Spotlight on CHI far from over after tense committee hearing
Today's appearance by Children's Health Ireland before the Joint Oireachtas Committee on Health was a very tense and difficult affair.
For the committee members, it left many questions unanswered, along with a sense of disbelief about the scale and gravity of events that have unfolded for children and parents.
Committee chairperson Padraig Rice, of the Social Democrats, set the scene by saying he struggled to know where to start, noting that they could be there for days at the hearing.
Some believed that all confidence in the CHI Board and management was now gone.
There remain big questions about the ability of CHI to move to the new National Children's Hospital next year against this background.
CHI has a lot of work to do to regain the trust of parents, the public and the political system, and it will likely be back before this committee soon for continuing scrutiny.
Former CHI Chief Executive Eilish Hardiman expressed "heartfelt" sympathy for what actually happened. Committee members pointed out that the main events occurred on her watch.
She is the Strategic Programme Director at CHI, and will have a key role in the move to the new hospital.
The recently appointed Chief Executive Lucy Nugent apologised to families and promised to have CHI regain trust.
Senator Tom Clonan said the events were a scandal of international dimensions, accusing CHI of running a three-ring circus and of having a toxic and broken culture with abhorrent work practices.
Sinn Féin health spokesperson David Cullinane said that what was happening at CHI was frightening.
There were questions about why some patients referenced in the unpublished internal review in a range of specialties, may have been affected by a lack of timely intervention, and why CHI has not been in contact with parents to notify them of this potential issue.
Fine Gael TD Brian Brennan said it could all amount to one of the biggest medical malpractices in the history of the State.
No one is quite sure how and when it will all end.
Plus we learned of tension between the HSE and CHI, after claims that the HSE had been notified about the 2022 internal review report around that time.
But the HSE told the committee the first its CEO Bernard Gloster and the HSE Regional Executive Officer learned about it was last month.
CHI also took a different view to referring the report to An Garda Siochana, believing it did not meet the threshold for referral.
The HSE decided to refer it recently.
Another major report on spinal surgeries is due soon.
And just 60 children out of 1,800 who had hip surgeries since 2010 have been reviewed to date under a lookback programme, which is expected to take six months to complete.
There is a long and difficult road ahead for CHI, which has said there are no other live reports which are not in the public domain.
The committee heard that a new CHI Director of Operations started on 9 June and the deputy CEO will start on 7 July.
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Irish Times
15 hours ago
- Irish Times
Minister in the spotlight as health controversies intensify
'It is frightening, what was happening at CHI', Sinn Féin health spokesman David Cullinane said as politician after politician at the Oireachtas health committee tore strips off the embattled group that runs children's hospital services in Dublin. The hospital group knew it would be facing a rough day given the litany of contentious issues facing it: the implantation of unauthorised springs , allegations surrounding unnecessary hip operations , controversy over lengthy waiting lists for spinal surgery, an internal report identifying dysfunctional behaviour and a toxic culture in parts of CHI as well as concerns over whether National Treatment Purchase Fund (NTPF) money earmarked for reducing hospital waiting lists had been misused. As CHI was heading to the bear pit that is the committee room on Thursday, Minister for Health Jennifer Carroll MacNeill was on her way to a European health council meeting in Luxembourg. But she and her officials were keeping a close eye on proceedings as the Oireachtas committee heard directly from those running CHI for the first time. 'There is absolutely zero confidence in the CHI board, zero confidence in the management,' said Fianna Fáil TD Martin Daly. READ MORE He later maintained he was reflecting the feelings of colleagues in the Oireachtas. On the ministerial corridors at Leinster House, senior figures may not be frightened by events at CHI. But there is no doubt there are strong concerns that after five years of relative quiet – accompanied by unprecedented levels of investment – health scandals are once again dominating the agenda. How all this is handled will be a big test for Carroll MacNeill in her first term as a senior Minister. Initially she was seen as one of the better performers in the Cabinet. But a number of figures in Government point out that in recent weeks things seem to be boiling over on a number of fronts. There is a clear sense within Government that the aggregate effect of the series of controversies represents an important moment and a shift in gears for Carroll MacNeill's ministerial career. 'It is a huge test for her, a huge challenge,' one source said, adding there were nascent concerns about keeping the centre of Government informed as the controversies develop. 