Jennifer Carroll MacNeill
Dún Laoghaire · Fine Gael · Ireland
“It will be provided by a registered pharmacist in accordance with the relevant pharmacy legislation, including this Bill. Section 2 of the Bill makes various amendments to the Irish Medicines Board Act and the Pharmacy Act. Those amendments ensure that whole legislative framework is cross-referenced correctly.”
“We now have a common conditions service where you can go to a pharmacy instead of a GP to get a diagnosis and prescription for eight basic conditions like conjunctivitis or urinary tract infections - the kind of things that just come up in people's lives all the time. We would like to expand more and more what pharmacies can do.”
“In particular, the board will be focusing on aspects of menstrual health, on aspects of postpartum mental health, particularly in traumatic birth cases, on something we have overlooked for some time, which is endometriosis, on women who are finding it difficult to access services in different ways, as Senator Harmon suggested, and on more…”
“The extension to 41- to 45-year-olds could possibly be €5 million to €8 million because there are statistically fewer women in that bracket trying to conceive, so the numbers are higher. It really is a question of funding. I remind Senators that they have also asked me to fund various other programmes.”
“That followed confirmation from the Pharmaceutical Society of Ireland and the Health Products Regulatory Authority that the patch and ring are classified as medicinal products, not medical devices. That is just a correction there.”
“That is why we have put so much money into supporting them in different ways, including the conclusion of a €50 million increase to their fees and to provide for the opportunity to raise private funds in this way, for example, the common conditions service. I want to see pharmacists doing more.”
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“There are nine HSE rapid access symptomatic breast disease clinics nationally, as the Deputy knows. The HSE has set a target of 95% of urgent referrals being seen within ten working days. Non-urgent referrals should be seen within 12 weeks. The HSE national cancer control programme monitors the performance of these clinics. Last year, national compliance with targets was 76% for urgent and non-urgent referrals but I recognise the variations the Deputy described. While five centres generally met or exceeded the targets during the year, four did not. This is often caused by staff shortages or problems in accessing diagnostics or radiology services. These clinics consistently operate at full capacity. Unfortunately, any disruption to services can lead to a backlog, which can take time to clear.”
“These sorts of incentives or opportunities are precisely what I am trying to identify, along with variations across hospitals or specialisms within hospitals, which is also important. I want to find ways to make sure that we are not permitting those incentives and there is a standardised approach that we can stand over and thereby reduce our dependence on such a system.”
“The Deputy raised the issue I am concerned about, namely that there are incentives to be under productive during the working week with a view to, or which have the outcome of, very busy clinics on Saturdays or bank holiday Mondays. That is exactly the sort of incentive I need to see stop. I cannot speak to the relative activity because I do not have that data. The Deputy's example is precisely the sort of example that prompted me to conduct the work on insourcing. I wish I was a couple of weeks ahead and had the data and could give her a better answer, but I will have the information during the next Priority Questions session. The Deputy is highlighting exactly what I might be concerned about. To be fair, Saturday clinics and the NTPF meet those who have waited the longest and there is a need for that work, as she acknowledged.”
“Rather, patients are referred to the system and will then be allocated an appointment according to capacity rather than an individual consultant having the capacity to manage their lists or patients in a way that is unhelpful.”
“It is an excellent question. It is exactly what I have asked Bernard Gloster to do. Of course, I have to wait for the report to be able to express my confidence in the quality of the work that has come back. The Deputy may take that as a reference example. As I said my opening reply, if there was underutilised capacity, that is, as the report states, other people in the hospital could have held surgeries at an earlier period but did not due to the waiting list management process, that is very serious. In advance of receiving the insourcing report, we have mandated a centralised referral mechanism so that if someone is referred to surgery, they are not referred to Jennifer, Sorca or whoever.”
