingness to continue pressing for the truth must be met with compassion, seriousness and action. On Tuesday I informed the Government of the appointment of Mr. Lorcan Staines SC as the independent facilitator to conduct this scoping exercise, again in engagement with Dignity4Patients and its legal representatives. I had been engaging with the Attorney General, considering the requirements for this facilitated exercise, to identify a suitable independent person of appropriate stature, experience and willingness to undertake this role. Again, it was on his recommendation that I appointed Mr. Staines, who commenced his work yesterday, 3 March. The exercise will similarly run for up to 16 weeks. He will discuss potential terms of reference for this scoping exercise and, ultimately, any inquiry in direct consultation with Dignity4Patients. Mr. Staines has two decades of experience in criminal, regulatory and administrative law. He is widely recognised for his specialist work with victims and vulnerable witnesses, particularly in sensitive cases involving sexual violence. He has advised both the Minister for justice and the Dublin Rape Crisis Centre on reforms to better protect people in the criminal process. Mr. Staines will fulfil his role as a facilitator through direct engagement with victims and survivors of Michael Shine, working alongside Dignity4Patients. During the process, Dignity4Patients will have the support of expert trauma-informed advisers: Maeve Lewis, former CEO of One in Four; Professor Phil Scraton, a specialist in inquests and inquiry models; and their solicitor, Diarmuid Brecknell of Phoenix Law. Mr. Staines will receive all of the necessary supports to ensure that a victim-centred, trauma-informed, human rights-based approach underpins the scoping exercise and any subsequent statutory processes. The well-being of victims and survivors will remain central throughout this process. The final report and recommendations will be submitted to me and to the Government to guide the development of an appropriate and bespoke response to the issues raised, and to the needs identified by Dignity4Patients on behalf of the victims and survivors of Michael Shine. We are committed to establishing a public inquiry and will take recommendations from Mr. Staines in the same way as to the content, form and structure of an appropriate inquiry that meets all of the needs that have been identified. Again, that decision comes back to me, as Minister, to the Government and to this House. Our commitment is to ensure a process that recognises the suffering experienced, honours the voices of victims and survivors, and seeks a path towards truth and healing. The third inquiry on which I want to update the House is the non-statutory inquiry into the historical licensing and use of sodium valproate in women of child-bearing potential in the State. The then Government approved the establishment of this inquiry in July 2023 in response to long-standing and serious concerns raised by women and families regarding the use of this medication, and the information, warnings and safeguards that were in place or not in place over time. Their experiences, often involving many years of uncertainty, medical complexity and profound emotional impact, deserve to be fully understood and acknowledged. I thank all of the people who advocated for that work. I have had the good fortune and opportunity to meet them and hear from them. Following a competitive process, Ms Bríd O’Flaherty BL was appointed as an independent chair in June 2024 and has since led the establishment and progression of the inquiry’s work. I acknowledge the women and families whose personal experiences underpin this inquiry. Many of them have engaged with this process after long periods of advocacy, often in deeply personal and challenging circumstances. It is essential that this work continues to be carried out in a way that respects those experiences and supports people to engage in a manner that is safe, dignified and meaningful. As Members will be aware, the public-facing work of the inquiry commenced once the necessary legal basis was in place for the processing of sensitive personal data and that took some time. This required the making and signing of three statutory instruments under the Data Protection Act 2018, which I did on 21 July 2025. This enabled the inquiry to formally commence its work the following day. Since commencement, the inquiry has been actively progressing its work in line with its terms of reference. Engagement has taken place with a wide range of stakeholders, alongside substantial preparatory and review work, to ensure the inquiry is positioned to examine the relevant matters in a thorough, structured and independent manner. A nationwide public awareness campaign was also undertaken to ensure that individuals and families who may wish to engage with the inquiry are aware of it and understand how to do so, resulting in strong levels of engagement. A central feature of the inquiry has been its emphasis on supporting participants. A range of practical and professional supports have been put in place to facilitate engagement, including psychological supports for individuals and families who choose to participate. This reflects a clear recognition that participation in an inquiry of this nature can be demanding and, for many, emotionally difficult, and that appropriate supports are essential to enabling people to come forward. The inquiry is being conducted in distinct strands, under the independent direction of the chair. These strands include a review of the historical regulation and use of sodium valproate; the gathering of experiences from affected individuals and families through oral statements; and an examination of current systems and supports, including the health service's capacity to respond to safety issues relating to the use of anti-seizure medications in women of child-bearing potential. In that context, I want to emphasise an important public health message reflected in the inquiry’s work to date. It is critically important that individuals do not stop taking prescribed medication without appropriate medical advice. Abruptly discontinuing anti-seizure medication can pose serious risks to a person’s health. Anyone with concerns about their treatment should consult a qualified healthcare professional, who is best placed to provide individual clinical advice. The inquiry hearings are scheduled to take place later this year. These processes are proceeding in accordance with the inquiry’s mandate and in a way that seeks to balance careful examination of the issues with sensitivity to those involved. Obviously the inquiry is independent of the Government. It is tasked with establishing facts, examining systems and practices within their historical context, and making recommendations where appropriate. It is not for me to anticipate its findings or conclusions, but I need to update the House about a financial extension to the inquiry so that it can continue to do its work. I have already updated the Cabinet on this. This is an important update, not only in terms of the conduct and public nature of the hearings that are going to happen later this year and what that will mean for families and advocates who will go through that part of the inquiry process, but also because I believe an additional financial element is appropriate to provide support for the inquiry. We have an established inquiry, the work of which is progressing, and we have some updates on its work. There are also updates on the two facilitated processes that the Government confirmed this week. It is important that I have updated the House on those. These are statements about two things - inquiries and scoliosis. I will take the opportunity to give the House an update on scoliosis services. As the House is aware, we have established a CHI oversight group to co-ordinate oversight of a range of matters being explored in terms of the improvement of scoliosis services generally. That includes the implementation of recommendations from various completed reviews, upcoming reports, spinal services, and the commissioning of the new children’s hospital. That group, which is co-chaired by the regional executive officer of the Dublin-midlands area and the chief clinical officer of the HSE, meets monthly. As Members will be aware from some of the reports, I received a high-level briefing from the CEO of the HSE on phase 1 of the Nayagam review on 28 January. For that briefing to take place, legal advice had to be sought given the significant legal constraints regarding the report. On foot of that briefing, I sought a much more detailed clinical briefing with Mr. Nayagam, which took place on 6 February. My priority, again, was always on timely and appropriate engagement with the patients and families impacted. Mr. Nayagam recommended a recall for clinical review of 62 of the 91 cases examined by him in phase 1. Letters were issued to the families involved with the review on 10 February and a briefing session took place with advocacy groups on 11 February. All families were also contacted by phone. The follow-up appointments for the 62 patients have been arranged and the reviews are ongoing. The HSE will also be carrying out a wider look-back review of the individual consultant’s practice following on from phase 1. That look-back will involve a review of the patients on whom the consultant performed surgeries between 2016 and 2023, including all spinal, limb reconstruction and surgical dislocation of the hip surgeries. The HSE is currently scoping out the numbers involved against the three criteria for the look-back, and it will be in contact directly with all of the patients identified very shortly. Phase 2 of the Nayagam review is continuing and is expected to be substantially complete by the end of this year. The second phase of the review will be important from a broader clinical and system patient safety perspective to assure future service provision, especially in context of the new children’s hospital. In relation to the HIQA review, just after the report was published in April of last year I stood in this House and we discussed the HIQA review of the governance of implantable medical devices in CHI, including the use of non-CE springs in Temple Street hospital. I can update the House that the recommendations from the HIQA report are nearing completion, with a completion rate of over 84% for the HSE recommendations and of 96% for the CHI recommendations. That is an important update for the House. In May, we were here to discuss the Thomas independent external medical audit for Children's Health Ireland and pelvic osteotomy. The immediate priority following the publication of this audit was, again, to ensure that there was clinical follow-up and care for patients who had undergone pelvic osteotomy surgery. Multidisciplinary team clinics have been under way since June of last year and 1,537 patients have now had clinical reviews as part of this process. It is expected that one last clinic will be held next week to close off the remaining patients. In relation to retrospective reviews of cases to determine the indications for surgery, the HSE is establishing a separate process involving external experts. This external expert panel review commenced last month and is chaired by Dr. Kishore Mulpuri, a consultant paediatric orthopaedic surgeon from Canada. The HSE has worked closely with advocacy groups in drafting the terms of reference for that review, which should be finalised and published shortly. In relation to other ongoing reviews, in particular the equity of access review that I established last year, the CEO of the HSE specifically commissioned an audit to assess governance and equity in access to care within CHI, especially regarding the balance between public and private patient management. That audit covers three specialties - orthopaedics, urology and respiratory - and is due for completion by the end of April. The audit is being augmented with a qualitative element, an independent view, capturing patient and staff experiences. I am attempting to pull out the orthopaedic one to have it published earlier alongside that independent view and hope to be able to update the House about that reasonably shortly, because I want to see it published. I would like to refer to the paediatric spinal surgery waiting lists, both to acknowledge the work that is being done alongside reforms and the very real challenges with this service and how they are being addressed. I thank Members of the House who continue to engage with me on this. I have placed a significant and systemic focus on productivity generally in our hospitals but particularly in this most acute area of need of paediatric spinal services. We do that because we are first and foremost concerned about the children whom these issues impact, their quality of life, the nature of these supports, the interventions they get and the necessity for those to be appropriate and timely. In particular, I thank all of the patients whom I discuss this with at various different times. I hear what they have said. There is a large group of patients with whom I engage regularly about their care. Regarding access, scoliosis affects about 1% of children and adolescents in Ireland. Many of those children do not require surgery but for those who do, timely access to intervention and appropriate treatment is critical. For those children who need surgical intervention, we agree the waiting times are too long. I am acutely aware of the burden that long waiting times place on these young patients. Improving access to spinal surgery and the timely nature of that has been pursued by several Ministers for Health. We have not yet fully reached our goals. I acknowledge that the efforts that have been put in so far have yielded tangible progress and I also acknowledge the dedication of all those involved, who are genuinely delivering better outcomes than has been the case before. There has been a significant focus on investment for these services. In 2024, 52 new full-time equivalent posts were approved to strengthen paediatric spinal services, including surgeons, anaesthesiologists, nursing staff and allied health professionals. Forty-one of those staff are in post. Three orthopaedic consultants have been recruited, in addition to the one last year who took up their post in August, and those successful candidates are expected to take up their posts from May 2026. That is a really important addition to the capacity to do orthopaedic surgery of all different kinds, including complex spinal work. This will support the transfer of non-spinal orthopaedic work from surgeons who currently perform spinal surgery. Alongside that, national and international outsourcing arrangements have been expanded. Domestic outsourcing arrangements have been strengthened, using pathways to Blackrock and Cappagh for non-complex spinal procedures. International outsourcing supports children to get the care they need abroad as clinically appropriate. As we know, not every child is necessarily suitable for travel, but we want to have the pathways for those who are. We are expanding our international options in both Europe and the United States. As Deputies are aware, at the moment, we have the New York-Presbyterian Hospital and Great Ormond Street Hospital. CHI has gone through a tender process for extra international outsourcing and two organisations have been identified, which are SJD Barcelona Children's Hospital and Gillette Children's Specialty Healthcare, Minnesota. Additionally, the treatment abroad scheme remains available for international treatment in other countries in the European Union, the European Economic Area, the United Kingdom or Switzerland. Of course, we are trying to expand domestic capacity. At operational level within CHI, the spinal surgery management unit was established in 2024 to co-ordinate surgeries better across the different hospitals. Efforts to expand capacity are progressing. We now have a fifth theatre in Temple Street, an additional MRI scanner in Crumlin and 24 additional new beds. The HSE has recently funded a business case to add additional spinal equipment into a second operating theatre in Crumlin. This will allow for more spinal procedures of greater complexity to take place. That goes alongside the additional consultants who have been recruited and are in post since August and will be from this May. The procurement process of all the equipment has begun and it is expected to be in place by the end of this month. CHI has advised that it will be in a position to do spinal fusions in the second theatre from April 2026. Additional outpatient clinics are being run to assess new patients more promptly. This has reduced the time these children are waiting to be seen by a consultant considerably, as well as a dedicated referral pathway for GPs having been introduced to support the prioritisation of urgent cases. We are seeing tangible results from that. There has been an increase in the number of spinal procedures undertaken compared with previous years, but we want to see more. What matters most is the length of time that children are waiting. There has been an improvement in the longest wait lists. At the end of 2025, 47% of those on the CHI active waiting list were within Sláintecare targets, compared with only 38% at the end of 2024. The number of longer waiters is down, with 3% waiting over 12 months at the end of 2025, compared with 11% at the end of 2024. There are no patients waiting over 24 months. The weighted average wait time for inpatient procedures has fallen significantly, from 6.2 months in January 2025 to 5.2 months in January 2026, an improvement of one month, but we want to see more. Some 25% of new outpatient appointments are within the ten-week Sláintecare target. No new outpatients are waiting over 12 months. Weighted average times for new outpatient appointments have reduced to 4.5 months from 9.7 months in January 2025. Those improvements ensure children are seen more quickly. While we acknowledge that progress, we also recognise that too many children are still waiting and children with complex cases are waiting. At the end of January, an additional 39 children had been added to the active surgical waiting list. This reflects a growing need and a better referral pathway. We want all of the children who are identified to receive appropriate treatment in a timely way. I thank the House for giving me the opportunity to provide these updates, both on spinal services and on scoliosis generally, but also on the important inquiries I have discussed today. I recognise that in each of the three cases, women who took anti-seizure medication without any expectation of harm being done are now raising families where they know that the medication they were taking harmed their children. They have an opportunity for an inquiry. Patients' advocates, including parents, families and those who had wrong implants put into their bodies, who have been waiting for too long for spinal surgeries and have not got the care for spina bifidia they needed, will now begin a process with an independent facilitator to scope how best we might give weight to their voice in a public inquiry. Regarding the victims and survivors of Michael Shine right across Meath and Louth, I pay tribute to the many hundreds of men who have been impacted and will be impacted yet again today as we discuss this. I acknowledge their work, dignity for patients and broad support network, which have brought us to this point where we are beginning the same facilitative process to scope the appropriate public inquiry to be able to have their voices heard and respected in the way they deserve to be.

