Concerns over ‘prudent management' of NTPF raised in CHI report

An internal Children's Health Ireland (CHI) report raised concerns about prudent management of clinics funded through the National Treatment Purchase Fund (NTPF).
The review also found that certain NTPF-funded clinics did not adhere to the standard of seeing the longest-waiting patients first.
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In addition, data suggested that some CHI patients could have been seen by other departmental colleagues within the existing day-to-day services and 'potentially managed in a more pro-active way'.
The NTPF, which is a body that arranges external treatments for patients on public hospital waiting lists as well as insourcing within public hospitals themselves, has come under scrutiny in recent weeks.
It was reported that a CHI consultant breached HSE guidelines by referring patients he was seeing in his public practice to his weekend private clinics, rather than securing earlier treatment for them by referring them to HSE colleagues.
The consultant was reported to have been paid thousands of euro through the NTPF, and the details were uncovered by an internal investigation by CHI into a certain department.
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After calls for the CHI report to be made public, the body instead published a summary of its findings on Monday.
However, Sinn Féin has described the 'limited' summary as inadequate.
David Cullinane, the party's health spokesman, said: 'The shocking details contained in the review are circulating and casting shadows across the organisation.
'We know that it has documented serious governance and cultural issues in CHI, and details have been extensively published in the press.'
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Sinn Fein's health spokesperson David Cullinane (Niall Carson/PA)
CHI said it became evident in 2020 and 2021 that 'multiple legacy and deep-rooted issues existed' that regular meetings could not address and senior examiners were assigned to undertake a review of issues in the department.
They found a number of issues in relation to a NTPF outpatient waiting list initiative.
The examination suggested that, based on the documentation review, certain NTPF-funded clinics did not adhere to standards of chronological scheduling.
Patients seen in the outpatient clinic who required ongoing treatment were placed on an already long inpatient waiting list without consideration of redistribution of patients to colleagues with a shorter waiting list.
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The examination raised the issue as to the possibility that this could have led to any negative outcomes for patients.
This raised concerns relating to the 'prudent and beneficial management of NTPF funding' and lack of oversight of access initiatives.
The review also found a high attrition rate among support staff due to bullying issues.
Most of those interviewed described a culture within the department where change was slow, lacked governance and robust processes, and was influenced by strong and challenging personalities.
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These interpersonal difficulties among team members led to poor working relationships and a challenging working environment.
A significant risk was identified where only one employee managed the needs of a complex tertiary speciality
Half of medical trainees described the learning environment as not conducive to learning. As a reflection of this, The training body had indicated that there would be no intake of any new trainees or Specialist Registrars (SpRs) into the programme in 2022 due to concerns about the trainee experience which was reputationally damaging for CHI.
Meanwhile, there was a substantial and persistent message of concern regarding the lack of strong site leadership and good governance, along with poor operational oversight and accountability.
There was also consistent feedback that the challenging behaviours of some staff were not adequately addressed by the site leadership team.
CHI, which listed a number of actions it had taken on foot of the findings, said it regularly conducts internal reviews and audits 'to ensure issues are identified and addressed across our services'.
It said it recognises the importance of transparency and the interests of the broader public in relation to the issues identified in the report.
On choosing to publish a summary of the review rather than the full document, it said the report came from an internal examination that was never intended to be made public.
It said it was important that its staff feel safe to engage in such processes which result in service reports.
CHI pointed out that the report states: 'This examination however, without question has demonstrated that there is a huge cohort of committed, diligent, people-centric staff across CHI willing and wanting change and reform.
'It is this cohort of staff with the support of strong leader's and good governance that will mend our culture and enable positive change across CHI.'