“Under the MOU, the public hospital confirms that any such work is additional work over and above core hospital activity and is specifically carried out to reduce waiting lists. In early April I requested that the HSE CEO initiate a detailed survey of all insourcing activity within the HSE to include activity funded directly by the hospital concerned and by the NTPF. The review is being co-ordinated through his office, assisted by finance, internal audit, HR and access and integration functions. The outcome of this review is expected shortly and will determine the appropriate next steps. We need to move away from this model by maximising internal underutilised capacity, whilst at the same time not negatively impact on patient waiting times and outcomes.”
“The Government remains committed to increasing capacity in the public system. The commitment is underpinned by unparalleled levels of investment as we move to universal access to health care. However, until the capacity is in place to meet the increased levels of demand, it is necessary in the interim to make use of all available capacity in the public and private systems to ensure that patients have access to the care they need. The waiting list action plan 2025 includes targeting the delivery of additional capacity in the public and private systems through a co-ordinated approach by the HSE and the National Treatment Purchase Fund, NTPF. NTPF insourcing initiatives are governed by a memorandum of understanding, MOU, between the NTPF and the relevant public hospital.”
“It is very important that we have a focus on men's health, just as we have, correctly, had an emphasis on women's health. The funding is spread across a number of different streams. I will have to ask my officials to pull the information out for the Deputy and update him. I assure him this issue continues to be a priority for my Department.”
“I thank the Deputy. I recognise the extraordinary impact long Covid can have on people. It is my understanding that this scheme has been extended on a number of occasions and there is no proposal to extend it further. People are entitled to illness benefit but there is no proposal to extend the scheme further at this time.”
“I am aware of the issues relating to early access and of the need to provide a system to enable that. That is the most updated position that I have. I will be watching very closely and working with Deputy O'Sullivan, and Deputy Aird who has raised this in a different context.”
“I thank the Deputy for his ongoing engagement on this issue more broadly. He is right that the drug has been approved by the EMA. The next stage is that the drug company must make an application to the HSE. I checked this morning to see if that had happened. It has not happened yet. Perhaps it has happened in the period I have been in the House, but it had not happened when I checked. I will be watching it very closely. I have already spoken to the Secretary General of my Department and to the CEO of the HSE about this drug and the process it will go through. The Deputy is aware that we have increased capacity by 100% in managing the process within the HSE to make that faster. There are a number of Deputies in the House with a very strong interest in this.”
“With regard to the KPIs, my understanding is that the most recent data are available from September 2024. I can provide detailed information to the Senator in this regard, as that might be better. I thank Senators generally for their genuine focus on this matter. While we spend this time talking about breast cancer, we must equally consider people who are not getting lung cancer diagnoses for the absence of a screening programme, colorectal cancers and the range of other cancers that are important. We could have a similar debate about any one of those cancers. A point was made with regard to Donegal. Surgical capacity in Donegal is important. We want to see surgeons having the opportunity to continue to perfect and develop their craft in Letterkenny as much as anywhere else.”
“I recently funded a project through the women’s health fund to deliver education on how to be aware of symptoms, specifically targeting underserved populations. We are doing that in partnership with the Marie Keating Foundation, which is an important measure. I thank Senator Costello in particular for her range of different questions. I will follow up on every one of them to the extent I can. Some of her questions relate to clinically-based decisions, however, and I will need better information to respond to them. The Senator is quite right to highlight lymphedema, for example. There are approximately 2,000 people with chronic lymphedema in this State. Its risk is, as she said, ever present and important. While there are some clinical questions I cannot address, I will ensure she gets a proper answer to them.”
“Today, there are 185 working in the system and we have 43 training places, which is an increase of 5%. That is a really important investment that will make a difference in time. I am conscious Senators have raised the issue of people not attending for BreastCheck appointments. It does not sit well with me that almost 50% of appointments issued with a time and date for screening using a mammogram are not attended. Such a situation does not work. We do take steps to try to address do-not-attends across the health system. For example, the chronic disease management hub in Sligo has managed to make real progress with the number of people who fail to attend appointments. At the end of the day, people need to turn up to appointments and have the benefit of them. Focusing on the underserved populations is important.”