The appalling failure of children's scoliosis and spina bifida services is a shameful indictment of this and successive Governments. For years, the harrowing stories of children left to wait in agony for their operations has been a distressing feature of debate here in the Dáil, yet the Government has never matched its promises with the actions needed. Heartbroken parents have been forced to watch their children suffer and deteriorate, robbed of a normal childhood, racing against the clock with a fear of becoming inoperable. Parents are forced to pour out their anguish in the media just to get the Government to pay attention. These parents have shown enormous bravery, a courage and fight that only the love for one's child can inspire. The cases of some of these children have provoked widespread public shock and anger. I am thinking of Harvey Morrison Sherratt, Mikey Henry-Benson, Daniel Collins, and of course, more recently, little Roxanne Kelly. Their stories spoke to the awful experiences of hundreds more children left to wait and suffer. It is now eight years since Simon Harris promised that no child would wait for longer than four months for spinal surgery, a promise broken repeatedly. Today, children are still left in desperate and dreadful situations. The family of seven-year-old Roxanne Kelly were left to fundraise so they can take her to America to get the scoliosis surgery she so badly needs. No child and no family should be forced to do this. The backdrop to the suffering of these children and families is the litany of scandals at Children's Health Ireland. This includes the use of unauthorised springs in surgeries on children and the carrying-out of unnecessary hip surgeries on children as young as seven. Children were failed catastrophically and public confidence shattered, not only in that organisation but also in the Government's basic ability to oversee the provision of children's healthcare. These failures sparked major reviews into practices at CHI, and it is disgraceful that families were left to learn of the completion of phase 1 of the Nayagam review in a Sunday newspaper last month even though the Minister, Deputy Carroll MacNeill, had been briefed days before and the HSE had received the completed report last September. The Minister hiding behind technicalities and refusing to publish phase 1 of the report is just unacceptable. It should be published immediately, and parents are entitled to know what it contains. Is drochtheist ar Rialtas i ndiaidh Rialtas é an teip ar leanaí le scolóis agus spina bifida. Ní mór don iniúchadh poiblí ar Sláinte Leanaí Éireann muinín na dtuismitheoirí a bheith aige. Caithfidh sé a bheith dírithe agus múnlaithe ag taithí agus riachtanais na leanaí agus na dteaghlaigh atá buailte leis seo. The death of nine-year-old Harvey Morrison Sherratt last July was a tipping point. His heartbroken parents endured not only his loss but also the revelation that he had been removed from the surgery waiting list without their knowledge or consent. Through their grief, Gillian and Stephen along with other parents fought for a public inquiry into Children's Health Ireland. This demand was finally secured in a meeting with the Tánaiste, Simon Harris, and the Minister, Deputy Carroll MacNeill, last November. However, four months on, parents and advocacy groups have real concerns about the Government backsliding on its commitments. Delays in producing the terms of reference and a lack of clarity regarding the role of the facilitator have stoked real worries. The Minister has now appointed a facilitator for the scoping exercise that will inform the terms of reference. We need to be very clear this evening. This must be a full public inquiry. It cannot be directed by Simon Harris or, indeed, by the Minister. It must be shaped primarily by the experiences of those impacted by the failures at CHI. The Government committed to equal partnership and to working with parents to get the terms of reference right, and that must be delivered - no railroading, no stonewalling, no whitewash, just transparency, truth and accountability. That is what the children affected and their families deserve. Those children waiting for surgery need the Government to match its promise of change with action on capacity, resources and funding. They do not need lip service or excuses; they need their operations.

The appalling ongoing treatment of children with scoliosis and spina bifida is absolutely disgraceful. This month is eight years since Simon Harris made that commitment that no child with scoliosis and spina bifida would have to wait longer than four months for life-changing and, in some cases, life-saving treatment. What has happened since is appalling, and it really shows how bad things were in CHI. Before I get to that, I want to acknowledge that there are some excellent staff working in Crumlin, Temple Street and Cappagh hospitals who do fantastic work because I have met many of them. They are as scandalised as I am and as the parents and advocates are because they want the best for children. If we look at what has happened since Simon Harris made that promise, more children have deteriorated, more children have got worse and more families have had to take to the media to highlight their children's cases. We have had scandal after scandal, and report after report. Let us look at some of that for a second to really digest how bad things were. We had a HIQA report that examined the use of unauthorised springs. As the Minister knows, that HIQA report was damning in relation to failures in CHI. It obviously identified clinical failures, and I accept those failures, but there were management failures, systemic failures and organisational failures. I would argue there were also political failures in all this because many of the issues that were identified had been raised by parents and by those of us in opposition and, in fact, by advocacy groups and I would say they were ignored. We had the Boston report. We had the Dixon report, which is still unpublished. As the Minister knows, the Dixon report talked about orphan children, by which it meant children who were falling through the cracks. They were not under one consultant or another. Their care was missed. They were not getting the multi-specialist treatment they should have been getting and so on. They were identified in that report as orphan children. Many more failings were identified as well. That report was never published. Even though it talked about a cohort or subset of children, I met a number of those parents this week in advance of this debate and they told me they still have not received that report and do not know what is in it, yet they know their children are mentioned. We had an Arthur Cox report that looked at the role of management in relation to, again, the use of unauthorised springs. We had the first part of the Nayagam review, which is still not published. We know there are findings in it. We know there are recommendations. We know very clear clinical failures were identified in that report, yet the very children who are part of that review and their parents, again, were the last to know, because everybody else seemed to know. The media knew before the parents were even briefed on it, and that was days after the Minister had received the report and, indeed, the HSE had the report since September of last year. That was only one part of two reviews Mr. Nayagam was doing. The second is now going to look at all those systemic failures that have been identified in many the other reports I have talked about. We also had the famous unpublished report that looked at failures in urology and oncology services for children. Again, it referenced the orphan children, HR issues and very clear management and systemic failures within CHI. We had a report on where and how money had been spent and whether it had been spent for the purposes for which it was intended. We had a report, unfortunately, on hip dysplasia and all the mistakes that were made in that area. There was also to be a report on equity of access. That was an audit the Minister had promised was to be published by the end of November. It was then promised to be published by the end of February. My understanding is that it still is not complete. That was to look at equity of access, particularly for those complex cases and all of that. I mention all those reports because it really does show the level of scandal, dysfunction and failure that was in CHI. This drives parents mad, and rightly so, and drives advocate groups mad. I meet them all at the time. As I said, I have met many campaigners. My party colleague spoke to a lady called Úna Baker, who is also an advocate and campaigner in this area. What they tell us is that they had been shouting from the rooftops about all those issues for years and they were met with a stone wall of resistance from the Government. In fact, an Teachta McDonald and I and others in opposition were coming in on a weekly basis and raising many of these issues and we were told in some instances that there was nothing to see here. That was the reality of it, yet we had to go back and face parents who were telling us there was something to see here. There is failure right across the board, and we now are seeing that. We saw it in some of the reports, but we obviously have not seen all of the reports. The problem then is that there are still children who are being failed. The Minister has committed to a public inquiry. I want to get to that because that is really important and that was the substance of the meeting I had with advocates and parents this week in advance of this debate. They met the Minister and the Tánaiste in good faith. They want to be equal partners in shaping the terms of reference. They should be equal partners. They are more equal, in my view, than CHI, the HSE or the Department because it is their children who are being failed. As an Teachta McDonald said, theirs are the voices that must be front and centre and must have primacy in relation to the terms of reference. However, they tell me they were promised a mediator, not a facilitator, who would recognise those advocates and parents as equal voices. They do not see that that is what this process is. I still do not know, and I did not hear it in the Minister's speech today. I accept she is going to say a facilitator has been appointed who will scope out what this public inquiry will do, but I have never really heard from the Minister what she expects this inquiry to do. I will tell her what I expect the inquiry to do, however, which is establish all the facts, wherever they lead us, and establish where the failures are, wherever they lead us, whether it is organisational, individual, clinical or political. It has to establish the facts and all the failures. It has to look at all those issues: at waiting times, how people were moved off urgent care lists, which is something we saw with tragic consequences; individual care needs for some children, for obvious reasons; urology services; and oncology services. It has to look at all the failures from top to bottom within CHI and it must look at each and every one of those failures for each and every one of those children. I do not get a sense that this is what this public inquiry will do. I still do not know if it will be a statutory inquiry and what role and powers it will actually have. However, I do know what parents want, which is an inquiry where there is absolutely no hiding place for anybody because what they have seen so far in all the reports I mentioned earlier is a lack of accountability and hiding places left, right and centre. We are told by the Minister that because of High Court proceedings the Nayagam review’s findings cannot be published. My understanding is the Minister was not party to those proceedings, which were between the HSE and the High Court. However, she is the Minister - she has a copy of a report that is very serious and has findings. Nobody, with the exception of the Minister and people in the HSE, knows what is in that report. The parents do not know and nor do we in opposition. I do not know when we will ever know. The Minister still has not told me when the report will be published, if ever, because the Dixon report was never published and nor have been the other report that caused consternation for families last year and many more, such as the Arthur Cox report and so on. There is a long history of report after report, review after review, all done behind closed doors, which never see the light of day and parents are the last to know. All the while, children like Mikey Henry-Benson, Lauren Kelly and many others are still waiting for treatment. Their families are heartbroken. They come to us all the time and ask us what can be done for their children. We can only raise it in here. This is the only way we can do it, by coming into the Dáil to use our voices to raise their cases. We want those children to get the care they need. I accept they are complex cases but they are children who are deteriorating before their parents’ eyes. They are asking us to appeal to the Government - to beg it - to do everything possible to ensure those children get the care they need. While I welcome the fact we are having a debate here today, we have an awful lot more to do and a lot of road to travel before we rebuild parents’ trust and confidence in CHI or in this Government’s handling of all these issues. Much more needs to be done for those complex cases and children who are waiting for urgent care and who are deteriorating by the day.