'While she is the line minister, she is responsible, from a public perception point of view, the Government is responsible.' She must also master the inner workings and unpredictable dynamics of a health crisis – something that eventually falls to everyone in her position. This is particularly the case for one that is, in fact, composed of several overlapping sub-crises – a 'sprawling controversy with so many elements', as one source described it. She must keep track of timelines, keep the information flow running, keep across who knew what and when. For a first-time Cabinet minister, it is the ultimate acid test. Some of this may just be timing. The report by the health services watchdog, the Health Information and Quality Authority (Hiqa) on the unauthorised springs was always set for May and Government knew this would probably cause a storm that would be quickly followed by an equally damaging analysis into operations for children with developmental dysplasia of the hip. However, the stunning leak of an internal CHI report identifying potential patient safety risks, questionable use of NTPF-funded waiting list clinics and a toxic culture at one CHI hospital came out of left field. Ministers and health chiefs said they had been blindsided. The revelations also highlighted divisions between different parts of the health system and put the spotlight on flaws in the governance structures. Last week the NTPF confirmed it had suspended funding for waiting list initiatives at another centre, Beaumont Hospital in Dublin, on foot of potential financial irregularities. The Irish Times revealed this followed a letter sent to the chairwoman of Beaumont by consultants in which they maintained the hospital had billed the NTPF for about 1,400 patients treated in their regular public clinic. The Department of Health – and presumably the Minister – had been aware of this development since April. Carroll MacNeill had directed the HSE to send internal auditors into Beaumont . However, the public was not told until June 11th. Some highly placed sources maintain all this has led to concerns about the information flow around Government. One Minister told The Irish Times there had been discussions about what was coming out. 'As we hear things, things are being circulated,' they said. 'There is no concern about the political messaging, but there is huge concern about what we hear is going on – everything, from what you hear about [HSE chief] Bernard Gloster bringing in the gardaí to everything that is going on in terms of governance, the whole shooting match. But the primary concern is about the children.' Another Government figure said there is real concern that health may blow up (politically) in a way that it has not done in five years and that there may be too much of a hands-off approach by the Minister. The Government is only too aware there is more drama to come. CHI, the HSE and the NTPF will be before the Dáil Public Accounts Committee in early July. An external review into paediatric orthopaedic surgery being carried out for the HSE is also still awaited. A separate HSE report on 'insourcing', where some staff formed private companies to carry out additional work outside regular hours to tackle waiting lists, is also due, as are the findings of the internal auditors sent into Beaumont. Governments have spent more than €1.6 billion on waiting lists over recent years, using the NTPF, the HSE 'insourcing' and other arrangements. Any questionable findings will undoubtedly lead to more allegations about waste. Carroll MacNeill is facing a balancing act of trying to deal with serious issues in CHI at a time when the organisation should, ideally, be concentrating on moving the three existing paediatric centres in Dublin into the new €2.4 billion national children's hospital. TDs, like Daly, may have no confidence in CHI. But in the meantime services for children have to continue and workforce planning and other arrangements for the move have to be carried out in parallel. In late May the Minister told the Dáil: 'I am trying to look at this question in relation to the broader governance of CHI in a way that enables the functional continuity of CHI, both to respond to the various patient needs and ... the broader running of the paediatric system and to move us towards opening the new hospital. I want to ensure we see the appropriate governance structure in place to make sure that we have clinical leads who are managing each team.' However, within Government the ghost of the 2018 cervical check scandal casts a long shadow. This centred on retrospective audits of cervical cancer screenings that showed that 221 women's smear test readings missed abnormalities, leading to the development of cervical cancer. The results were not disclosed to 162 women and a number subsequently died. [ Justine McCarthy: Ireland's grubby treatment of Covid-19 heroes will cause frontline workers to think twice next time Opens in new window ] The fallout caused a national outcry. Ministers, doctors and health administrators did not adequately argue their own case and in the face of relentless criticism, a narrative took root and proved difficult to eradicate. There are fears that further revelations at the Public Accounts Committee or in forthcoming reports could spark further controversy. A number of sources have voiced concerns that the health service and CHI could replicate the rolling controversy seen over the RTÉ payments scandal two summers ago. The gaps and governance flaws identified by the CHI controversy also leaves the Minister with a decision on whether further reforms are needed. Health economist at UCC Dr Brian Turner described the current system as a complex mix of public and private funding and delivery with a large degree of overlap. He said there were publicly-funded public hospitals (run by the HSE), publicly-funded voluntary hospitals (run by their own boards) and public patients in private facilities such as nursing homes. In addition, the NTPF buys treatment in both the public and private systems. On top of this HSE reforms introduced last year led to new regional chief executives appointed to oversee services in geographic areas that covered both public and voluntary hospitals. [ Flying to Spain for medical care: 'The Irish really appreciate the services; they are actually really easy patients' Opens in new window ] One obvious question from this is who does the chief executive in a voluntary hospital primarily report to? Is it to the hospital board or the HSE regional chief executive? Such questions are not purely academic. At the Oireachtas committee, it became clear CHI did not believe its internal report merited a referral to the Garda. The HSE, on the other hand, wanted