“Those experts tell me that most public population screening programmes like BreastCheck do not use breast density measurements but I recognise there are those that do. Let us get the scientific evidence and take the best steps forward while recognising there will be a cost, which we will have to address together. Recognising that, Senators will be aware the NDP review is coming up. I encourage Senators to contact their favourite Cabinet Ministers about investment for health infrastructure throughout the country, but that is a little shameless of me to say so. Of course I want to extend hospital infrastructure throughout the country. Nevertheless, there have been important budgetary supports that have enabled us to increase the number of consultant radiologists.”
“The recently updated European Commission initiative on breast cancer and European guidelines on breast cancer screening and diagnosis talk about the low certainty of evidence incorporating breast density measurements into population health screening programmes. It directly contrasts with the recommendation by the European Society for Breast Imaging, which recommends that women with extremely dense breast tissue be offered screening with breast MRI. We need to have a scientific reconciliation of those pieces of evidence. Thankfully, we remain in a democracy that does rely on experts. This work will take about 18 months and I ask for the Senators to support me in ensuring experts are given the opportunity to do that.”
“I do hear what Senators are saying, but I am a politician and I am not able to make a scientific decision on it no more than on the screening programme. As I may have mentioned before, during negotiations on the programme for Government, we considered extending the ages but realised that none of knew what we were talking about and should ask the actual people who knew what they were talking about. In the same way with the breast density issue, there is competing evidence at a European level about how that is best done. Breast density has gained greater attention and Senators have described how it appears on a mammogram. There are differences in international clinical perspectives on the effective integration of this in breast cancer screening, as I have said.”
“Let us not forget that there is a very significant cost element and we will have to deal with that on a different day in the form of Estimates and so on. We must strike the right balance when it comes to expansion. The programme has already been expanded to cover people aged 50 to 69 years, when it was formerly 64 years. We are conducting an assessment on how best to extend the programme. Is it 45 to 49 years or is it 70 to 74 years? There is also the breast density issue. That needs to be a scientific analysis. On the breast density piece, I am glad so many Senators have raised this issue and placed an important focus on that aspect. I thank Martha Lovett Cullen for her contribution to the debate today and recognise her very important words, on behalf of her mother.”
“They very clearly acknowledged the limitations of any screening programme. It is a screening programme, so it is never going to detect 100% of cases. They said to me that people must understand the balance whereby, if 99% of cases are picked up, then the screening is worthwhile. There are inherent known limitations to screening programmes, but that does not mean they are not of very considerable value in reducing an overall disease burden in a population generally. We must recognise that screening is not diagnostic. Also, even a screening programme at 99% excellence is going to miss things and there will be harms done. However, we know the evidence we have been able to pick up with screening programmes and the value they are in themselves. That is important, and so we try to think about the best way of extending screening programmes.”
“I thank Senators for giving me the opportunity to listen to them and I acknowledge the important issues they have raised. First and foremost, I again recognise the women and their families who are impacted. So many people in this room have either been impacted very directly and personally or have a close family member who has been. I am no different, so I recognise the importance of BreastCheck in diagnosing breast cancer and the ongoing care it gives to women. I wish to state clearly that I have every confidence in the breast screening service and every interest in expanding it in ways that are scientifically appropriate. I want to first make sure the science is there and ensure expansion is based on science. On the screening programme, I visited Eccles Street where I spoke to the radiographers and radiologists.”
“We have these personalised, individualised treatment programmes that identify, manipulate and interrupt cancer in a very different way. I was hugely encouraged to see that. I know Senators have more contributions, so I will finish.”