We welcome the announcement of the inquiry into Michael Shine. My party colleague Deputy Nash will speak more about that and about the update on the sodium valproate scandal that has taken place in this country. I will confine my remarks to the scandal that has taken place with regard to children, those suffering from scoliosis or spina bifida and those with orthopaedic and urology conditions. I have been my party's health spokesperson for only 12 months and we have been in this Chamber a number of times making statements on these issues in recent months. I pay tribute to the advocacy groups and parents who have to do so much to look after their children and also fight for justice for the children who have not been so fortunate to make it, who died, or those children whose lives have been impacted forever. Their courage and fortitude in continuing that campaign is enormous. We have made very little progress, notwithstanding everything that has been said, over the past 12 months. The waiting list has reduced by just eight children in that time. During the month of January alone, there were fewer surgeries compared with January 12 months ago. The number of children with confirmed admission dates has fallen. The children categorised as active has gone up but they do not have a date. The number of long waiters has gone from 26 to 45 over the course of the year. I do not doubt that efforts are being made, particularly by the HSE, and we have seen that money has gone into this, but there are very serious questions about the progress being made. The families I talk to feel a lot is being talked about but very little is happening on the ground. That has to change. The Minister spoke earlier about the equity of access review, which was instigated last year. That was supposed to happen at the end of November; we now hear it will be published in April. There has been a delay on this and that is crucial for the children who are waiting and who need procedures in the near future. We need to see the reports on that. There has been a whole raft of reports about the scandals in CHI over many years now but it is now nearly 11 months on from the HIQA report. The HSE told us last month that 12 of the 19 recommendations have been implemented. CHI has implemented many more of the recommendations. What is holding up the full implementation of the HIQA recommendations from 11 months ago? They cover process, culture, management and oversight and in order to give confidence to those families we need to ensure that all those recommendations, at the very minimum, are enacted. The Nayagam report, when fully published, will give an insight into what happened and why. However, families have been waiting over two years for that report and it is not acceptable that they still have not had any contact with Mr. Nayagam himself and have had no sight of the report. I know there is ambiguity about when Mr. Nayagam will talk to the families but the families thought they would have been contacted by now. It is not acceptable that the families would not have had insight into their cases. They have been called back, but they have no insight into what Mr. Nayagam is saying about those specific cases. On the public inquiry, there was a very powerful moment last November. It seemed like an enormous breakthrough that the Government agreed to a public inquiry and we in the Labour Party very much supported that. However, we have gone from an agreement that first suggested that a mediator would be put in place to now having a facilitator. I am sure Mr. Farrell will do an excellent job for what the Minister intends but there is a difference between a mediator and a facilitator. I believe there has been a shift from that initial commitment to parity of esteem and of input between the Minister and the advocacy groups into the terms of reference of this review. Many of the families feel that the power and input they were initially promised will not now materialise. There is also concern about the term “complex scoliosis”. From freedom of information requests to the Department, we know that conditions such as adolescent idiopathic scoliosis are deemed to be non-complex. Are we creating two classes of children with scoliosis here? A child who just has scoliosis might be as dramatically impacted as a child who has multiple conditions. We need to ensure that all children suffering from scoliosis will be included in the public inquiry. There is already a crisis of confidence in this public inquiry before it has ever got off the ground. The Minister needs to do significant work to reassure the families and the advocacy groups that they will get the public inquiry they need and deserve. Crucially, for the children who are waiting for treatment, we need to see much more dramatic interventions by the Minister and the HSE to ensure those waiting lists go down much further and that, particularly for those long waiters, there is very significant action to address what is an absolutely unacceptable position for them. It is appalling that we are eight years on from those Government commitments being made and we have that extent of long waiters still in the health system.

I thank the Minister for her personal interest since her appointment in working with Dignity4Patients and the victims and survivors of disgraced paedophile and former doctor Michael Shine. It is to be recognised and noted that we are at a point now that we were not at a few months ago. The first contribution I made in this Chamber on my election 15 years ago was in relation to the actions of Michael Shine, who is probably one of Ireland's most prolific paedophiles. I spoke that day of the need for supports for the Dignity4Patients group and they, with the Minister, have delivered. She has worked collaboratively with Dignity4Patients, the victims and survivors and members of that wonderful group over the past few months to get to the point we are at. As the Minister knows, hundreds of men in my community, specifically in Drogheda but also in the wider Louth and Meath areas, have made formal complaints to An Garda Síochána over many years about the disgraceful actions of Michael Shine over many decades. We are of the view that thousands of men across my community may very well have been affected but have chosen for their own reasons not to come forward. These men are my peers and my contemporaries and their lives have been extremely adversely affected because of the abuse and sexual violence perpetrated against them by a doctor working in our health service over many decades who behaved so many ways in a untrammelled fashion, unchallenged by anyone else bar a few who worked alongside him and those who decided to blow the whistle, who were inevitably targeted for the actions they undertook to expose this scandal, and it is a scandal. Michael Shine, as the Minister knows, has served only a short time behind bars and a criminal conviction and prison sentence do not of themselves justice make. Real accountability will start to be delivered from today. There are high hopes for the scoping inquiry. There is a meeting with the lawyer for Dignity4Patients next week and that Lorcan Staines SC has been appointed as the facilitator along with Phil Scraton and Maeve Lewis who have been engaged to work with the group throughout this process. I look forward to the outcome of that. I want to place on record my gratitude to the Minister on behalf of the people I represent, including my peers and my contemporaries, who have had to deal with this for more years than any of us care to mention, and for the commitment of our newly elected colleague in Louth, Deputy Paula Butterly, who has very much focused on this issue with Dignity4Patients and the victims and survivors over the recent period. That is welcome, it is recognised, it is understood and we are all hopeful of a positive outcome.

I thank the Minister for her genuine interest in this matter, which has not been lost on the survivors of Michael Shine. I welcome the announcement from the Minister on appointing Lorcan Staines SC as the independent facilitator for the scoping exercise, as requested by Dignity4Patients on behalf of the survivors of Michael Shine. This is a significant and long-awaited step and it is important we acknowledge how long it has taken to get here. I would also like to acknowledge the exceptional support and advocacy provided to survivors by Adrienne Reilly and all at Dignity4Patients. I also want to acknowledge Deputy Nash, who, as he said, for more years than he cares to remember has stood by the survivors, has advocated and has fought for them every step of the way. He was very eager that I, as a newly elected Deputy, was well aware of what had happened to these people, that justice must be sought and that they must find some peace at some stage. The Minister's decision to appoint Mr. Staines, a senior counsel with deep experience supporting victims and vulnerable witnesses, particularly in cases involving sexual violence, is an important signal that this process must be rooted in dignity, compassion and respect. Supported by expert advisers, Maeve Lewis and Phil Scraton, I am confident that their collective expertise with victims of sexual violence and in shaping effective public enquiries will not only be invaluable but will set the direction for the public inquiry that must follow. I want to recognise the extraordinary courage of the survivors. For decades, they have carried the trauma of what they have endured, too often in silence and too often without the support of the very systems meant to protect them. Their perseverance is the reason we are here today. Their determination has kept this issue in the public eye and pushed the State towards the action it should have taken long ago. I have had the honour of meeting victims and survivors of the convicted sexual offender, Michael Shine, and have listened to their brutal accounts of how they were not only abused by Shine, but how they were ignored for so long. I have seen the pain etched on their faces, lines that have deepened over the years not only as a result of the trauma caused by the paedophile, Shine, but also because of the silence and disbelief they have met in their search for answers and accountability. For 30 years Shine, the convicted sexual offender, was hidden in plain sight. He built a successful practice while he abused young boys and men. He became for many a pillar of society and for many a god, while young lives lay in tatters. Michael Shine started working in Our Lady of Lourdes Hospital in 1964. For context, that was 62 years ago. The first allegations were reported in 1977 but no action was taken. In 1983, further and separate allegations were made but no action was taken. In 1995, Bernadette Sullivan blew the lid off the sordid actions of this sick, vile man and the scandal was exposed. Michael Shine retired in 1995 on a full pension. He continued to live a carefree life while those he abused plunged deeper into despair. Finally in 2017, over 40 years after the first complaint and after serious challenges by Mr. Shine to avoid justice at all costs, he was convicted. I have heard people in Drogheda and in the wider constituency of Louth say that even the dogs on the street knew what he was up to, yet nothing happened. I find this deeply disturbing as it speaks to a society and culture that I cannot comprehend but unfortunately I know has existed for far too long. To date, more than 400 men have come forward. One man aided and abetted by a society and institutions of secrecy and complicity did this to over 400 young boys and men. How did this happen? Who knew? Who did not want to believe? Who knew but simply chose to look the other way and who did nothing?

