First and foremost at the heart of this controversy over spinal operations are the children and families affected.
Three children were failed in the care they received and had unapproved spinal springs inserted.
Some have since had these removed.
It has shone a spotlight on the governance at Children's Health Ireland (CHI) in Temple Street University Hospital and the lack of clear lines of reporting and accountability.
This was acknowledged by Chairman of the CHI Board Dr Jim Browne who has announced his resignation.
The use of unapproved medical devices in surgery is a matter of major concern, especially without ethical approval.
Minister for Health Jennifer Carroll MacNeill said that the trust parents had put in clinicians to treat their very sick children had been breached and they were not protected from the risk of harm.
Children's Health Ireland has apologised to the parents and families for the failings in the report.
Lessons must be learned from these events, especially as Temple Street and CHI prepare to move next year to the new National Children's Hospital.
CHI cares for over 200,000 children and young people every year.
It was a concern that the HIQA report found that there were opportunities for CHI to be more proactive in the ongoing care and support of affected children and their families.
Some had to go to the High Court to secure full medical records.
The report does acknowledge that Surgeon A was well-intentioned.
He also was facing long waiting lists and spinal surgery and scoliosis have been major issues on the health agenda.
This story has not yet fully played out and there are other reviews under way yet to be published relating to Temple Street.
CHI has said that issues of poor performance and non-compliance with policies are being addressed with the staff involved.
CHI is a HSE funded entity and it has said it will also be seeking oversight of how CHI approaches the recommendations specific to them.
There are also recommendations specific to the HSE and the wider hospital system from this affair.
Read More:
Live: CHI chair resigns, apologises for spinal care failings
Key findings from HIQA spinal surgeries review
Children 'not protected from risk' in spinal surgeries
HIQA report into spinal surgeries 'devastating' - SF