“In budget 2025, an additional €23 million was secured for the national cancer strategy. The Government has invested more than €230 million in additional funding for cancer services since 2017. However, the benefit is seen in the number of patients who are surviving a cancer diagnosis. When the strategy was published in 2017, that figure was 150,000. Today, it is 220,000 and that, of course, is 220,000 people in our families and communities who are surviving cancer better. Behind every one of those numbers is an individual whose cancer is unique and very deeply personal, and they really do deserve the very best care. What I am encouraged about is that the treatment has become so very personal. I really learned that in the research institute in County Galway.”
“A donation of €4 million was made to it by community fundraising right across the west to support breast cancer research, building on the already significant investment in place. However, it is very widely accepted that we have to do more to support clinical trials. The national clinical trials oversight group is identifying some challenges and formatting solutions to increase the number of clinical trials, and I expect its final draft report in the coming months. I want to see greater access to clinical trials. I want to be very clear about that. Since 1996, our national cancer strategies have been shaping and informing cancer controls. We have seen sustained investment and very clear strategic direction. The centres of excellence model has worked in large part, but we want to make sure treatment is available as locally as it can be.”
“We have also introduced an application tracker, administered by the HSE, to increase transparency in the medicines assessment process. On the one hand, this is for the HSE to do well, but it is also for the drug companies to do well. A bit like financial services and the Central Bank, both parties have to submit things on time and keep up with the process. I will be monitoring this matter closely. Alongside improved detection and treatment, we must really drive more on clinical trials. Last month, I was delighted to officially launch a new phase of the philanthropic partnership between the University of Galway and the National Breast Cancer Research Institute, which is an extraordinary place doing extraordinary research.”
“The HSE approved reimbursement for 74 drugs for cancer treatment between 2021 and 2024. Our budget for that has been €645 million, which is significant. Since 2022, eight drugs for breast cancer alone have been approved for treatment of early and late stages of the disease as well different types of the disease. However, I recognise that we want to have these drugs, where appropriate, approved at a faster pace. The HSE recently recruited 34 additional staff to the pricing and reimbursement process. It is important to recognise that this is a 100% increase on the number of people there, which is a significant expansion. Of course, it is my job to ensure that the HSE's processes are such that it is using these additional resources in an effective and efficient way.”
“The referral guidelines provide a clear pathway to patients of all ages with suspected breast cancer to attend symptomatic breast disease clinics. Approximately 45,000 women are seen in these clinics every year and the clinics detect approximately two thirds of all breast cancers, with the other third being detected in the screening clinics. Attendance at these clinics is very high and, for many reasons, I do not want to see delays. The HSE maintains a suite of clinical guidelines for cancer. Just last month, we launched the update to the HSE's clinical guidelines for the diagnosis and staging of breast cancer. This is all fine but we must ensure that we have the medicine for people who need it. New medicines have played an important role in improving the outcomes for cancer patients.”
“We have continued to expand the national screening service with an additional €2.9 million allocated to the BreastCheck programme this year. This will recruit an extra 22 whole-time-equivalent positions, mostly radiographers. That is in addition to the current 79 radiographers, so it is a significant expansion. These will be staff like the radiographers and radiologists I met recently on Eccles Street when I visited the BreastCheck clinic there to celebrate 25 years of BreastCheck, and the staff in the Merrion centre, Cork and Galway. This important funding will help to expand capacity and deal with some of the waiting list issues that have existed for a time. Our nine symptomatic breast disease clinics are important for breast cancer diagnosis. The GP referral guidelines are also important. I believe the Senators will raise this issue.”
“This is a particularly important review because we have two competing pieces of scientific information, one from the European Commission initiative on breast cancer and, in contrast, one from the European Society of Breast Imaging. They take slightly different perspectives on the science, so we must ensure we are making an evidence-based scientific decision. It is important to say that the NSAC is asking HIQA to look at the scientific evidence for the expansion of the programme. Work is definitely expected to start by October but I am told potentially as early as next month. I expect the review will take approximately 18 months. It is an important scientific base for what we do next, and, of course, that is how we like to do things.”