Deputy Butterly has set it all out very well. It raises the question as to why people within the system do not listen and why they turn a deaf ear to a lot of the information they get. Some of it is quite harrowing yet it is just kept quiet and then we are here today looking back years ago. It begs a question about the use of this House and the committee system to allow people to come forward under some form of protection to explain what has happened to them and receive the type of support that is needed in the context of having a wrongdoing dealt with or a wrongdoing exposed because unless the scoping exercise is absolutely clear and defined, parties on both sides of the argument will not be happy with tribunals and inquiries. As Deputy Cullinane said earlier, we need to know who, where and why. We need to apportion the blame in terms of people who were involved and who knew. They need to take on the responsibility and own up to what they turned a blind eye to. We need to ask the State why it has taken such an effort to get to here. If the scoping exercise does not answer all of those questions or allow those questions to be answered in the context of an inquiry, it will then be all for nothing. I have seen too many inquiries in this House run into the sand simply because there was some form of legal action against it. They never get a chance to really get to the truth. It does not look good for the State. It gives some credence to the claim that is often made that there is a cover-up happening here. Let us just stop the cover-up. Let us be fair, honest and truthful to the person carrying out the scoping exercise to allow that truth, story and experience to come out. I support the comments of Deputy Cullinane on that. On the statements on scoliosis, I have asked many questions of CHI and this is what shocked me about the replies is that CHI tells me that due to patient confidentiality, it will not respond. These questions come from the parents of the child in question. That is shocking. The parent comes and demands some answers. As their Member of this Parliament, I pose the question and we are told, "No, we are not telling you." That is what causes most of the problems in the House. It is the fact that the truth will not be told. If we stand for anything, we have to stand for truth and justice. That is why we were elected here. Do not hide behind any tribunals. Do not hide behind procedures. Let us get the facts out there. In asking for the facts, the question I referred to, like many others, was a general question. How many are on the list for counties Carlow or Kilkenny? That is not a breach of any confidentiality. It is not breaching anyone's confidence, yet CHI would not give the figures. It would not give the details of how parents and children were treated when it was given specific information. We have to ask ourselves a question in this House: will we take back that power? Will we act as parliamentarians, with the appropriate powers and with the appropriate authority, to get to the truth and deliver justice wherever it is needed? If we do not do that, it will just become a cynical exercise in burying issues that have come before us for another few years.

This month marks eight years since the Tánaiste promised that no child would wait longer than four months for spinal surgery. It has been eight years since children and families were given hope, yet children are still left today in desperate, painful, terrible situations. Why? Because it was another promise broken. This is not just about statistics. This is about children growing in pain, families living in fear for their children and parents are forced to watch their child's spine curve further, while they wait in a system that continues to fail them. Parents and advocacy groups are deeply concerned about the commitments to an independent inquiry. We have seen delays and backsliding. We have seen a lack of clarity regarding the role. We still have no terms of reference. Families deserve transparency, certainty and respect. Instead, they are getting silence. What about phase 1 of the review into the care of children with scoliosis and spina bifida? The review has been completed and sitting with the HSE since September. The Minister was made aware of this report but families found out through a Sunday newspaper. What way is that to treat families? Families should have been informed in a proper, compassionate and understanding manner, not blindsided in the media. That was absolutely disgraceful. We then learned of the children left without a consultant and almost forgotten when services moved from Crumlin to Temple Street. How could anyone forget those children? How could any system allow that to happen? There must be full truth here, there must be accountability, and there must be no more internal reviews to gather dust and no more defensive briefings. Families deserve honesty. The HSE has confirmed that the concerns raised were serious enough to trigger a further review. More children's cases are being examined and that tells its own story. While reviews roll on, children remain in pain. At the end of January 2026, 229 children were on spinal surgery waiting lists compared to 230 at the end of January 2025. A total of 75 are waiting longer than three months. Behind every one of those numbers is a child missing school, missing sleep and missing out on being a child. I speak not only as a public representative but as someone who suffers from scoliosis myself. I am extremely lucky that my condition is not as severe as others. I know how to live with and I know how to work through it because I have no choice. It is progressive and it carries a lot of pain with it. No child should be forced to simply live with worsening pain because the Government cannot get its act together. We demand an independent statutory inquiry, with clear terms of reference and transparency. We need accountability and above all, timely care for every child who needs it. These families cannot wait and cannot endure another broken promise. The time for excuses is over and the time for action is now.

I welcome the updates on the inquiries and the opportunity to discuss scoliosis and spina bifida. Yesterday, I spoke to parents and advocates and they had three key asks. The first was the independent statutory inquiry, the second was the publication of all existing reports and background information and the third was action now on existing waiting lists for children who are still on waiting lists. What really struck me from that conversation was that I had a conversation with them just after the election and the things they asked for were remarkably similar. In fact, in some instances, they said things had gotten worse and not better. That is deeply concerning. It is crucially important that there is an independent statutory inquiry and there is nowhere left for anybody to hide so we get to the bottom of this and all of the facts, to identify all of the failures and to get answers to the long lists of questions that parents and families have. I would like a commitment from the Minister on the form of the inquiry and what she thinks would be the best form of inquiry. There needs to be a collaboration with the families over the coming weeks on the terms of reference. That is vitally important. In particular, the voice of the child and the voice of young people must be central to this. Many of these are in their late teens or early twenties and their voices need to be heard. They need to be included and not just talked about in the weeks ahead. It is really important that happens not just on paper but in practice. Complex scoliosis was raised earlier and concerns raised with me about a fear among families that would be used to narrow the terms of reference. Parents have said they cannot find anything within departmental guidelines or CHI guidelines defining what complex scoliosis is. There is a real risk that will narrow the terms of reference from the start. In her conclusion, I would appreciate if the Minister could comment on that. One parent said the purpose of the statutory inquiry is to examine systemic issues and systemic failures do not confine themselves to diagnostic labels. That is an important point and maybe one we can tease out. There has been an element of trust being broken between families and CHI and the State. It is crucially important that in the time ahead, that is rebuilt and families feel as included as possible so this inquiry looks at the issues they really want it to look at, such as waiting list categorisation and prioritisation, the decision-making, the variation in access pathways and the disparities in treatment. Crucially, it must get to the facts and identify all of the failures. The other thing families really want is for this public inquiry to release interim reports and not just wait until the end so we are not just waiting years for answers. The families want the inquiry to have reports and a statutory provision requiring that those be implemented in full and that those recommendations be put in place. I would like a commitment from the Minister that there will be ongoing reporting and updates, and things will improve while this process goes on because we have to learn from the failures of the past. The State has gotten this wrong in the past when it comes to tribunals and public inquiries. They have run for years, in some cases decades. They have cost huge sums and they have not got the answers or the outcomes that we wanted. We cannot let that happen here. We need a robust public inquiry that gets us the answers and that changes things. It is crucially important that at the end of this we have better outcomes for families and that we have answers to the long list of questions that parents have. Crucial to having an effective inquiry from the start, all the facts need to be on the table. All the information needs to be laid out and all sides need be furnished with the same evidence and information. That starts by publishing all of the information that is available and publishing all the reports because to date, what has happened is we have relied on whistleblowers. Without whistleblowers in CHI, we would know far less than we do. That is not acceptable. All of the information needs to be put out there. The Nayagam report was commissioned in 2023, yet it still is not fully complete. We learned last month that phase 1 is complete, but it is still not published. Issues were identified in the communication of that and the publication in a Sunday newspaper before families knew about it. One parent told me that they got a notice just 30 minutes before the Department briefing that the briefing was on and that they had not heard. The Minister has said that for legal reasons phase 1 cannot be published but I do not understand how that was not foreseen. Is she confident that the entire report will be published later this year, when phase 2 is complete? There is not just the Nayagam report. There is also the Dickson report, the Arthur Cox report, the Crumlin report that referred to patients as "orphans" within the system and the waiting list management audit, and there are potentially other reports that we do not know about. All of this needs to be on the table. If we are to have that effective public inquiry that we all want, let us get the information out there, let us publish that and let us ensure that there is a level playing field for all involved in this because it cannot be the case that the inquiry and the State have access to documents but parents and families do not. There is a real worry among families that will happen. We need to get a clear timeline on the publication of the waiting list management audit. It was due in November. Then it was due for February. The Minister is saying today it is April. Is that the last deadline we are going to have on this? It seems there is constant delay after delay. Is it the case that CHI is still withholding information? Is that what is holding it up? The lack of information released by CHI is concerning. There is a lack of information about infection rates. We do not know why spinal surgery infection rates are not being published. Parents want to know what the spinal infection rate was for 2024 and 2025, how these figures compare to international benchmarks and whether that data has been independently verified. We need to get as much information out in the open as possible and my experience of CHI is that it has not been releasing information. Officials have been not answering parliamentary questions as frankly as they should and there needs to be more honesty, transparency and accountability. I will briefly mention the audit into unnecessary hip surgeries. My understanding is that the external expert panel review commenced two weeks ago, which is welcome, although overdue. However, there still seems to be some uncertainty about the terms of reference. Last month, the HSE told me: "The Terms of Reference for the External Expert Panel Review have been drafted and are under final review by the Chair and the panel members." Where does that stand? I also believe that the external expert panel review will take 12 months. Can the Minister confirm that whether that is the case and whether the legal issues with the Nayagam review will have any impact on this expert panel’s work? It would be good to know. I refer to the current waiting list because it is crucially important in all of this that we do not lose sight of those who are waiting today and those who are waiting to get access to services. The services need to improve in the here and now and we are not seeing the kind of improvements that we need to see. The CHI seems to be incapable of improving the waiting list. In January, there were 215 children on CHI's spinal service waiting list, unchanged from December last. A total of 128 children were on the active waiting list, up from 108 in December. There were 45 children waiting longer than six months for scoliosis surgery, up from 29 in December. Last year, 534 spinal surgeries were carried out, just 21 more than were completed the previous year. We do not know how many of these surgeries were on the same patient. This is important, because we know that children are returning to theatre for further surgeries. We also know that services are not keeping pace with demand, with 524 patients added to the waiting list in 2025. Therefore, there are real issues with the waiting lists. In relation to the outsourcing, only 19 children have had surgery abroad though outsourcing arrangements with the US and UK since 2024. During that period, 1,047 children have had spinal surgeries, meaning that only 1.8% of these surgeries have been outsourced abroad, despite the availability of €16 million. Last September, the Minister for Health said: "I am not satisfied with the international referral pathways and have lots of questions about why there is a decrease in international pathways and an increase in referrals to Blackrock. I fully accept that going abroad is not viable for many patients and families." Has the Minister got answers to these questions that she was looking for? Do we know what is happening, because, as of 7 November, CHI confirmed to me that 62 patients had been outsourced to Blackrock in 2025? Can the Minister confirm whether the arrangements in place with Blackrock are being examined in the overdue waiting list management audit and whether that will be considered in the report, and crucially, that all the outsourcing arrangements will be examined by the inquiry? Finally, I would like to mention the inquiry into Michael Shine and welcome the progress following the appointment of a facilitator. It is crucial that any ultimate statutory inquiry is victim-centred and adheres to their experiences and needs. Victims' stories must be listened to, and their questions must be answered. Above all, we must ensure that nothing like this can never happen again.

