Analysis – State Failures: Letterheads and Waiting Lists and Silence

By Pádraig Ó Meiscill. Originally published in The Ditch's State Failures.

In September 2023, I wrote the first story about the use of non-medical grade springs in surgical implants at Temple Street Children’s Hospital in Dublin, as well as broader concerns about care received by spinal patients there. Some reflections.

The doubt can get to you with a story like this. Can’t be happening, no way. Then you talk to the manufacturer, who mentions “park benches”, to let you know what some of their products are used for, to give an idea of the type of springs they produce for the market. Even when the story is published, when you’re prepared to stand over every word, when the HSE steps in and releases a statement that amounts to, Yeah, okay, it’s a bit of a nightmare, a part of your mind still goes, Neah, not here. You spend hours talking to someone with decades of experience in medical devices and their regulation and they’re adamant with you.“Nothing like this has happened in Europe since the Second World War.”

You’ve spent months talking to concerned staff, people with a lot of experience in a lot of different hospitals, who tell you that they can’t sleep at night for thinking of the “insanity” they’ve seen at Temple Street. Still, you think, Can’t be, though. There can’t be a health service in this country that would allow this to happen. 

Then you remember Gabriel Scally. 

In November 2022, at the publication of his report into the CervicalCheck scandal, Dr Scally said there was “unfinished business” and “serious work” to be done in creating a policy of open disclosure in Irish healthcare. 

Not long after I submitted my first freedom of information requests to Children’s Health Ireland on practice at Temple Street, Dr Scally was in the Radisson Royal Hotel in Dublin saying he was “astounded” there is a legal prohibition against making complaints to the HSE about doctors’ clinical decisions.

Weeks later, Children’s Health Ireland sent what might as well have been a blanket no comment to my first set of questions on Temple Street, beginning a pattern of stonewalling that has continued right up to the present. Most recently, they’ve refused to answer a simple question on why some consultants working out of the private clinic based in Temple Street insist on cash-only payments. 

You remember that your name and address were doing the rounds in the hospital days after you made your first requests under freedom of information, that someone had set up an email account in your name to contact doctors at their personal addresses, presumably to see who might break ranks. 

Parents and advocacy groups such as the Scoliosis Advocacy Network are also demanding answers from Temple Street. They want access to the levers of power; they’re sick of this painful, imposed observer status; they want some influence over the things that afflict them.

The families – these people who know most intimately the suffering and the waiting – are wary of the new inquiry into the Temple Street scandal. They want to see the terms of reference; they want their knowledge and experience acknowledged. They have been failed twice by the state – in its promise not to leave their children languishing on waiting lists and in its duty of care once they entered the healthcare system. They don’t want to be failed a third time.

This sounds like a reasonable ask, but when the team from Boston led by Dr Daniel Hedequist were appointed to do the first external review earlier this year, affected families were denied the right to participate. They were instead told they could make submissions through an appointed advocate. So, when the team from Boston arrived in May to conduct their enquiries, there were parents, experts in their field, who didn’t even get a phone call.  

Solicitor Caoimhe Haughey, who represents some of the families battling for full disclosure from Children’s Health Ireland, says, “The health service fails the most vulnerable, the most marginalised and those with little means or chance of holding them to account.”

Having previously represented many of the women failed in the CervicalCheck scandal, Haughey knows what she is talking about. “Delay, deny, defend,” is how she describes what HSE decision makers do when they’re caught.  

“Ministers come and go, but the culture doesn’t change from one minister to the next. It’s only when a case gets a massive amount of media coverage that something is seen to be done – but even then, what of substance actually is done?”

Power – the ability to do things with people’s lives, shape the course of them with relative impunity – works in many ways. It can be subtle and delicate in its practice as often as it can be vicious, but the impact on the powerless is, regardless, often brutal. 

We’re accustomed to thinking of power as something that comes out of the barrel of a gun or from the open doors of a bomber jet, but that is power in crisis or power in its ascent. When it has settled into its routine, feels unthreatened, sure of itself, power expresses itself through letterheads and waiting lists and silence.

'The legacy of not asking tough questions of our presumed betters has damaged us'

Ask anyone who has suffered from the failings of the health service in Ireland how they fared when they tried to mount a challenge. Talk to anybody – parents, solicitors, concerned staff, campaigners – attempting to get to the truth of the latest scandal, this time at Children’s Health Ireland, and they all agree on one thing, that the people who wield power at Temple Street are looking to protect themselves.

“They’re closing ranks in the face of the patients and their parents,” says one father. Concerned staff in Temple Street agree. 

“There’s no one more exhausted than the family of a disabled child – and management are counting on this,” says a staff member. “As far as they’re concerned, all the sensational stuff has come out, so they can dig in now and count on the public getting bored and the families getting weary to the point where they’ll just accept whatever they’re given.”

When the advocacy groups managed to secure a meeting with the taoiseach and the health minister at the end of September, it was they who had to insist that the meeting be minuted. Six weeks later, they were still waiting for those minutes to be produced. 

“To be honest, I think they don’t know what to do with us or the situation, so they’re ignoring us and hoping we will get bored,” says parent and campaigner Úna Keightley, who was at the September meeting. “If they give us a taskforce, they are admitting defeat because the only way to solve this and get the 325 kids waiting on their surgeries is to send probably half abroad. That will be totally embarrassing for them. So they are hoping they can kick the can down the road but that won’t work. Some of the kids are really sick and they don’t have time to wait and we know this and parents know this.”

Something approaching an allergic reaction takes place when people in the upper stratum of Irish society are asked to account for themselves. A class that earned its place through generations of deference to imperial power made sure they could replicate that arrangement when they gained control of the new Irish state. Since the establishment of that state, we’ve been suffering from a colonial hangover, never able to shake off the fear that comes from supping the slops doled out by the resident publican/politician/undertaker. 

On Temple Street, the injustice crystallises around who has the right to know what and when. Since September, families have been fighting for access to their own children’s medical files, often having to take the battle into court, sometimes to the ire of judges. 

Parents have been agonising over whether to bring solicitors to their appointments with their children’s consultants. Some are trying to raise the money to get second opinions in Britain. They weigh up their words carefully, anxious about what to say, to whom and when, terrified that putting themselves out there too forcefully could lead to further failings in care. 

Again, you doubt what you’re hearing. Children’s Health Ireland is staffed by doctors and nurses of experience who care about the children they are treating, so how could anything a parent says affect their child’s care? 

But this story isn’t about the commitment of countless nurses and doctors, it’s about a system that often doesn’t even notice when the vulnerable are failed and that regards any questioning of its conduct as an attack on its right to know best. The parents’ fears are more than reasonable because of these failings in practice, safeguarding and accountability that have occurred over decades and the lack of evidence that any reflection has taken place. 

What then does the Temple Street scandal say about us? It says that we’re dysfunctional. That we haven’t yet managed to pull ourselves together into a society that respects itself. The legacy of not asking tough questions of our presumed betters has damaged us. But we’re not a lost cause, not yet anyway.

“It’s not money we’re talking about here, it’s kids’ health. It’s not some grey area like RTÉ, it’s not Ryan Tubridy and The Late, Late Show – people instinctively side with the sick kid,” says one parent of the public reaction he has witnessed since the revelations of September.  

“People ask of authority, What the fuck are you doing like? That’s why I, maybe naïvely, believe the truth will out this time.”

Pádraig Ó Meiscill writes on current affairs. His work has featured in, among other publications, Red Pepper and the Irish News. More of his work can be read on Substack.

Pádraig Ó Meiscill

Pádraig Ó Meiscill