“Some 625,000 women are eligible for this screening programme and this figure has grown by 19% in six years, which is a significant expansion. The programme detects early-stage cancers, which are the ones capable of being treated the best. BreastCheck is currently inviting women aged between 50 and 69 years to have a mammogram at regular intervals. Senators will be aware that we are trying to expand the programme and are asking the national screening advisory committee, which is independent, for the best evidence as to how best to do so. The question is whether it would be best to base the expansion on age or the very important issue of breast density measurement.”
“While our overall five-year survival rate is now 88%, far too many women still die from breast cancer. It is important to reflect on the comparative figures. Our survival rates have improved to 88% for those diagnosed between 2014 and 2018. That is an important increase. Prior to that, for the period 2010 to 2014, it was 82%. We need to do more to continue this process of improvement, though. The programme for Government sets out several priority areas for improving cancer services, including the continued expansion of cancer screening programmes, improving access to medication and supporting survivorship and research programmes for all cancer patients. Starting with the BreastCheck screening programme, which we all know to be fantastic, it has done 2.6 million mammograms and identified 18,000 cancers in total.”
“I thank the Acting Chair. I have a lot to get through. I thank Senators for inviting me to the House to discuss this important topic. I was here in March to speak about women's health on International Women's Day. Breast cancer was raised by several Senators then and many have raised it continually since. As Senators are aware, approximately 3,600 women are diagnosed with breast cancer every year, making it the most common cancer among women in Ireland. One in seven women receive a breast cancer diagnosis in their lifetime. For example, in 2024, 9,000 people began chemotherapy treatment for cancer, 85% of whom were within the 15-day target, and 6,500 began radiation treatment, 75% of whom were within the 15-day target. It is a significant cancer in Ireland.”
“I was aware of the briefing and was sorry I was not able to attend yesterday on an otherwise busy day. As the Deputy is aware, the process for processing, authorising and reimbursing drugs is managed by the HSE, which considers all of the different factors involved, including the European position and the effectiveness and broader reach of a drug at a given time. I will examine the case raised by the Deputy. I know the circumstances he has mentioned and perhaps we can speak about the matter again more directly.”
“It has caused enormous worry to many parents who thought they were taking the right steps on behalf of their children in a properly governed, properly functional system with professional consultants making correct decisions. I want that other perspective also to be heard clearly. Ministers of State have articulated it. Deputies on both sides of the House have articulated it. We do so as a collective and I wanted to take the time to make sure it was done by me as well.”
“The responsibility parents take upon themselves to follow clinical advice and the lack of alternative information available to them is like a Chinese sign being on the wall and the doctor the only person who can read Chinese. People have no choice in many ways but to follow the guidance. The responsibility a clinician holds is enormous and where it has been used in a way that is wrong, it is problematic, but where it is used in a way that is casually wrong and has implications for the small bodies of small children is unconscionable. I wanted to take the time to say that, so my response is not removed from the feeling of these things and overly focused on the executive response, which is appropriate and necessary. It is important that I am held accountable, but I wanted to take the opportunity to recognise that this is deeply hurtful.”
“While I have tried to answer as many questions as I can on this report, I appreciate that I have spoken for almost 25 minutes between the beginning and the end of the debate in a very governance-focused, executive way, trying to answer the questions that were rightly asked and to set a direction of policy change and accountability. I will use my last two minutes to just speak about it as a public representative. In the same way as others have very personal concerns about what has happened, I am aware of the impact of surgeries that were not warranted being done on children. I am aware of the feeling parents will have had when they heard that a surgery was warranted and made a decision either to have it or not have it as the case may be.”
“However, it is also important that we use the levers we have to address the waiting lists where we can because that means our constituents, our people, getting operations today instead of some other time, while we all go on this transition together. I am an advocate of a public healthcare system. There is no advantage to having insurance in the paediatric system in particular and I do not want to see hospitals asking people whether they have insurance ever again. It is not important or relevant in a public hospital. I wanted to clarify that in case it needed clarification.”