Is mór agam an deis seo labhairt ar cheist na scolóis agus an gortú agus dochar atá tar éis bheith déanta do pháistí a bhí ag fanacht ar obráid. As a topic, like for any parent or anyone who has loved ones as children in this House, it is an incredibly tough subject to talk about. It is something that we have spoken about quite a bit since the general election. It is something that should be top of mind and focus, but also something that we show that there is progress being made on not only in making sure that every child has access to timely and appropriate care, but that we understand fully what happened in the past and make sure that never happens again. I am also conscious that when I speak I have been lucky in the fact that no one close to me has been afflicted with scoliosis or has had to be at the centre of a lot of the stories there and I am mindful that when I speak there are people listening or watching who have been through that experience. I want to be mindful of that in the words that I choose and the sentiments that I convey. One element that has been most striking and shocking to me in following the story has been the culture that seemed to exist among certain aspects of CHI with regard to the treatment of children. It is often said that culture eats strategy for breakfast but in terms of the efforts that are being made, I still have serious questions over that culture that existed in CHI. The integration of CHI into the HSE is a welcome move. It makes sense and I hope it deals with the fundamental cultural issue that seems to have been at the core of a lot of what has happened. Anther aspect of this is the basic tenet of communication. I welcome the approach that has been taken with regard to the inquiry and involving and communicating with parents about the inquiry. Every one of us who has had a medical intervention or a medical consultation values our relationship with the clinician we are dealing with. What we value about it is their ability to communicate to us in a timely, transparent and fair way about what sort of procedure we might have to undergo and what the prognosis is for our condition. It seems that value of basic, clear, transparent communication was not always there with regard to some of the families in this instances and that is something that needs to be top of mind, and especially as we look towards the inquiry. I welcome that progress has been made towards establishing that inquiry but it is important that communication and that transparency be key to it. A lot of statistics are used in the discussion of this issue. It is important that we as politicians make sure that we are comfortable with analysing the data underlying those statistics, that we get under the bonnet of why exactly trends are happening and whether we are seeing the progress that we need to see, that we ensure the accountability that is necessary for the systems that are supposed to be delivering this care for children to ensure that those systems are delivering the progress and that we are fully across and fully understand what is going on in our hospitals. Since the Government was elected, that is something that the Minister has been leading from the front on in understanding what is going on with regard to the data, why are the numbers saying what they are saying and how do we ensure that we continue to bring down that overall waiting time. We are not done with this yet; there is still progress to be made here. The most important thing for any of us who are parents to children is that we get a clear understanding of what has happened in the past, and that some of the unacceptable failures that transpired are avoided again in the future. Compassion, communication and transparency must be at the heart of our approach going forward and the awful mistakes and tragedies that have happened here must be avoided again in the future. That should be our wish and desire for anyone who accesses our healthcare system, but especially for children.

I welcome the announcement that a facilitator, Mr. Remy Farrell SC, has been appointed to the scoping exercise and terms of reference for the public inquiry into the spina bifida and scoliosis services. Over the next 16 weeks, I look forward to families engaging with Mr. Farrell to inform the structure of the inquiry. I am a firm believer that when it comes to public inquiries, we must take into account the views of those who have lived through these things first-hand. Across Carlow, Kilkenny and the country at large, there are families who have been let down by paediatric spinal services. If we are to fully come to terms with the issue, we must allow them the space to tell their story. As we carry out this process, I am heartened to see the Government's commitment to a human rights-based, patient-centred and trauma-informed approach, which will allow for the most transparent examination possible of the issue. I look forward to engaging in due course with the formal report of Mr. Farrell, which will come before the Government in the near future. We have all become aware of the shortcomings of the paediatric services offered to spinal patients in this country in the past. The number of paediatric spinal surgeries cancelled due to emergency surgeries or a shortage of ICU beds increased every year between 2022 and 2025. In recent months, I have raised in this Chamber the case of a young child in my own constituency who had been on the surgery waitlist for a period of over two years. Following on from a successful first surgery, this child's second surgery was cancelled due to an emergency presenting at the hospital. At the time, I reflected that while it was maybe easy for an outsider to accept this, to a parent there is no greater emergency than the health and well-being of their child. Following representations to the HSE and the Department of Health, that child received her surgery without any further undue wait, and she is in good health and care now. That is a testament to the hard-working staff in the HSE and the hospital. With that in mind, and thinking of the incredible healthcare professionals we have working in Ireland today, I know how difficult it must be to tell parents that their child's needs are not urgent enough. Paediatric spinal services have not been adequate for a large number of families, but it is important to recognise that progress is being made. Waiting lists are being shortened. Delivery is being boosted for children and parents across the country. GP referral pathways are being improved. Greater numbers of orthopaedic surgeons are being brought into the network. Thankfully, the Minister for Health has led by introducing a central referral process for patients. This will ensure children are seen in the right location by the right consultants and as timely as possible. The work being done by the Government and the Minister, Deputy Carroll MacNeill, is borne out in the facts. Waiting times across the board for spinal surgeries are going down. Fewer children are waiting a long time for their surgeries. This has been achieved in the face of rising demand for these surgeries. While progress is undoubtedly being made, there will always be more that needs to be done. Over the coming weeks and months, I look forward to seeing the Government build on the progress that has already been made to shorten waiting times and to improve outcomes for the children who need our support the most.

Over the years, I got to know Gillian Sherratt and Stephen Morrison quite well as they campaigned for the care of their young son, Harvey. They are an ordinary couple who wanted to bring up and raise their family as best they could, but in an extraordinary situation. They welcomed me into their home numerous times over the years. They are neighbours of mine. I did not know them before this campaign, but I would like to think I would have got to know them under different circumstances. Any time I was in their home, I never got to meet Harvey, but I feel like I know him. The reason I did not get to meet him was because he was either too sick or in hospital. However, over the years, I feel I have got to know him. If you go by Harvey's home, there is a lovely tree outside and on that tree, there is a beautiful photograph of Harvey. It stops people in their tracks as they are walking down the street when they see the beautiful smile that young boy had. It is like a ray of sunshine on the road. It is heartbreaking to think of this horrible loss of life. Six weeks ago, Gillian and Stephen marked what should have been Harvey's tenth birthday. Harvey had a seven-year wait for scoliosis surgery, and this sparked outrage across the country. He sadly passed away in July, following years of pain and breathing difficulties. Prior to his passing, Harvey's spine had reached a life-threatening 130° curve, which pressed down on his ribcage and put pressure on his heart and lungs. If anybody has seen the video of Harvey trying to breathe, it is another heartbreaking instance and a very visual example. It captured the emotions of the nation. Harvey was let down so many times. He was removed from the critical waiting list without his parents' knowledge. Have his parents been given a reason at this stage? I raised this last November. Have they been given a reason at this stage as to why he was taken off that critical waiting list? He was not treated well. He only lived nine and a half years. He spent 33 months deteriorating in pain, not being able to do the things he wanted to do due to his pain level. His parents had to watch him deteriorate. When he finally got the surgery he really needed, tragically he only lived for another short eight months. It is very important that parents like Harvey's, and others who have been directly impacted by years of false promises and mistreatment, are at the heart of any public inquiry and must be in partnership in this. Anything else will not do justice for Harvey. I want to take a second to commend the other advocates who have been calling for a statutory public inquiry into spina bifida and scoliosis services. I cautiously welcomed this back in November and the reason for that was because parents have been let down so many times. We are looking to see what the terms of reference are. We need to see that Nayagam report published because that could lead to the better terms of references that have been called for. I know there are legal issues there, but the Minister has been sitting on it for a while and I would like to see it addressed.

I have not.

I will start with a few questions, which will give the Minister a chance to think about the answers. I will then make a few general points after. The first question relates to Harvey specifically. Across the whole of society, the story of what happened touched a nerve. Why have the head of the spinal management unit, David Moore, or CHI not informed Gillian and Stephen of why Harvey was removed from the scoliosis list? Has the Minister asked that question of CHI? My second question relates to reports and access to information by all the parties in this process. The Minister and the newly announced counsel, Mr. Remy Farrell, will have access to all the relevant reports, including those that remain unpublished, but the parental advocacy groups representing the affected children will not. It is like sending two teams out with different rule books and different access to information. If the Minister's counsel is entitled to see the full material shaping the inquiry, the legal representatives of those affected should be given the same right. There has to be an equal process. That is my second point. Third, can the Minister confirm the scoping inquiry will include the voices of the parents and families whose children have died post spinal surgery or while waiting on spinal surgery?

Yes.

I have some general points. Parents have been expressing disappointment that the input into the terms of reference that was agreed in meetings does not seem to have been heard. Parents were not consulted and did not have a real say in the facilitator. I know nothing about the facilitator, but they should have been involved in that. It is also problematic, and I do not know if she can answer how she will address this, that the Minister is helping to shape the inquiry while also potentially being called as a witness in the inquiry. This would seem to be a conflict of interest. How is that going to be managed? Parents and children have to be at the heart of framing the terms of reference. I salute the campaigning work of the parents who have brought this about. We have all been in here badgering for this to happen on their behalf. The inquiry has to fully listen to parents, families and patients. It is not a good sign if the facilitator did not fully have their input. The second question I asked is about documents and access to information. It is currently set up that the facilitator of the inquiry and the Minister would be the only ones with full access to all of the reports that are unpublished. That cannot continue. Controversy has continued despite the setting up of this. There have been several controversies since. Last month, we had the separate review into spinal waiting lists but that was delayed due to CHI refusing to give out information requested by the review. There were 62 patients who were requested to come in for checkups after the first review. Over the last three years, €374,000 was spent on a flight to the US by staff to travel to visit the premises of an IT giant which was awarded a contract by CHI. We have had issues with HR systems at all three sites run by CHI. All of these have continued on. This inquiry cannot be a sweep-it-under-the-rug job. It has to fully involve parents and it must involve giving full information to all of the parties.

