A letter suggesting discussions around experimental spinal surgeries on children at Temple Street Hospital took place as far back as 2020 has been revealed in the Dáil by the Sinn Féin leader.

Mary Lou McDonald said the letter indicates that a meeting, which discussed this issue, was attended by clinicians and a representative from Children's Health Ireland (CHI).

Taoiseach Leo Varadkar said the letter puts a new complexion on things and he urged people not to jump to conclusions.

The letter adds a new dimension to this controversy, which was described in the Dáil as a national scandal.

However, the Taoiseach said it is not clear if the letter was ever sent and that its validity must be established along with all the facts.

But he said it did suggest that there was a level of knowledge at management level about the surgeries and in some cases it looks like parents consented to them.

Ms McDonald said it is now essential that the HSE and CHI have no hand, act or part in drafting the terms of reference for the review into these surgeries.

Mr Varadkar promised that those organisations would not write the terms of reference but they would be consulted.

He pledged too that the review would take account of the concerns of families.

Nineteen children had poor surgical outcomes following surgery at Temple Street. One of the 19 children later died.