“However, let us perhaps get the Nayagam report and then reflect on how to think about the mechanism for that as well. On the public-private system more broadly, I want it to be clear that I am an advocate of the public health system. If people want to have private health insurance and go to private hospitals, they are welcome to do so. This is a free country. However, I am a Minister trying to implement a public system with no other interest in it. I am an advocate of the full implementation of the public-only consultant contract. I will be taking further steps to remove the perverse incentives, or whatever people want to call them, that feature today because of the overhanging mix of public and private activity. I will not be dissuaded from that. That is important.”
“The question of why has come up in a range of ways, with regard to motive and financial issues. There is a range of questions. The straight answer is that I do not know the answer to that at this point, nor was it investigated in the clinical audit, although it is an exceptionally important question, as the Taoiseach articulated this morning. I would like to take steps to reflect on how we might get to the bottom of it, recognising that it is important that we also get the Nayagam report, which is linked to these different issues within orthopaedic surgery. Perhaps Deputies would allow me to get that report also and then reflect on those questions about motivation and how we might get better answers about it. I am not discounting anything about motivation and I am always interested in hearing Deputies' perspectives on it.”
“There are good reasons for this but I wonder about the interplay over time and it is something the House should reflect on more broadly. To answer a question asked by Deputy Rice, it is the case that explanations were advanced by surgeons which were discounted by the auditor. It is, therefore, the case that surgeons were contesting, at least within the audit process, the findings and advancing alternative explanations, which did not stand up. I am not aware of legal proceedings but this does not mean they will not be taken. In relation to trust in the running of CHI more broadly, I have said clearly, and let me say again, this is something I am looking at in the round. There is a way to go on this and I will work with Deputies, particularly those on the health committee, on this.”
“Even if we think about the circumstances relating to Limerick, where the CEO of the HSE took various steps against people working in the healthcare system, those issues went through a court process. That is well publicised. This is with regard to even taking those different steps. There is an imbalance with regard to the fair procedures individuals have the protection of in all cases, not only in the criminal process but in employment law processes and other accountability processes. This is with regard to the balance of protection given to the individual and their fair procedures, which are constitutional protections, versus the balance of the broad public good and getting information out there. We have to go through fair processes and behave in the correct way.”
“I recognise the limitations with the phone line. It really was an effort to provide some answers to people over the weekend. The people answering those questions do not have any more information than I do. It was an initial signposting opportunity to have a clinical ear for parents at the earliest stage over the weekend, rather than leaving them in total silence. Other questions have been raised regarding the accountability and the why. Many different questions have been asked on this. My broad view on accountability in relation to the individual clinicians is that there really are two mechanisms available for it. These are within the employment law structure and within the professional registration regulations. I do not have the capacity to fire a consultant in any context.”
“I appreciate there are different perspectives on when I should have commissioned it but having received the report it is very important to get the recommendations and act on them expeditiously. I appreciate some Deputies would have taken a different approach. That is as may be; the important thing is that it is done as quickly as possible. On the letter from Cappagh, I have confirmed with the CEO of the HSE that it went to approximately 20 people. It was the same group but for a different reason. It is slightly different. The letters have not yet issued, either to Cappagh or anywhere else, as I understand it. To be clear, those parents got a call this morning to say they could, of course, bring both parents or additional guardians or whatever else. That is something slightly different and not related to this.”
“While we are prioritising this, the follow up and the care is most important. Let me say several things. I completely respect that parents should not have to walk into a hospital where they have had, or feel they have had or worry they have had, a negative experience. We need to provide follow up but there has to be a measure of flexibility in it. I will discuss this with the HSE and CHI. I do not expect parents to have to go back to the same clinician or go through the same process. This will require us to have more flexibility. Deputies also referenced the impact on service delivery, which has to be taken into account. We have a finite number of healthcare professionals. We are trying to grow more. There is an interplay between these different things. The other expert review panel necessarily must be independent and external.”