gardaí involved. One experienced health service figure told The Irish Times the CHI issue was casting a spotlight on the key governance question: who is in charge of what in the health service? With some exceptions, most of the main academic teaching hospitals covering most of the main specialities are in the voluntary sector. The staff are considered to be public servants but the hospitals are run by their own boards. Voluntary hospitals tend to jealously guard their independence. One senior figure pointed to a row last year when former minister for health Stephen Donnelly wanted all hospitals to adopt a new system that would provide greater visibility over productivity. A number of voluntary hospitals objected until the minster threatened to withhold capital funding. CHI reported to the minister, not to the HSE. However, when Donnelly wanted a new chief executive appointed as the former chief executive Eilish Hardiman had served the maximum two terms under Government policy, the CHI board disagreed. Simon Harris , as minister for health in 2017 established a review of the role of voluntary organisations in the operation of the health sector. But many key structures remained in place. One senior health source said voluntary hospitals previously argued they provided a set level of services for the State under an agreement each year but were subsequently free to treat fee-paying patients and do other work. However, private practice in public hospitals is now to be eliminated over time under Sláintecare , the long-term plan to achieve universal, single-tier health and social care. One experienced health figure said it was widely known that the governance arrangements were flawed. However, he questioned whether the Government had the bandwidth or determination to deal with the aggravation that would flow from trying to change the current model of care – a process that could take several years, and possibly beyond the next general election.
Irish Times
a day ago
- Irish Times
HSE aims to bring in new weekend work rosters for healthcare staff over summer
The HSE hopes to introduce new rostering arrangements over the summer that could require many healthcare staff to work at weekends for the first time, its chief executive has said. Bernard Gloster said final management proposals for the introduction of rostering staff to work any five days in a week – known as 5/7 day working – was currently with trade unions. In one of the biggest policy changes in years, the HSE has indicated it wants up to 10 per cent of the workforce to be available for rostered weekend work. Under the reforms, the HSE is seeking more staff on duty at weekends to: facilitate discharges of patients; boost the numbers providing care in emergency departments; increase the capacity in delivering diagnostics; and establish new outpatient clinics on Saturdays in hospitals and or community primary care centres. READ MORE It said that 'for Sunday, it is patient flow that is the priority. Between Saturday and Sunday, we discharge about 11-14 per cent of overall discharges for the week. We are aiming to get this to between 17-20 per cent.' HSE proposals given to trade unions said where a need for an extended service was identified, initially staff would be sought to work weekends on a voluntary basis. It said if there were not enough volunteers, 'eligible staff would be identified to resource the extended hours of service'. The HSE maintained that all staff employed or promoted on or after December 16th, 2008, would be contractually obliged to be rostered for weekend working. It said the requirement to match working patterns to service needs was set out in a HSE circular going back to 2009, as well as in successive public service pay agreements. [ Opinion: Nobody wants to stay in hospital longer than necessary. There's a better way to handle patient discharge Opens in new window ] The HSE told The Irish Times there was now 'a critical mass' of consultants in hospitals operating under the new public patient-only contract, which provides for senior doctors to work on Saturdays and later in the evening on weekdays. It said it needed other health professionals to work outside the traditional Monday-Friday working week. It also needs staff – some administrative, some nursing/allied health professionals – to be rostered on five out of seven days. 'Engagements have taken place with health unions and a final HSE proposal is in the last stage of feedback from the unions. Once cleared, there will be a mechanism for each [HSE] region to move to a roster in this new format. The initial rosters to be implemented will be in two categories of work: (a) Supporting services which have a direct benefit on patient flow such as emergency department avoidance, emergency department care and in hospital care such as diagnostics and discharge. (b) Supporting the establishment of a minimum number of outpatient clinics on Saturday in hospital and or community primary care centres as a means of big reform.' [ Just how unsafe are emergency departments in Irish hospitals? Opens in new window ] Mr Gloster said in a statement: 'We are determined to make this change which will be the basis for radical reform in access to care and patient flow and we hope to see the first fixed rosters in place over the summer. The prioritisation of this by Minister [for Health] Jennifer Carroll MacNeill is significant.' Minutes of the meeting in April of the Health Budget Oversight Group, which looks at spending in the health sector, said: 'Both HSE and Department of Health noted that they are examining the option of making changes to consultant rosters to ensure a more even distribution of consultants over seven days.' Mr Gloster said: 'We know consultants work hard, we know many are in at weekends for different things, we know the service is emergency/on call at weekends as opposed to core service. It is the move to core that is central to our plans on rosters. We have all the tools now, we have 25 per cent more staff, we need to utilise it to the maximum in the public interest.'
