Gerard P. Craughwell urges clarity on €19.1m and scoliosis waitlists
Gerard P. Craughwell addressed the House on deficiencies in scoliosis services and questioned the allocation of €19.1 million. He pressed the minister for documentary evidence of how the funds were spent and called for transparent, early triage and separate treatment streams to reduce parental anxiety and waiting times.
Mr Craughwell asked where the reported €19.1 million was allocated and whether it was spent within the scoliosis system. He requested documentation to prove the money was used for the specific task, arguing parents need assurance that ministerial funding is spent as intended.
He advocated establishing a clear triage system so families are informed at diagnosis whether a child may require surgery or can be managed non-surgically. He argued children who do not need invasive surgery should be routed into a different stream - managed by non-surgical clinicians - to free up surgeons and reduce unnecessary anxiety for parents.
Mr Craughwell highlighted rising numbers and delays, noting a 10% increase between 24 and 25, 233 children on a waiting list, 43 waiting over six months and 15 waiting more than two years. He warned many families wait long periods only to be told after short consultations that surgery is not required, often after MRI, CT scans or further assessment.
He described clinics where surgeons must see large numbers of anxious parents in limited time, limiting explanations and trust. He said freeing surgeons to focus on operations and reallocating assessment work to other clinicians would improve care and communication for families.
Referencing work by Senator MacDool, Mr Craughwell noted the proposal recognises ministers cannot always be held personally accountable for all HSE actions and provides statutory protections for ministers, families and children. He urged a transparent, accountable system for scoliosis treatment modeled on clear clinical pathways and documented spending.
Questions on €19.1 million
Mr Craughwell asked where the reported €19.1 million was allocated and whether it was spent within the scoliosis system. He requested documentation to prove the money was used for the specific task, arguing parents need assurance that ministerial funding is spent as intended.
Call for early triage and separate streams
He advocated establishing a clear triage system so families are informed at diagnosis whether a child may require surgery or can be managed non-surgically. He argued children who do not need invasive surgery should be routed into a different stream - managed by non-surgical clinicians - to free up surgeons and reduce unnecessary anxiety for parents.
Waiting lists and diagnostic delays
Mr Craughwell highlighted rising numbers and delays, noting a 10% increase between 24 and 25, 233 children on a waiting list, 43 waiting over six months and 15 waiting more than two years. He warned many families wait long periods only to be told after short consultations that surgery is not required, often after MRI, CT scans or further assessment.
Pressure on surgeons and clinic experience
He described clinics where surgeons must see large numbers of anxious parents in limited time, limiting explanations and trust. He said freeing surgeons to focus on operations and reallocating assessment work to other clinicians would improve care and communication for families.
Accountability and statutory protections
Referencing work by Senator MacDool, Mr Craughwell noted the proposal recognises ministers cannot always be held personally accountable for all HSE actions and provides statutory protections for ministers, families and children. He urged a transparent, accountable system for scoliosis treatment modeled on clear clinical pathways and documented spending.
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Transcript
Minister, you're welcome to the House, this is my first time to meet you in this House and congratulations on your elevation. Minister, recently on an RTE programme I heard you interviewed and you came across as a person who is not prepared to take any old answer, you came across as an assertive, committed minister and you know one of the problems of the position you hold is when things go wrong, you're held accountable and fired, while the people who made things go wrong continue on in their posts. Now my colleagues have mentioned the 19.1 million Euros, we need clarity on that, where did that 19.1 million Euros go, was it put into the scoliosis system and if it was can we have documentation to make that stand up because I think it's extremely important that parents and children, but particularly the parents, the ones who are looking after the developing child, that they have some assurance that monies that are gotten by ministers to carry out a specific task, that those monies are spent on that task and only that task. We cannot have people second guessing what the minister may or may not have thought at the time. The minister gets money and you know better than any of us how difficult it is to fight for your corner at Cabinet and to get money. So we cannot have people second guessing what you do. In the area of scoliosis, I am mindful of what happened with CF and how we were able to isolate CF within I think St Vincent's Hospital. So people suffering from CF are always guaranteed a bed if they need one in a safe and sterile environment where they are not going to be subjected to infection from other parts of the hospital. I think in the case of scoliosis we need to go back to the drawing board maybe a little and look at things. First and foremost we should have a triage system. When a parent gets notice that their child has scoliosis the first thing that will happen is discussion amongst the relations and friends about oh my god the child is going to have to have surgery. I think it has been pointed out more than once that not every case of scoliosis requires surgery. But imagine waiting for a year to see the consultant and in 10 or 15 minutes the consultant says oh look if the child doesn't need surgery we can deal with it through A, B, C or D and out the door with you and there you're devastated. You don't know what to do. You've been planning and you've been set up for this thing oh my god my child is going to have surgery and suddenly your child doesn't need surgery and you go out the door wondering are they just fobbing me off here? Are they just trying to shorten the queues? Are they really when I look at my child my child has a problem and these people give me 15 minutes of their time and I'm out the door and I don't know where I stand. So we need a little transparency at the very beginning when