Victor Boyhan demands external review of HSE scoliosis report
Victor Boyhan spoke at committee stage on a bill to establish a specialised treatment service for inpatient and outpatient care for children and adults with spinal scoliosis. He argued for stronger, validated waiting‑time data, a legislative role for the National Treatment Purchase Fund, and an external review of an HSE internal audit report that flagged capacity and accountability concerns.
Bill overview
The bill seeks to impose duties and powers on the Health Service Executive to establish a specialised treatment service for the inpatient and outpatient treatment of children and adults with spinal scoliosis resident in the state, and to confer related duties and powers on the minister. Boyhan emphasised that the discussion should remain focused on section one at this committee stage.
Call for data and accountability
Boyhan highlighted acute waiting lists and the need for exact, validated data on the number of children waiting four months or more for scoliosis treatment. He proposed a legislative role for the National Treatment Purchase Fund in recording and reporting procedures and waiting times, and pressed for greater accountability over a reported 19 million that he said required explanation.
Concerns over HSE internal audit report
Boyhan drew attention to an HSE internal audit report that he said raised multiple issues, including risks and mitigation factors noted on page 57 and reputational risk to the CHI owing to media and advocacy interest. He said he would not be satisfied with the internal report as it stands and urged consideration of an external review and follow-up on its findings.
Operational issues flagged
He identified operational problems cited in the report and the debate, including international outsourcing, ring‑fencing of beds, theatre availability, MRI capacity and unused MRI infrastructure, and staff shortages. Boyhan said these issues require clearer, exact information to address service shortfalls for scoliosis patients.
Next steps urged
Boyhan welcomed the incoming minister for health and expressed confidence in their capability while calling for immediate engagement with the National Treatment Purchase Fund and a rigorous follow‑up on the audit findings. He said the committee should prioritise validated waiting‑time data, legislative clarity on the Fund's role, and an external review of the audit to restore confidence and improve service delivery for scoliosis patients.
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Firstly, I want to take this opportunity, I think it is the first I have been in the House since the Minister for Health has taken up her position in health, and to wish you well. I know for some time you are my local TD, so I see you on the coalface in our own constituency and the work you do. I want to genuinely wish you well, I think you are the right person, you have the tenacity, the commitment and the absolute intelligence and political noose that I believe is necessary for the like of taking on this task. I think just to put the context for those who are joining us who weren't here in the last channel, before I concentrate and specifically stay on the section one, our bill, as I say, seeks to impose on the health service executive certain special duties and powers in relation to the establishment of a specialised treatment service for the inpatient and outpatient treatment of children and adults with spinal scoliosis who are resident in the state and to confer certain duties and powers on the Minister for Health in relation to the service to be established and to provide for related matters. It is a joint initiative by the Shandity Independent Group. I am very conscious this is committee stage and I want to stay really focused in on section one which is the section that we are dealing with now. But I think it is important, just to put a few pointers here, I think Senator McDougall said, right, this bill should not have been really necessary, Minister. A certain turn of events precipitated this and brought it on and we had a very, very robust engagement with her predecessor, of which I think there were more questions than answers asked and the 19 million was one aspect of it and I suppose at the very outset I want to say I am a former director of the National Treatment Purchase Fund, having served two terms on its board and therefore know very, know the workings of the National Treatment Purchase Fund, although things have always moved and it is an evolving situation there. But I suppose I just want to say there are acute waiting lists showing that all, we need an acute waiting list, I think that is the problem. We need exact data, validated data on a very regular basis in relation to the amount of children that are waiting four months or more for scoliosis treatment. There is a role for the National Treatment Purchase Fund in relation to the recording and reporting on sets of data, in relation to a whole range of waiting systems and I don't know Minister if you have yet had time to meet with them but they do have a function and they do have a role and are slightly removed from the department but fully under your remit I accept and acknowledge. But I think they have a proven track record in terms and expertise in maintaining data and there is a confidence in the data that they put out there and of course that is in collaboration with the providers of the service and your department. So I think central to what we are proposing there should be a legislative role for the National Treatment Purchase Fund to account in its recording of other procedures and waiting times within the health service. And I think there is a role for the National Treatment Purchase in tackling this problem. I think the international outsourcing is an issue. The ring fencing of beds clearly is something we need more information, exact information on. Because I think one of the problems is the lack of clarity on issues like the ring fencing of beds, like the availability of theatres, like MRI capacity. And I read in this report, this auditor's report that Senator McDougall is referring to that was actually signed off on the 18th of October 2024 but wasn't published until December 2024, which is an interesting timeframe when you look at the political background and landscape at the time. And I don't know the delay from October to December, but anyway, this report is now in our hands. And it raised a number of issues. And I think this, I