Irish Examiner
a day ago
- Irish Examiner
New miscarriage counselling service: trauma and grief that dare not speak its name
The Irish Family Planning Association (IFPA) announced earlier this month that it is expanding its counselling service to include women and couples who experience recurrent pregnancy loss. As part of a HSE-funded pilot project, anyone who has two or more miscarriages in a row is entitled to eight free counselling sessions. 'We've supported the sexual and reproductive health of people in Ireland since 1969, providing specialist counselling throughout that time,' says the IFPA's counselling director, Clare O'Brien. IFPA counselling director Clare O'Brien. 'We're delighted to have received HSE funding that enables us to become the first State-funded organisation to provide the psychological care women and couples need following miscarriage.' This care is sorely needed. Every year, approximately 14,000 women in Ireland have a miscarriage, meaning about one in every four pregnancies ends in loss. According to the Irish Examiner's women's health survey, some 58% of women report that the availability of support in the aftermath of miscarriage is poor. Women and couples have turned to organisations like the Miscarriage Association of Ireland and Pregnancy and Infant Loss Ireland or to independent therapists. 'There was nothing integrated alongside medical care, up until now. Women who have experienced recurrent miscarriage, and their partners, will now be referred to our specialist counselling services by their local maternity hospital,' O'Brien says. The custom of keeping pregnancies secret until after the first scan at 12 weeks can complicate how people grieve, O'Brien acknowledges: 'In other countries, people share their happy news much earlier. But here, the norm is to wait until after that first scan. Because many miscarriages happen in the first trimester, this means many couples won't have told anyone they are pregnant, which makes it harder to share that they have lost their baby.' Couples can grieve alone, as a result. 'And they do so in such individual ways,' says O'Brien. 'Miscarriage can cause sadness, anger, confusion, guilt, numbness, uncertainty, and fear for the future. There are so many unanswered questions about what happened and why. It's a very difficult time for people.' Alice Sheridan: 'The ripple effect of miscarriage goes on for miles. It's the loss of a life and all its possibilities." Photograph: Moya Nolan No heartbeat Alice Sheridan is a 45-year-old from Skerries in Dublin. She believes many women and couples are 'silently screaming and no one is hearing them'. 'The ripple effect of miscarriage goes on for miles. It's the loss of a life and all its possibilities. For some, it's the loss of the prospect of parenthood. It's a whole future that gets abruptly and violently taken away,' she says. Sheridan speaks from experience. She married in 2009, became pregnant three months later, and gave birth to her son, Jack, in 2010. 'I sailed through that pregnancy,' she says. However, when she and her husband tried for another baby, it took them four years to conceive. 'We were so excited, but at the eight-week scan, we realised there was no heartbeat,' she says. 'We'd lost our baby.' Over the next four years, the couple had two more pregnancies, but both ended in miscarriage. None of the pregnancies progressed beyond eight weeks, meaning Sheridan never developed a baby bump. 'In many ways, I felt this mirrored how our grief wasn't seen,' says Sheridan. 'The grief that follows miscarriage isn't always recognised by society. Lots of people don't know what to say to people who have lost pregnancies, so, often, they don't say anything at all.' Jennifer Duggan, Chairperson of the Irish Miscarriage Association at her home in Carrigaline, Co. Cork. Picture: David Creedon Relying on one another Jennifer Duggan is a 40-year-old from Carrigaline, in Cork, who also knows the pain of miscarriage. When she married at 23, she never imagined she would have difficulty starting a family. 'We married in 2007 and were pregnant at the start of 2008,' she says. 'I was already starting to show when we had our first scan at 12 weeks.' They were devastated when that scan failed to find a heartbeat. Their baby had stopped growing at eight weeks. Having been reassured by doctors that their miscarriage was 'just one of those things that happens as part of women's reproductive life', Duggan and her husband soon started trying again. They experienced another loss before having their son Dáithí in 2009. Two years and two more miscarriages were to follow, before their daughter, Síofra, was born in 2011. 