That would have been communication with the Taoiseach's Department through July and August and I can check as to exactly what communication may have included information on the springs.

The short answer is "Yes". It is also important to say that the reviewer will meet directly with the families and groups. In fact, it is specifically within the terms of reference which includes consultations with patients' families and staff. The intention was that Mr. Nayagam would meet with them and he has full discretion within the current terms to adjust them according to what he hears directly from the families. I also want to say that with the benefit of hindsight, I believe the draft terms should have been …

In the spirit of questions and answers, and I appreciate that the Deputy has a question, I will be short. I hear and agree with the Deputy and say that should have happened but it is important to state that it was and remains the intention that would happen, but that it would happen directly with the reviewer. In addition to that, yes, it should have happened with the Department and with me ahead of that as well.

I am out of time, but may I take a-----

The Crumlin review will be published. The families are being engaged with tomorrow. Crumlin hospital did this review off its own bat given the concerns raised in Temple Street. The very clear advice I have from CHI is that that review did not show higher return rates or complication rates than would have been expected internationally. Yes, we will publish the broader review. We will not be waiting a year. I will expect interim reviews and I will publish those interim reviews. Both Bernard Gloster and I intervened d…

That is right. Representatives of CHI will appear before the committee on Thursday. The advice I have is that Crumlin hospital took it upon itself to do a similar review on the basis that concerns had been raised in Temple Street. The advice I have is that it was not based on concerns being raised and that it did not find an unexpected level of complication.

I believe it was commissioned around September of last year and I believe 11 cases were involved.

This is one of the core questions we need to get to the bottom of. I am deeply frustrated that I do not yet have a satisfactory answer because I have posed this question to Children's Health Ireland on more than one occasion, as have my officials. We know there has been a very large investment and a really fantastic clinical workforce has turned that money into far more surgeries happening. However, the waiting list did not fall as it should have fallen. We have no evidence there is a higher incidence of scoliosis …

It will be part of Mr. Nayagam's review. The third objective is "To assess the governance of the Paediatric Orthopaedic Surgery Service and to make findings, [that is right across the board] and to make any necessary recommendations in regard to improvement in governance including quality, safety, outcomes and performance metrics." Dr. Colm Henry and I have spoken directly on this. I have instructed very clearly that this issue be looked at and that waiting list management be looked at. The State has invested the m…

I will double check the exact details, but my understanding is that it was paused last November. It is still paused and the last kyphectomy procedure happened in the middle of last year, perhaps in July 2022. It was officially paused in around November, but we can get the Deputy the exact dates.

I will get the Deputy exact details. I do not have it in terms of individual surgeries that are being recommended for particular patients. However, the reality is that we have two surgeons who do complex spina bifida care and it is done in Temple Street. One of those surgeons is currently not doing those surgeries. Will that have an effect and is it already having an effect on the time these children are waiting? Yes, unfortunately it is. That is being taken deadly seriously. As I alluded to earlier, all potential …

Yes, I have. The clinical director is very clear that in CHI and in Temple Street additional communications and additional protocols were put in place. As they would say very clearly, there are already numerous protocols in place in every operating theatre in the country to ensure things like this do not happen.

I certainly can but there is no need because that exact process is already built into the review.

Let me state clearly that it is absolutely the intention and has always been the intention that the families directly meet with the lead reviewer. The terms have been crafted such that he adjusts them depending on what they say. As I said to Deputy Cullinane earlier, with the benefit of hindsight, that process should have happened twice. It should have happened before the draft terms were published rather than just being shown the draft terms. I fully accept that should have happened. That was a mistake. It was int…

Yes.

The advice I have right now is that they do not believe so but we will double-check. That review was done for a small number of children in Crumlin.

I am sure we can.

I thank the Deputy. This is exactly what the additional review is looking at right now. Of course I have spoken to CHI and the HSE. My officials are engaged. I have a view on some of those questions. However, I am very much of the view that we have to establish the full facts. We have to establish who, at a management and a clinical level, knew what. This relates to several questions. First of all is the use of the springs in the operation. We know it was an operation that was being trialled in Utrecht, for example…

The framework timeline is four months. I ask the Deputy to bear with me. When I heard that, I made it clear to CHI that I and the Oireachtas would not wait for four months to get answers to these questions. I have asked for it to be accelerated for that reason.

CHI is carrying out that review. I beg the Deputy's pardon. Sorry. It is an external review.