diagnosis is made. Parents need to be made aware of the fact that the child may or may not need surgery and that following MRI scans, CT scans or whatever is involved that a clearer picture will emerge and in the case of a child that does not need surgery then they're put into a different stream. So they're not in the same queue as those who need radical altering surgery and they know from the earliest point possible that the child is in a position that the child can be dealt to it without invasive surgery and they should be delighted to get that news, absolutely delighted. Now my colleague Senator MacDool when he put this together, he put it together on the basis that ministers cannot be always accountable for what happens within the health service executive and this is protection for the minister, it's protection for the families, it's protection for the children because there's a statutory basis on which scoliosis treatment will be given. When I look at the numbers today, first and foremost we have a serious problem in trying to understand why the numbers are increasing. Why was there an increase of 10% between 24 and 25? What's going on there? Is it that we have become better at diagnosing the situation? Is it that the, I suppose the clinicians have become better? But when you look at 233 children on a waiting list and some of them, 43 of them are on a waiting list for over six months and when I look a little further I find that 15 more are on a waiting list for more than two years. I wonder when I look at those 43 and the 15 how many will at the end of the process be told, actually your child doesn't need surgery, they need a specific brace or they need some sort of physiotherapy to bring them over the line and this is where time is lost, this is where anger grows, this is where doubts and distrust arises. If I've been waiting a long time and at the end of the wait I'm told, actually you don't need surgery, you're fine, we can do it with a brace, we can do it with physiotherapy, we can do it in some other way and I think the earlier we get to that stage Minister, I think the earlier we get to that stage the better and once we know that a child does not need surgery we can then put them into a stream where they're dealt with by a different set of clinicians, a different set of medics and we can free up the surgeons time to do what surgeons do and that is to carry out the surgery on the children in question. It's extremely difficult to expect surgeons to interview and speak to 10, 20, 30 parents in a particular session in an afternoon and we've all been in those clinics at some stage or other where there are massive numbers, all of them at high anxiety levels, all of them waiting to see a surgeon and at the end of the day time constraints limit the amount of time the surgeon has to explain the situation and for surgeons it's a question of dealing with facts which sometimes are not easy to take. So from that point of view I am really concerned that what we do here is we make an accountable system. We have a system where everything in it is transparent, where the accountability and the reporting back to you minister and those who follow you is vitally important so you're kept aware of the situation. If we can do it with CF we can do it with scoliosis. Scoliosis is a horrible painful disease or condition should I say for those who suffer from it and you will know yourself that when any sort of illness enters a family it finds its way down through the entire family. The person suffering from the illness becomes the focus of the family and other kids, you'll have heard it yourself, other kids feel resentful at the end of the day that mum and dad were tied up with the child that has the condition while I was left to my own devices type thing. Again the prospect of using the purchase fund to send children to wherever we can get the surgery done quickest. Again that brings other problems. It brings problems of maybe a working parent having to take leave of absence to go with the child to the United Kingdom or the United States and again we've got to provide provision there to make sure that the family does not fall into some sort of economic problems. So from that point of view I think it's hugely important. Minister I really appreciate the fact that I understand this bill is not going to be contested, that you're not going to object to it and that's really important because it shows that you have similar concerns to the concerns our group has and when Senator McDool drew up this bill it was about the children, it was about the families, it was never going to be a political thing. I abhor the notion that ministers be kicked all over the place purely because something under their area of responsibility didn't work. We should never get to that stage. We should hold the people accountable on the coalface, the people that are wrong in this and I heard you speak about the need to have weekend cover in hospitals and things like that. You clearly have some very strong views as to how to fix things within the health service and I really applaud you for that. I think it's wonderful that you've taken that stand. What I would like to see now is that on the scoliosis issue we use this bill to ring fence scoliosis as a condition that can be looked after under the bill. I think Senator McDool, I missed the opening part of his debate but I think he will probably have adverted to the fact that scoliosis is not just children. Children grow into adults and adults develop problems as they grow older. So those who are diagnosed with scoliosis will have to live with it all their lives and there will be constant visits back to clinicians. There will be constant issues that have to be dealt with and any of these chronic conditions it means that there is a commitment from the state to look after you from day one. And the problem is I remember one time when I was president of the union one of the officials in the union says to me we've only to put up with you for a year and somebody else will take over. There might be a certain amount of that within our public service. Next election he or she will be gone and somebody else will have to deal with it and that's why it's important that the legislation is there to tie down this regardless of who is the minister in the position at the end of the day. So I could go around in circles all afternoon I'm not going to do that. I thank you for your time. I do believe you are a seriously committed minister and I do believe that you have your eye on the targets that you want to meet and any way we can support that we would like to do that but I really do want to see this bill pass into law. Thank you.