I mostly want to focus on some specifics and some particular questions. I will start with some general points that shape the particulars. The most obvious general point made by many is that this is a heartbreaking scandal. It is awful that so many children have been failed in this way, Harvey, along with his family, among them. It is a horrendous failure by the State. Now we have a process of various reviews, reports and lookbacks into the various medical failures at CHI. What should shape those reviews? What will be the general overall approach? Two things are key. First, I emphasise again and again that it should be patient-centred, child-centred and family-centred. It needs to have their voices at the heart of it. They need to shape the process in order to have confidence in it. Secondly, when a decision is to be made about going broad or narrow, we need to go broad in terms of being expansive and covering all potential issues. Otherwise, there is real danger that these various reviews will not fully get to the bottom of the problems and then they will have to be repeated again. The guiding principle should be to take in more patients as opposed to trying to exclude patients. I will move on to my particular questions. I will start with the lookback which flows from the Nayagam report. The Nayagam report looked at a surgeon's cases and said that we needed to review two thirds of the cases he was involved in. It is the same surgeon who was responsible for inserting non-medical grade springs, which he had got himself, into children. These are some very serious red flags. There is currently a Medical Council investigation into him. Why, then, is the lookback quite narrow, and contrary to the request of the orthopaedic surgeons? The lookback is on surgeries between 2016 and 2023, and it includes all spinal, limb reconstruction, and surgical dislocation of the hip surgeries, but not surgeries in the area of trauma and general orthopaedics. As I understand it, many orthopaedic surgeons have made a request that this should be expanded to cover all surgeries and this has been denied with this narrower review. If we have a number of red flags about a surgeon - the term "red flags" understates what they are - why do we have an approach that limits it to some areas of speciality? Linked to that, why are we excluding adults? I have been raising this for years now. I was contacted by an adult about this. I will not give any of the details because it would reveal their identity. This adult is convinced that they were wrongly pressurised to have a surgery by Connor Green, which was a disaster. That may or may not be accurate, but you can go and have a lookback. I do not understand why adults have been excluded. I do not understand why other specialties have been excluded. If we have someone acting in this way as a rogue surgeon, why do we assume it is only happening in these areas of speciality as opposed to others? I have raised a related point in parliamentary questions over the past months. I raised it in a question to the Taoiseach a few weeks ago. The Minister is absolutely aware of it. How come this surgeon is registered to practise in Maryland? As I understand it, in order to get registered in another country one would need to have a fitness to practise certificate. I understand from a reply to a parliamentary question that there is no fitness to practice certificate and none has been issued. How is this surgeon potentially operating on patients in America? Has the Government contacted the Maryland Board of Physicians to say that there is some very important information that it should be aware of? Do we not have a duty of care in relation to that? With regard to the Nayagam report, will the Minister confirm that an injunction has been sought? Presumably this is still going through the courts. On the scoping exercise for the Farrell review, is it going to be broad?

Will the Deputy conclude?

Will it include general practice? Will it include the method for this? Will it include the waiting lists, which then were used to pressurise, or were part of the pressure on surgeons to do operations, and so on?

Thanks, Deputy Murphy.

Will it also consider the points made by Deputy Coppinger about all of the information being made available to the families? Otherwise it is a very unfair playing field.

I will start by acknowledging the Minister's statement. She has dealt with the issues - the surgical mismanagement of children with scoliosis and hip dysplasia in CHI, the sodium valproate injury cases and the Michael Shine abuse case - in an open and comprehensive manner. The Minister has established the process by which senior counsel Farrell and Staines will establish the statutory public inquiries into CHI and Michael Shine, and she has spoken about the ongoing non-statutory inquiry into the harm done to pregnant women and to children who were prescribed sodium valproate. I commend the Minister on her commitment to the ongoing audits of the developmental dysplastic hip review and phase 2 of the Nayagam report. I first want to address the care of children with scoliosis and complex spinal conditions. At the centre of this discussion are children and parents who have endured years of uncertainty, long waiting times and after all of that in some cases have had devastating medical outcomes in a system that would appear to have been dysfunctional with the failure of organisational and clinical governance. The response of the system to families' concerns and distress has in the past been defensive and paternalistic. Their experiences must remain at the heart of how we respond as legislators and policymakers. The inquiries must establish the facts and the consequences of those facts. Notwithstanding due process and natural justice, these inquiries have to be acute in their examination of how and why we arrived at this juncture. Over the past number of years, a series of reviews and investigations have highlighted serious shortcomings within the system. Clinical reviews of complex spinal surgeries carried out between 2018 and 2022 identified extraordinarily high complication rates, including infection rates exceeding 70%, and the need for repeat surgeries in a majority of cases within one cohort. These findings have, understandably, shocked families and the wider public. Further investigations also exposed significant governance failures, including the use of implantable devices that did not have the appropriate regulatory approval, and also shortcomings in oversight, documentation and ethical processes. We must be clear that when failures occur in health care systems, and particularly when they involve children, transparency and accountability are essential. Families and citizens deserve answers and they deserve assurance that lessons are being learned. That inquiry process is now entering a scoping phase, which will help to determine the terms of reference and structure required to fully examine what went wrong and how to prevent it happening again. The terms of reference need to be expansive enough to assuage public concern and focused enough to identify the issues without obfuscation. As we wait for the outcome of these historical inquiries, we must drive forward to improve care for patients currently waiting for treatment. The Minister has driven change with zeal in the past 12 months. Governance issues have been addressed with wider and more inclusive decision-making. Capacity has been expanded through domestic and international outsourcing arrangements. Additional surgical time has been ring fenced. A spinal surgery management unit and ministerial task force have been established to oversee progress. That must be acknowledged but with this investment must come progress, timely access and interventions in a high-quality environment with robust systemic and clinical governance. We must rebuild trust with performance that is audited and transparent. Families must see real change, shorter waiting times, better oversight, safer governance structures and better communication from healthcare providers. We need a healthcare culture that empowers clinicians and staff to raise concerns early, encourages multidisciplinary collaboration and ensures patient safety is always the overriding priority. Most important, the voices of patients and their families must continue to shape the reforms we implement. Ireland is fortunate to have highly skilled clinicians and healthcare professionals who dedicate their lives to caring for children. We must have systems that support their skills and deliver robust, transparent and accountable care. Our responsibility in this House is to ensure lessons from these events lead to lasting change. We have had too many inquiries and too many failures. We owe that to the children affected, to the families who fought tirelessly for service and for answers, and to every patient who puts their trust in our health service.

I welcome the opportunity to contribute to today’s statements on scoliosis and the inquiries announced by the Minister. I welcome the Minister’s appointment yesterday of Mr. Remy Farrell SC as the independent facilitator on the scoping exercise. I also welcome the appointment of Mr. Lorcan Staines SC in relation to the Shine report. Both appointments are long overdue and much needed. The terms of reference and structure of the statutory public inquiry into spina bifida and complex scoliosis services is an important and necessary step. Massive public trust issues remain in Children’s Health Ireland. There have been a succession of reports and controversies that have left families feeling ignored, unheard and in some cases betrayed. Parents should never have had to campaign for the basics of timely treatment, clear communication and reassurance that governance is strong and patient safety comes first. As I have said in the Chamber before, I do not believe it is possible to regain the public’s trust in CHI. I welcome the Minister’s decision that clinical services will be integrated into the new national children’s hospital and brought under the direct governance of the HSE. Today’s priority, however, is the children and families living with the consequences of CHI’s failures. We all accept the principle that every child should receive a surgical intervention when clinicians recommend it, at the right time. It is deeply concerning that children have been waiting far longer than they should for spinal surgery. While we can point to progress, the continued delays have a real impact on those children, many living in pain, with mobility loss, anxiety and missed childhood milestones. Any efforts to accelerate services must be welcomed, including the additional €30 million to provide extra Saturday outpatient appointments, improve referral pathways, recruit additional orthopaedic surgeons and provide international outsourcing arrangements to support children’s care abroad, which the Minister alluded to. Activity levels have improved, with 534 spinal procedures completed in 2025, up from 513 in 2024. I thank front-line staff for their efforts in this regard. While the progress is welcome, demand continues to rise and cancellations remain a serious issue for families. They are saying the system still does not feel patient centred enough. Even where cancellations are clinically necessary, a child being prepared for surgery and then stood down is not an operational statistic; it is a huge setback for a family. This is where the inquiry process matters. The scoping exercise led by Mr. Farrell must do two things. First, it must centre families, not as an afterthought or as a consultation box-ticking exercise, but as partners in establishing what went wrong and what must change. The review must be patient centred, trauma informed and human rights based and the commitment must be reflected in how families are listened to and supported throughout. Second, it must deliver accountability and learning. We need answers in governance, systems, culture and capacity. We need to understand where communication broke down and why warning signs were not acted upon sooner. We need recommendations that are practical, measurable and implemented, not left gathering dust. I look forward to Mr Farrell’s report at the conclusion of this 16-week period, and I ask that the House receive a clear update on the next steps immediately thereafter, including a timeline for finalising the terms of reference and establishing the inquiry in a way that maintains public confidence. Finally, I want to say this directly to the families. You should never have been put through this ordeal by CHI and the system. It is not good enough but I welcome the progress confirmed today. It shows you have been heard. It must signal the start of a new, transparent, patient-centred culture in these critical services.

I want to say what is abundantly clear: the failures for children with spina bifida and scoliosis represent a major scandal and the investigation and review of that scandal needs to be comprehensive. Families have been failed for far too long with too many broken promises. Therefore, nothing should get in the way of full truth and delivering on promises made. I welcome progress made on the Michael Shine case but it is hard to celebrate the appointment of a senior counsel to carry out a scoping exercise because the story is very familiar. Allegations against Michael Shine first emerged in the 1970s, before we were even born. They continued throughout the seventies, eighties, nineties and 2000s. Victims have come forward and any of us who have met those victims knew this represented another scandal. The cover-ups that had to have been involved to allow this man to commit the crimes he committed over such a long time deserved to be investigated and now we are getting there. I welcome the fact we have a scoping exercise. I sometimes fear scoping exercises are delaying tactics. I hope it is not the case in this instance. I have huge respect for Lorcan Staines. After so many years and so many Members of this House - I am thinking of Caoimhghin Ó Caoláin, Arthur Morgan, Gerry Adams, Imelda Munster, current Louth Deputies and others - repeatedly demanding a thorough investigation, I hope the victims will finally get to the truth.

Dignity4Patients represents 400 abuse survivors - that is 398 men and two women. I have an abject fear that that does not represent all the people abused by Michael Shine, a consultant who was able to operate like God. There were failures by Our Lady of Lourdes, the Medical Missionaries of Mary, the Garda and successive Departments of Health, and there was failure by this State and its governments over many years. I welcome that Lorcan Staines is in position and we have a timeline for a scoping exercise, but it needs to deliver a full public inquiry that delivers for the likes of Larry, Cianan, Gerard and Peter, whom we heard from when Deputy Joanna Byrne had a presentation in the audiovisual room. "Horrified" does not even cut it in relation to what was done to these people and the failure to provide them with truth and justice. We need to make sure that happens. For far too long we have been in here dealing with the failures of the State. We need delivery for those who have been abused and have survived.