might add, this is a HSE internal audit report. And given having just a general look at this only today, I'd certainly be looking at this again, Minister. I'd be asking you to consider, there needs a follow-up in relation to some of the issues in relation to this report. And I draw particularly your attention to the issues in terms of the risks and mitigation factors that are set out on page 57 of the report. And it talks a lot about reputational risks to the CHI owing to the interest of the media and advocacy groups. So that's a concern. So this report is concerned about what the media might think of them. And they say this, you know, in this section, reputational risk of the CHI owing to the interest from media and advocacy groups. And that's one of a number of issues. So we need to look at the risks of mitigation. I, if I was Minister, wouldn't be satisfied with this report. I think this warrants an external review. This is an internal HSE report. And certainly it's something that I'd be referring. It clearly has a status in relation to each of the risks and each of the mitigations. And I would draw our members' attention to this very detailed report. Because it also raises issues about MRI, having MRI facilities and infrastructure in place, but not put into use. And issues about shortage of staff. When we are at a time of crisis, and I don't want to spend too much of this part of our report going through drama, as Senator Michael McDool says, we have a problem. I don't doubt your commitment, by the way, Minister, here at all. And I think it's great that someone afresh is coming into this. But we need to look at that. We need greater accountability in relation to the 19 million that the Minister told us, as a result of questioning by Senator McDool and Senator Clonan, that there was an issue of 19 million swilling around somewhere, but no one quite knew where it was spent. I presume it was spent within the health budget or the health envelope. But again, we need reassurances on that. You need reassurances as the Minister has taken on these problems. We need also to look at the programme in terms of works, the capacity for Temple Street Hospital, Crumlin Hospital, Carpaw Hospital, Black Rock Health. And again, that very much relates to the central core of this bill, which is really covered off in section one. And so I think the issue is the task force. Minister you were given a brief as coming into a Minister, in briefing. And I have had a look at it. And embedded in all of that is the suggestion, this is a brief that was presented to you in taking your office as Minister for Health, that the task force would possibly be winding down to be a new mechanism in place. So I am talking about the work, the task force of Mark Connacht and Senior Counsel. Well, that is what is in your brief. But again, I have only read that. Now clearly, you are a Minister that I have high expectation for. I am glad that you signalled that it won't be happening. But that was put by officials in your department on your desk and I really would be interested and I am greatly encouraged by your firm nod there in relation to that because I think that is really interesting. But that is what the officials in your department, so it raises questions about the relationship between the Department of Health and the HSE and indeed the then Minister, the then Minister. But you are the new Minister, I have high hopes for you. So I think we would like to hear more about it. That document in itself and that briefing document is fairly challenging for you Minister, but this isn't the day to go through that and we will have another opportunity to talk about that. So we are on the issue of availability for nurses, the availability of theatres, the resources that are required, the validation of the waiting lists and it goes back to that central theme in our legislation, proposed legislation is the role for the National Treatment Purchase Fund. And I think that is a good model. It works. I want to see on a monthly and quarterly basis the figures for the National Treatment Purchase Fund and how is that. I rang the National Treatment Purchase Fund, don't forget I told you I was a director twice there and I spoke to an official there today and they said they didn't really have a formal role in all of this. They described the Minister as having made arrangements in the UK and of course in New York, in the the Morgan Stanley Children's Hospital in New York and of course the Great Ormond Street in the hospital. I don't like informal arrangements and they refer to 16 patients who receive surgery. I understand again from briefings I read from a number of sources, reliable sources, that there are plans to continue that practice. And one has to ask for the moment and I accept that and Minister you might just touch on that because again it is about accountability, it is about transparency. It is about communication, it is about engaging with the patients, the children. That is really an important part and their parents and their guardians because there is an information deficit in that. And I suppose I just want to touch on just two or three issues Minister. I think we have problems. The task force I think is really important and I had hoped that the task force would stay in place. Had I known what I know today having read the brief that you were given as Minister that there was now going to be a question by your department about the task force, I would have been adding or we would have been adding additional amendments here to this legislation. So it is going to be helpful what you might say and what you might share with us on that. Look Minister, we want to get on with it. But it is important that we are going to learn. We have to analyse the past, the mistakes that were made. We have to increase capacity. We have to address the risks and mitigation that are in the audit report that is before you. And I finish by saying this, I want you to look at that report, I would respectfully ask you to look again at that HSE internal audit report. I think there is a lot of questions there and I think it may warrant, but that is a matter for you, it may warrant a referral to a more specialised second look or an external look. But look, we are here to work with you, it is not about beating people up here, it is about making this arrangement, tackling these issues so we can address them for the people that are on these lists. Thank you.
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