'Looking at us from the outside, people probably thought we had planned the perfect family: A boy followed by a girl two years later,' says Jennifer. 'They would never have guessed we had lost four babies along the way.' Both had come from large families, so they yearned for more children. 'But we held off for a while, after Síofra, for fear of something going wrong,' says Duggan. 'But, eventually, the want for another baby grew bigger than the fear.' They had two more miscarriages before they sought help from a fertility clinic. 'They told me my ovarian reserve was low and recommended we try IVF with donor eggs,' says Jennifer. 'But that didn't feel right to us, so we decided to try one last time, and, happily, we had our son Oisín in 2015.' Looking back on it now, Duggan can see how traumatic the pregnancy losses were: 'My husband and I really relied on one another for support. Our family were great at looking after us, but friends often struggled to know what to say. I started trying for a family at the age of 24, when none of them were at that stage of life.' She found the peer-to-peer support offered by the Miscarriage Association of Ireland helpful. 'Because members had been through it themselves, they understood the jealousy I'd feel at others being pregnant or the sadness I'd feel coming up to the due date of a baby I'd lost. They got what I was going through,' says Duggan, who is now chairperson of the association. Alice Sheridan: 'The grief that follows miscarriage isn't always recognised by society. Lots of people don't know what to say to people who have lost pregnancies, so, often, they don't say anything at all.' Photograph: Moya Nolan Grieving alone Sheridan benefited from counselling after her miscarriages: 'It helped me process my loss and figure out what the future would look like for me and my family.' Sheridan found the experience so beneficial that she decided to retrain as a counsellor: 'I wrote my thesis about the disenfranchised grief many feel after miscarriage. People don't always recognise the profound loss involved and how women and couples need that loss to be acknowledged.' Acknowledging that loss is what the IFPA's new counselling service plans to do. 'It's difficult to say what the demand will be, but we do know that one in four women experiences miscarriage and our team of eight counsellors will be there to support them,' says O'Brien. 'All of us are accredited by the Irish Association for Counselling and Psychotherapy or the Irish Association for Humanistic and Integrative Psychotherapy and have decades of experience. Women and couples will be able to choose between in-person counselling at six centres throughout Ireland or sessions over the phone or Zoom.' These sessions will aim to validate people's bereavement. 'The grief that accompanies miscarriage is real and deeply felt,' says O'Brien. 'We don't want anyone to feel isolated and alone. We want them to know they can speak to us about their loss, frustrations, and fear, without judgement and with total confidentiality and support.' In the meantime, if you know someone who has experienced pregnancy loss, O'Brien has advice on how to support them. 'Sit with them and listen to what they have to say,' she says. 'Don't feel you have to suggest something to fix the situation, as they have just had a huge loss that can't be fixed. And remember that practical help — like childcare, cooking meals, doing shopping or cleaning the house — can make a big difference when people are going through something as physically and emotionally taxing as pregnancy loss.' If you have experienced miscarriage and want to avail of free counselling from the IFPA, ask your healthcare professional to refer you to the service. Click here to read our National Women's Health Survey. The Irish Examiner Women's Health Survey 2025 Ipsos B&A designed and implemented a research project for the Irish Examiner involving a nationally representative sample of n=1,078 women over the age of 16 years. The study was undertaken online with fieldwork conducted between April 30 and May 15, 2025. The sample was quota controlled by age, socio-economic class, region and area of residence to reflect the known profile of women in Ireland based on the census of population and industry agreed guidelines. Ipsos B&A has strict quality control measures in place to ensure robust and reliable findings; results based on the full sample carry a margin of error of +/-2.8%. In other words, if the research was repeated identically results would be expected to lie within this range on 19 occasions out of 20. A variety of aspects were assessed in relation to women's health including fertility, birth, menopause, mental health, health behaviour, and alcohol consumption.