I acknowledge the representatives of the spina bifida paediatric advocacy group and the Scoliosis Advocacy Network, in particular the mothers who have carried this fight with dignity and determination. After our engagement with these parents, we know these concerns are rooted in the experience of children whose health has been affected by systemic failure. The very least those families deserve now is an open and public inquiry, not one conducted behind closed doors, not one limited in scope and certainly not one where key reports remain unpublished. From our point of view, it is deeply troubling that unpublished reports have been reviewed at ministerial level, that a facilitator has been permitted to have sight of them and yet the very families affected and their legal counsel do not have access. We are being asked to sign up to an inquiry process without full transparency. How can any counsel meaningfully agree on the scope of an inquiry without being given the documents necessary to assess the scope? Both sides must be able to review the relevant reports. If legal representatives can examine them, there can be no credible argument against transparency; otherwise, we risk a situation where halfway through the inquiry fundamental issues emerge that could and should have been addressed from the outset. Most importantly, harm is not historical alone. Families are telling us that harm is still occurring. Improvements may have been promised but confidence will not be restored without accountability. These children are victims. Their families are not asking for the impossible. They are asking for openness, for access to documents, for proper legal representation and for an inquiry that is genuinely child centred. This is not an unreasonable demand; it is the minimum that justice demands. We have spoken about this at length. Because of the fallout from one of these cases, we had a vote of no-confidence. At that time, I wanted to have the focus on this report, not on the no-confidence vote. That is what the family asked for. They did not ask for a vote of no-confidence. I was inside in the room. I was listening and talking to them. They did not ask for that. They wanted the full report to be open and transparent. I have not been at the very root of this and in fairness the Minister has. It looks to me that this is not open and transparent. The families are not happy with this. In fairness, we have to show them the respect they deserve. It looks as if what was promised has not been delivered. If certain people can look into this report and others cannot, there is something wrong somewhere and it is going to cause a lot of upset. There has been a lot of upset at this matter already. It has been a huge crisis in this country. A wrong has been done to a lot of parents with children who needed help and were ignored. Unfortunately, I am worried that this might go on and further concern and upset might be ongoing. We have spoken at length here. A very open and clear inquiry was promised. I would like to see an open and clear outcome so that the parents can have some ease of mind. Some have lost children and others are in a dire situation as we speak. I hope there is movement and that the families will find some ease going forward because it is certainly something that I advocated for. I put the family first always. Ahead of my political career on this one, I put the family first. I could easily have done the easy thing of voting for the no-confidence motion, which would provide a great Facebook caption, but that is not what I do. I wanted to put the family first because I wanted their needs first. I would appreciate if the Minister would deliver on that.

At the heart of this is a human tragedy. The response to a recent parliamentary question I submitted showed that in the last five years 126 individuals have been damaged up to and including permanent incapacity or death at CHI. A total of 752 other individuals have been damaged needing medical treatment. There have been 6,900 dangerous system failures within that organisation. Some 23,000 other incidents were reported in that period. The answer to another parliamentary question I put in recently showed that 525 scoliosis surgeries on children have been cancelled in the last four years and that increased from 85 in 2022 to 164 last year, so it is increasing all the time. I do not believe the Minister has explained why that is the case. Organisations defend themselves; that is what organisations do. When there are dozens of reasons given over time as to why information cannot be provided to families or advocacy groups, we should not be surprised that people are sceptical and cynical about the reasons for it. The Nayagam report is another example of that. Phase 1 has been completed but families have been refused sight, supposedly for legal reasons. The family of Harvey Morrison Sherratt are not getting the information they need. Documents are being redacted. Documents are being withheld even from the legal representatives of the advocacy groups. Now we hear today of the facilitator. I believe that is a downgrading from an independent mediator down to a facilitator. The 16 weeks for terms of reference to be decided should be coming to an end now-----

No, they start now.

-----but they are only starting now. They were promised to the families at the meeting-----

I am sorry if the Deputy cannot follow it, but they start now.

Okay. At the meeting the Minister had with the families along with Simon Harris, it was understood that the 16 weeks were going to come to an end roughly now and that is what the families understand, which is a problem. In 2014, Temple Street said it had 500 children with spina bifida in its care. Now CHI has 254 children in its care. I want the Minister to outline why that is the case. I do not want to take time from my colleague on that. It would be really important to have external oversight of CHI currently. Given that the situation is happening, we need to have external oversight of what is happening in CHI, in both the clinical and management areas.

Following what Deputy Tóibín said, why is CHI still in existence? That is something that needs to be looked at. Obviously, we have to go through the 16-week scoping exercise, led by Remy Farrell SC. That is something that the advocacy groups do not trust. It does not meet the definition of what we would call an independent mediator. The Minister might call him a kind of a facilitator to get all the information together for an inquiry, but these are people who have been damaged by Children's Health Ireland and its predecessor. These are people who do not trust the system because the system has failed them and their children, and in some cases led to the death of their children. If the Minister is trying to go forward in line with the promises given a few weeks ago, she should be listening to the groups and trying to get the independent facilitator to do the scoping process and then go into the inquiry. When the process is scoped, I just hope that the inquiry itself will be 100% independent and transparent. As I have mentioned twice in this Chamber already, as have others, the children with scoliosis and spina bifida, their parents and the adult sufferers have all asked for certain things to be done while the inquiry is going on in terms of the levels of service being provided. I note that the waiting lists have gone down, which is welcome and credit is due to the Minister in that sense. However, not enough people who are suitable for international treatments are using it for some reason and that needs to be encouraged. We still do not have full answers to the question of the huge number of cancellations since 2022 and they need to be addressed in more detail.

I am a TD for Meath West and Our Lady of Lourdes Hospital in Drogheda is one of my local hospitals. Like so many Meath people over the years, I was born there and have had many experiences in it. Michael Shine's unspeakable depravity is not an abstract to me. It is personal, it is local and it is still profoundly shocking. There is nearly half a century between his sick acts and the wholly separate issue of the scoliosis scandal of today. It may seem strange to many people looking in that we are discussing these topics together but it is not because both scandals have so much in common despite the decades between them. Both issues have shaken the public confidence in our health service in a way that is deeply distressing. In both cases families who placed their trust in the system have had that trust betrayed. In both cases there was a complete failure of oversight and governance. In both cases there has been very little accountability or indeed answerability. In both cases those who raised questions were ignored or very least unheeded. That there is so much in common despite such a time lapse between them points to a dysfunctional system that will continue to severely disappoint those who depend on it when they are most vulnerable. We have had too many scandals whereby vulnerable patients, particularly our women and children, were failed by the systems that should have protected them. These must be the last scandals. We cannot stand over a health system that fails to learn lessons even after severe harm is done. Parents consented to invasive spinal surgeries believing they were acting in the best interests of their children. That trust was not honoured in so many cases. In recent weeks, I spoke again to a mother I know in Meath West whose child underwent scoliosis surgery during the timeframe in question. She was anxious when she first heard about the potential of there having been unnecessary surgeries. That soon turned to fear, upset, anger and disbelief - the full range of emotions. As a parent, I can understand and imagine what it was like for her. At the time, she was told it was necessary. She trusted that advice because she had no reason not to. In light of what has come to pass, she is simply wracked with guilt, not because she did anything wrong, which we know she did not, but because she feels she should have questioned that diagnosis. Imagine that, a parent who acted in good faith and from love is now carrying a burden that should never have been hers to carry. The fault does not lie with her or any of the parents. It lies with failures of oversight, governance and accountability. It lies with systems that did not escalate concerns quickly enough and with a culture that is at times too slow to challenge and certainly too slow to listen. As a Government TD, I believe our responsibilities now are immense. We must ensure full transparency. Families deserve the truth and not partial disclosures or defensive statements but the full facts. We must ensure accountability. Where wrongdoing occurred, it must be acknowledged clearly and addressed appropriately. Professional standards must be robust and oversight mechanisms must be strengthened so that no single individual can operate without effective scrutiny. Most importantly, we must reform the system in a way that will restore confidence. That means independent clinical audits, real-time monitoring of surgical outcomes, protected whistleblower channels and a culture where patient safety is the overriding priority. The Michael Shine inquiry and scoliosis review need to come to swift conclusions. They need to be robust and transparent and bring some sort of closure to those who are so deeply affected. The people of Meath and Louth, and people from across this country, deserve a health service they can trust without any hesitation. Parents should never again have to question whether a recommended surgery is truly necessary. They should never again feel guilt for trusting medical advice or putting their children into the hands of medical professionals. We owe it to those affected to ensure, not just in words but in swift action, that these are the last scandals of this kind.

I welcome the opportunity to contribute to this important discussion on scoliosis services and the wider need for accountability within our healthcare system. First and foremost, I must acknowledge the frustration, anger and stress experienced by children and families waiting far too long for spinal surgery. Every child deserves timely care when clinicians determine it is needed. While additional investment, increased theatre capacity and the outsourcing of procedures have helped to reduce waiting times, we must be honest that more needs to be done. It is clear, however, from every action the Minister has taken since she took up her portfolio that she is committed to doing more. Families navigating these services deserve not only treatment but clear communication, transparency and respect. Those are the basic standards that people should be able to expect from any healthcare system. The proposed statutory inquiry into spina bifida and complex scoliosis services will, therefore, be an essential step to understanding what went wrong and ensuring it never happens again. It must be thorough, independent and centred on the experiences of patients and families. I will take this opportunity to acknowledge the significant development this week regarding the victims and survivors of Michael Shine. Being from Louth, this is personal. Michael Shine was a disgusting and despicable paedophile. He preyed on hundreds of boys and young men over decades, using his place of authority and perceived respectability to hide and continue the abhorrent abuse. It was known around Louth. It was known that he was an abuser. As a child, I knew he was bad but I was never old or articulate enough to understand what that "bad" meant. It was an open secret and open shame that authorities kept it a secret and kept it slammed down. The courage of the victims, many of whom have spent years seeking truth and accountability, cannot be overestimated. I have had the privilege of meeting some of those brave men. Their stories will never leave me. They spoke with desperate honesty and vulnerability about the trauma they carried for decades. They spoke about the years of silence and about the doors that should have been open to them but were instead slammed shut. Instead of being listened to and supported, far too many of them were treated deplorably. A moment from those meetings stayed with me and I go back to it when I think about these horrors. I saw a photograph of one of the victims when he was a young boy. He was a beautiful wee boy. When I looked at that photo, I saw my own boys. My gut instinct was to reach out and hug him, to scream for him that no one was able to protect that wee child and hundreds of other wee children who had the desperate experience of having Michael Shine as their doctor. When I looked at the eyes of that wee boy, I imagined the horror he must have been living through at that moment. When I looked at the man that the child grew into, I saw the hurt that was still there and the trauma that he carried with him in those wee eyes. That was what brought him to my office that day. I also saw incredible honesty, decency and extraordinary strength. I thank Dignity4Patients for its incredible work, and congratulate it and the victims who have come forward and have given up so much to get this point. I thank the Minister for her openness to getting this done. I thank the Taoiseach for meeting the victims a few months back. That meeting had a deep and lasting effect on all who were in that office that day. The confirmation of the independent facilitator to begin the scoping exercise for the statutory inquiry is welcome. I spoke to representatives of Dignity4Patients today. They are enthusiastic, anxious and positive. The survivors have said that for the first time in many years they feel genuinely positive that progress is being made. It is absolutely essential that any inquiry arising from this process is victim-centred, trauma-informed and grounded in a human rights-based approach. Survivors must not simply be participants in the process. Their voices must shape it. I know the Minister is thoroughly committed to that. I wish to raise the issue of the timeline for the scoping exercise, which is currently set at 16 weeks. We absolutely agree that progress needs to be made swiftly. We must ensure most of all that it is not rushed. It is incredibly ambitious and a great timeline. However, if additional time or resources are required to properly engage with survivors and to develop robust terms of reference, I ask for them to be granted. After decades of waiting, the victims deserve a process that is thorough, respectful and capable of delivering truth. If I look at the photo of that wee boy again, I want to think we did justice for him in 2026.

