The Minister has said she believes in equality for every baby born in our public maternity hospitals and I absolutely agree. However, the EY report into CHI shows that children whose parents can afford to go private are being prioritised for essential surgery in our public hospitals. Surely the same equality should apply to children as well.

I was very concerned about this and specifically about the management of waiting lists, particularly for spinal surgeries. Because of that, along with the former HSE CEO, I undertook an audit into equity of access and waiting list management in CHI. Recognising the challenges families have faced regarding paediatric services, we also undertook a separate qualitative piece of work to try to capture their experiences away from the strict terms of the counting audit and to ensure their voices inform the development of services. The audit took much longer than I wanted it to and much longer than anticipated - I was correctly questioned about that in the House - but that time was essential to ensure that the findings, conclusions and overall report were accurate and robust. The report found no clear evidence of inequity between public and private patients, but it did outline important findings in governance, including recurring delays against clinical recommended timeframes and inconsistent documentation in relation to waiting list management, neither of which is acceptable.

Importantly, the patient and family feedback revealed dissatisfaction with waiting list management with significant emotional and health impacts, although it did not need revealing to anybody here as we were already aware. These impacts was not just for the children but also for the parents. Parents and families want to be informed, involved and treated with empathy and respect. Those findings were capable of being anticipated - I would not have initiated the report had we not had shared concerns - but nevertheless they are disappointing. We need to provide a better experience for children and their families. I have met with the HSE and CHI and I am more satisfied than I would have been 12 months ago that there is a different attitude in senior management in CHI in its responsiveness and care around this. I am not saying everything situation is perfect - I certainly would not say that - but I can see a real change in the reaction and response of senior CHI management to this audit and qualitative report, which I think is important.

I reject the question of trying to present this in any particular way. I commissioned the audit because of my concerns about this. There is no question but that I was uncomfortable with what was being found overall, but specifically when I drill into those a bit more there is not a systemic problem I can see. What I did see and what I was concerned about was that less complex procedures were being too easily moved to private facilities, resulting in the more complex procedures remaining. I think what the Deputy describes with those figures reflects some of that. There is a bigger complexity than what he has presented.

This is why I initiated it. This was my concern. My concern in particular was that this was more endemic than the report ultimately gives credit for. The Deputy is right that there is a limitation in data, but there is no question but that this audit was done with the best of intent and in good faith. We see more real experiences in the qualitative piece that Lily Collison did. That was an important piece of work that really speaks to the experience children had. It is improving but is not perfect.

There is often an attempt to suggest that discrimination between private and public patients does not have an impact on safety or patient care. That happened in the debate on the Rotunda. The Minister was involved and was on the correct side of that debate. I again quote the report, which states, "For Spinal patients, only 41% (9 out of 22) were treated within the Clinical Recommended Timeframes (CRTs), meaning 59% faced delays, sometimes for several months." In terms of urology, "Of the 73 patients reviewed, 30 (41%) were treated outside the Clinical Recommended Timeframes." The median delay was 152 days. There was one case where a child waited seven years for routine surgery. The report points out that "children may wait longer than clinically recommended for assessment, investigation or treatment, with potential consequences for clinical outcomes, disease progression, and quality of life." Does the Minister agree that just as private healthcare has no place in our public maternity hospitals, it similarly has no place in CHI? We should not be building private suites in the national children’s hospital. We should not be building inequality into our health system.

Yes, I am a firm supporter of the public system. There is no question about that. Some 71% of our consultants in CHI are on the public-only consultant contract. However, there is also a contractual requirement to continue to provide private space for those old, type B contract holders. It is anticipated that fewer than half of the eight planned consultancy rooms will have any private clinics. The rest of the rooms are dedicated for public clinics. More important, they will be private clinics winding down over time and that will all move to public because only be public consultants will be hired in. We are still committed to the rule of law and to upholding contracts. If I say contracts have to be upheld, I have to uphold them on the other side and we have to make that space, as the Deputy is aware. We have a very strong commitment to public service. I do not believe there is space for private work in the same way. I am in agreement with the Deputy, but there are still contract holders who have a contractual entitlement to a certain number of private rooms. I see in the new hospital that will be wound down and down, as we get from 71% to 80% and 85%. That will happen over time.