“I have a transitional model of care for those aged 16, 17 and 18 who are moving into adult care. I will discuss it with the CEO of the HSE. There is no desire to exclude and there never is. In relation to the age of seven brought up by two Deputies, this was a clinical audit of children between the ages of 12 months and seven years. It was designed to try to capture the experience between 2021 and 2023. Again, it does not seek to exclude the other experience. It is about a clinical audit within these parameters. It is not limited to this. I have to be very clear it was an anonymised audit. I said this on Friday but please allow me to say again that there is no way a parent can ring up and ask whether their child was in the audit. I do not know and CHI does not know. By definition, it was an anonymised clinical audit.”
“I thank the Deputies for their questions and contributions. I will answer as many questions as I can and I can provide a further briefing for Deputies on a technical basis. I am very happy to come to the committee where we can do more back and forth. It is important Deputies have the opportunity to contribute in the House and, as I always try to do, I will answer as many questions as I possibly can, recognising there is some duplication in those questions. With regard to the questions on 2010, it is simply on the point of skeletal maturity. This was the initial look back to account for the children who are still children. I do not think it should necessarily be cut off at that point but I do think we should prioritise the children first before people who are now adults.”
“I will consider further responses to the issues around waiting list management and the NTPF raised in the report. I have also asked the NTPF for its perspective. We are mandating centralised referral to all CHI surgical services in order that all GP referrals will be processed via a central system, enhancing transparency, equity and efficiency, with the aim of ensuring patients are cared for based on clinical need and to increase effective management of waiting lists. I tried to leave as much time as possible to take questions throughout. We will speak about this matter again very shortly at the Oireachtas committee.”
“That report was provided by CHI to the CEO of the HSE on Monday, 26 May, and I also received a copy from the HSE on the same day. Yesterday evening, I wrote to the board of CHI requesting a full response to the report. I wrote a detailed letter asking specific questions and I reserve the right to write further letters. I need to receive the response but, on its receipt, my officials will follow up to address outstanding risks or concerns where they still exist. In addition, the CEO of the HSE is commissioning an audit of governance and equity in patient access and waiting list management at CHI. The audit aims to assess governance and equity in access to care, especially regarding the balance between public and private patient management.”
“What this means is that consultants work to a clinical governance structure from which they take direction and to which they are accountable. Earlier today, I met with the Attorney General to discuss my next steps in relation to the board, clinical governance structures, broader governance issues and how CHI interfaces with the HSE, recognising that the HSE funds CHI. I will take a steady approach to this. I welcome all perspectives from Members of this House about the desirable outcome and the steps to get there while enabling the continued functioning of CHI. I want to facilitate the Minister of State, Deputy Murnane O'Connor, in contributing to the debate. While we are discussing hip dysplasia, it is very important that I update the House on an internal CHI report that was covered in the media on Sunday.”
“My appointments to date have signalled that direction. I have said, as I referenced previously in this House, for example, on 9 April, the day after the publication of the HIQA report, that I am open to looking at the governance of CHI in the round. I said that we need to have a functional system to be able to work towards the opening of the national children's hospital. I also said that I am open to looking at everything in the round, but that I would like to receive the other two reports first. Some weeks later, it is now clear that we have a very different board to the one that was there when I took office and, much more importantly, when these events occurred. Second, I have clearly said that I want to see an appropriate clinical governance structure.”
“At operational level, there will be a strengthening of the service level agreement between CHI and the HSE to strengthen operational oversight, and increased involvement and support from the Dublin and midlands region regional executive officer and senior management. That is designed to support the new CEO, Lucy Nugent, in CHI and enable her to continue with the transformation programme she has begun. Ms Nugent has been in post just since February and is in the process of establishing a new executive team around her to lead this next stage for CHI in the way we want to see it done. She reports to the board and needs a functional board to be able to function. It is in nobody's interests to move things too rapidly. There does need to be a functional board, although it is clear that I want it to move in a particular direction.”