I received a message this morning from the parents of Mikey Henry-Benson from Mayo, who has scoliosis. The Minister met and knows the family. The parents stated that CHI has ruined their lives, shattered Mikey's sisters' lives and destroyed Mikey's chance at life. They stated that the HSE has put another nail in it. They stated that they asked the HSE for an independent assessment for Mikey but he most certainly did not get that. The HSE said it was going to go with what CHI said. The message went on to ask why the State is not helping the family to get Mikey to a hospital where surgeons deal with cases such as his on a daily basis. They asked if he is not worth the bother. I heard the Minister's statement earlier. She spoke about improved access to international options for assessment. I ask her to please clear the pathway for Mikey to have that international assessment. I am not asking for a clinical decision. I am begging for an assessment to save his life. In September 2024, I first raised the case of Mikey Henry-Benson, who was under the care of CHI to treat his scoliosis. On that occasion and on many occasions since, I asked for a full independent assessment of his case after the family were let down time and again by CHI. How was his spinal curve allowed to go from 82° to now 130° without intervention and in full view of CHI and the HSE, and, indeed, Ministers for Health? Families like Mikey's are constantly given assurances that are not translated into action. Let me once again outline Mikey's journey and the progression of his condition to illustrate the human consequences of a system that fails to respond with urgency. Mikey is a wheelchair user with a neurological condition. In 2023, he was diagnosed with severe scoliosis. It was made clear to his parents what could happen to his vital organs if his scoliosis was not treated, yet Mikey was left to deteriorate. He was told he needed surgery. His spine and lungs were not monitored for another eight months. His spinal curvature progressed significantly and, as I said, is now 130°. His lungs are severely compromised and he requires a machine to breathe at night. The need for specialist surgical intervention has long passed. His parents watch their child live with constant discomfort and physical distress. They have repeatedly raised concerns about the speed of the progression of his curve and the impact it is having on his health and well-being. They asked to access surgeons and hospitals outside of the State with extensive experience in treating severe and complex scoliosis cases. I ask the Minister to please help us to save Mikey's life. This has been going on for far too long. I first brought this case to the attention of the Dáil in September 2024 .

I have raised the issue of scoliosis since at least April 2017, when I initially submitted parliamentary questions to the then Minister for Health and now Tánaiste, Deputy Simon Harris. At that time, I asked for details of the current waiting lists for children with scoliosis, the number of children on the waiting list for treatment and the steps that the then Minister was taking to ensure scoliosis patients received treatment in a timely manner. I was told that improvements in scoliosis services were a priority for the Government and HSE and that steps were being taken to bring Ireland into line with the waiting times of the NHS in the UK. We all know what has happened to that commitment and those priorities. Since then, the situation has become immeasurably worse. The pain that children and their families endure is being compounded by a deep sense of betrayal and abandonment by successive Governments. The scoliosis waiting list action plan 2017 was jointly developed by the HSE and children's hospital group and has failed to deliver, despite the fact that as part of the proposal to address the spinal fusion waiting list a number of children were identified as being clinically appropriate to have their scoliosis surgery in other hospitals, such as the Mater, Cappagh and Temple Street. I would like to know how many additional nurses and consultants have started in the service since then. Without them, we cannot have the increase in theatre capacity we so badly need. How can the Government and Children's Health Ireland keep getting this issue so wrong? How on earth are we still here, almost a decade on from 2017, when I initially raised these questions? Is it incompetence or indifference? Is it just the cruel and unpalatable fact that the State is simply mired in dysfunction when it comes to addressing issues of this kind of complexity? We should be embarrassed and the pain and distress this has caused to so many families throughout the State is absolutely scandalous. We have to get to grips with this quickly. We have to instil confidence in services. People no longer have confidence because they have been treated so badly. Unfortunately, children have suffered.

Yesterday, two public statutory inquiries into scoliosis and spina bifida care and Michael Shine were announced. The Minister, Deputy Carroll MacNeill, has appointed facilitators to begin work aimed at establishing two public statutory inquiries. Remy Farrell SC has been appointed as the facilitator with regard to scoliosis and spina bifida at CHI. Lorcan Staines SC has been appointed to work as facilitator on the abuse carried out by the convicted sex offender Michael Shine. Michael Shine, a former surgeon, worked in Our Lady of Lourdes Hospital, Drogheda, from 1964 until 1995. In March 1995, the CEO of the hospital was made aware of a complaint of abuse against Mr. Shine by the North Eastern Health Board. Mr. Shine took leave while the complaint was being addressed and subsequently retired in October 1995. By the time of his retirement, he was already the subject of multiple allegations of sexual abuse. Dignity4Patients has been campaigning on behalf of the victims for many years. The organisation has long sought a full inquiry into the sexual abuse of patients and in the past year has sought a commission of investigation. For decades, victims and survivors of Michael Shine have carried trauma and sought recognition and accountability. Their strength and willingness to continue pressing for the truth must be met with compassion, seriousness and action. I commend the Minister for Health on how she has had to deal with issues that arose before she ever came into this office. Michael Shine retired in 1995, yet Deputy Ó Murchú blamed this Government for those issues, which is very strange. The Minister for Health has led on this and put the inquiry in place. Cheap political points will not help any of the victims of Shine. The Minister has done this with compassion, effectiveness and due diligence. She has listened to the lived and living experience of many victims, those people of all ages who were wronged and those who were wronged while availing of health services. We have to have a little bit of fairness. The Minister is trying to deal with issues she inherited. She has worked tirelessly over the past 12 months to put this in place and it is an honour and privilege to work beside her. The Minister is not the person who has harmed anyone. I ask for a little bit of fairness.

I will address a number of issues and questions that Deputies raised. We take the same approach to both inquiries, with the appointment of a facilitator specifically to engage with the different groups. That request has been socialised and agreed with the different groups, which includes Dignity4Patients on the Michael Shine side and eight groups on the scoliosis side. There are different views among the groups and it is important to acknowledge and reflect on that, as there have been different views among scoliosis and spina bifida advocates in previous years. Some participated on a spinal task force and others did not, and I respect both perspectives. I have been the recipient of responses from all of the different groups and those voices are not being reflected in their entirety here today. That is because people have not necessarily been in touch with Deputies in the same way, but I have to acknowledge there are more voices than those who have been reflected as having been in touch with Deputies. I know that because I have seen their responses and they stand somewhat in contrast to what was said. I do not say that with any disrespect to any group, but I have to acknowledge that there are many groups involved in this. Dignity4Patients is on one side and there are multiple scoliosis and spina bifida action groups on the other. That is important. On the Nayagam report, I condemn any reference to it in a Sunday newspaper prior to communication with families. That did not come from me. A small group of people were engaged with that. I read lots of things in Sunday newspapers that are never put there by me. I am hurt and appalled on behalf of the health system that any person with access to such a sensitive report would do any such thing. It certainly did not come from me and our communication was focused on getting a deep clinical briefing and putting a proper structure in place between that clinical briefing on 6 February, which was a Friday, and communication with families on 11 February, the following week, in an intelligent, appropriate and accurate way. I deeply regret any Sunday newspaper ridiculousness. I cannot publish Nayagam 1 until Nayagam 2 has been completed. That is how the process was structured. Those are the commitments that were given to the High Court and I cannot, as a member of the Government, knowingly take actions that contradict commitments that have been given to the High Court. If I could find a way to publish the report without doing that as a member of Government and a Member of Parliament I would, but I cannot. Nayagam 1 will be published when Nayagam 2 is completed, which is how the process was established. Regarding the terms of reference, the word "complex" is not intended to in any way narrow the terms of reference. They are being given a facilitated process to be agreed and determined, and we take the broadest possible view in that regard. I am sorry if that is the impression that was given. It is certainly not the intention. We have never really had this process previoulsy, which has been deliberately set up so it is not the Minister or the Government dictating it, as was the case in the past, where terms of reference were set and then people were sent on their way. We are pausing, specifically, to enable the breadth of analysis about the documents that are there and the breadth of engagement that is possible. This is a different way of doing that so there is no intention to narrow it. Many Deputies have raised the point of the interplay and tension between the breadth, the robustness and the timeliness. This is a triangle of great difficulty in determining how tribunals can and should be structured. What every Member wants is to have a tribunal, a commission of investigation or whatever the forum that is effective. We talked about the sodium valproate one here. I am not prescribing that, nor am I prescribing interim reports, which was raised. I am not prescribing anything. I am very deliberately asking for a report from somebody who is independent of the Department of Health and of Government to engage and to look at all of the structures and to recommend to me how that be done. There is an interplay between the breadth we want to achieve, as mentioned by Deputies Rice and Paul Murphy, but also the timeliness. We do not want something that is going on as was referred to, for ten or 11 years, and we do want something that is legally robust. That is going to be a complex interplay and that is going to be something about which there is great capacity for disagreement such as on how it should be indexed. At the end of the day, I have to receive the recommendations and make an actual decision about how we take that forwar, rather than getting stuck in limbo forever in relation to it. I wanted to take both of these inquiries forward independent of Government, transparent and impactful on behalf of the people who very badly need them. I will speak to some of the issues in relation to scoliosis services and the improvements or the issues that are contained with them. Not every Deputy is here but I will carry on. There are four additional consultants, one of whom started in August and three of whom are starting in May, which is very significant additional capacity, as well as additional theatre capacity. The question of waiting lists versus waiting times was raised by Deputies Rice and Sherlock in particular. I would ask the following question: if you need a specified procedure, would you rather be one of ten patients waiting for a year or one of a hundred patients waiting for a month? The answer is so obvious. If my child needs complex scoliosis surgery, it is the timeliness, not the number of other people on the list, that matters. The number of people on the list is less important than the time they are waiting. The number of people on the list should be added to as the population grows and as diagnostics get better. If in a time of increasing population, increased diagnostics and additional Saturday outpatient clinics, our waiting lists do not increase, then we are doing something wrong. This is a basic tenet of how healthcare is delivered. It has to be quick. That is why Sláintecare sets timelines, not list lines around these things and it is really important that I update the House again on the time measures that are relevant to the individual patient. The outpatient list has fallen since January 2025 from a waiting time of 9.7 months to 4.5 months in February 2026. That is a considerable improvement by anybody's standard, and that is because we are doing additional outpatient clinics. Because we are doing additional outpatient clinics, we are identifying more people who need surgery, so the waiting list goes up. This is really straightforward. It is the time that matters, and the time for surgery is also coming down from a weighted average of 6.2 months in January 2025 to 5.2 months in February 2026. Is that enough? No, I want to drive it further, but could we all speak the same language? This is from the perspective of the child and the time that they are waiting, and for the appropriate clinical and-or surgical intervention, and let us be at least on the same page, so that if it goes up, Deputies legitimately criticise me on behalf of the Government for that. At least let us speak the same language. The language that matters to a parent whose child is waiting for surgery is the length of time, and parents, I assure Deputies, are thoroughly unconcerned about the number of other people who also wait. The access to care for so very many is such an important issue and I commit to continuing to work on it month by month to deliver additional resources, services, and improvements. However, for this point on, I ask that we speak the same language on how we are measuring impact for individual patients.