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Telegraph

an hour ago

• Telegraph

NHS sends patients abroad after waiting lists hit record high

The NHS is paying to send rising numbers of British patients abroad for treatment after waiting lists in England hit record highs. The health service is funding treatments across Europe in countries including Poland, Lithuania and the Czech Republic. Treatments being carried out abroad range from routine operations, including hip replacements and cataract operations, to more complex cancer surgery. The number of people having such procedures overseas has jumped by 42 per cent in just two years, The Telegraph can reveal. The Health Secretary described the situation as 'unacceptable', saying a 'broken NHS' had left patients waiting 'far too long for treatment, forcing many to go private or even seek healthcare abroad'. The revelations come as Wes Streeting prepares to publish a 10-year health plan that aims to clear backlogs and reform the way services are delivered. On Friday night, he pledged his plan would 'catapult the NHS into the 21st century and get people seen on time in a modern health service on British shores'. Experts said the rising cases were a 'terrible indictment' of the state of the NHS, with Poland, Germany, Italy and Belgium among the main beneficiaries. Under a little-known post-Brexit healthcare agreement, the NHS will pay another European country to treat UK patients where there is 'undue delay' to them accessing equivalent treatment on the NHS within a 'medically acceptable timeframe'. Patients desperate to have gynaecology surgery and hip replacements were the most likely to get NHS approval to travel overseas for their treatment. Those waiting for cancer treatment, and surgery to repair hernias, remove gallbladders and treat cataracts also fled Britain to get help more quickly, the investigation reveals. The treatment or surgery must be provided by a state healthcare system, not a private clinic, and patients must fund their own travel and accommodation costs. There has been a rapid rise in the number of UK patients using the scheme, as the NHS battles to reduce waiting lists, which peaked in 2023. In the last three years, the NHS has spent £4.32 million sending 352 patients overseas for treatment, according to data from the NHS Business Services Authority, which handles the payments. The number of overseas treatments paid for by the NHS jumped from 99 in 2022-23 to 112 in 2023-24 and rose again to 141 in 2024-25, according to figures obtained by The Telegraph under Freedom of Information laws. Mr Streeting said: 'This Government inherited a broken NHS, with patients left waiting far too long for treatment, forcing many to go private or even seeking healthcare abroad. This is unacceptable and, since day one in office, we have been delivering the investment and reform needed to turn the NHS around. 'We are focused on delivering for patients, so they get the treatment they need, when they need it, closer to home. In less than a year, we've delivered 3.6 million more appointments, cut the waiting list by almost a quarter of a million, and diagnosed an extra 100,000 suspected cancer patients on time. 'There's a long way to go, but we are finally putting the NHS on the road to recovery. 'Our forthcoming 10-year plan will lay out how we catapult the NHS into the 21st century and get people seen on time in a modern health service on British shores.' Dennis Reed, from Silver Voices, said: 'This is a terrible indictment of the state of the NHS. People have to be desperate to think about having hospital treatment in another country, hundreds of miles away. 'It is really worrying and it's also worrying about the inequalities – most of us wouldn't know about this scheme, and many could not afford the travel and hotels, so the vast majority of the population just have to put up with really long waits.' 'Says a lot about pressures on NHS' There are currently 1.4 million people waiting for NHS gynaecology or orthopaedic procedures, including hip replacements, in England. Of these, nearly 43,000 have waited more than a year for treatment since being diagnosed, latest figures for April 2025 show. Siva Anandaciva, director of policy at The King's Fund, said it was 'striking' that more Britons were getting treatment overseas. 'It was only a few years ago that the concerns about medical tourism were that too many people were coming to the UK to seek treatment. It says a lot about the pressures the NHS is under that the concern now is that too many people [from the UK] are seeking treatment overseas,' he said. 'The NHS has made substantial progress in tackling the very longest waits for care that built up before and after the Covid-19 pandemic, but the reality is that it will be several years before national waiting list targets are routinely met again.' Patients were most likely to travel to Poland for treatment, with the NHS paying for 72 procedures to be carried out there between 2022-23 and 2024-25. This was followed by Germany (59 procedures), Italy (32), Belgium (31) and Ireland (26). But the NHS spent the most money on treatments performed in Ireland, which cost around £3.15 million over the last three years. It also spent £224,000 on NHS patients having treatment in Germany; £147,000 on treatments in Poland; £138,000 in Switzerland; £138,000 in Italy; and £134,000 in Austria. Payment figures were recorded by the NHS in the local currency and converted to pound sterling by The Telegraph based on currency exchange rates at the time of writing. Separate NHS England figures also revealed that nearly two out of every five applications (37 per cent) made by patients wanting to travel abroad for treatment were approved in 2024, up from just one in five (21 per cent) in 2022, suggesting more applications are meeting the criteria for 'undue delay'. Rachel Power, chief executive of The Patients Association, said when patients felt compelled to seek treatment abroad, it was 'a reflection of the state of the waiting lists and the very severe problems of the NHS'. Mrs Power suggested the system could worsen 'inequalities', as the scheme is only accessible to those able to work out the application process and who have the means to pay for travel and accommodation. 'To do this, you have to have the confidence and ability to navigate the system – we talk to patients all the time who can't navigate and access treatment [on the NHS],' she said. Prof Ranee Thakar, president of the Royal College of Obstetricians and Gynaecologists, said the fact patients were travelling long distances for treatment was 'clear evidence that they can't access the care they need, when they need it'. She added the Government must tackle the 'critical issue' of long waits for gynaecology treatment in its upcoming NHS 10-year health plan. 'There are more than three quarters of a million women in the UK waiting for hospital gynaecology care, with serious conditions that have a devastating impact on almost every aspect of their lives,' said Prof Thakar.

The Sun

3 hours ago

• The Sun

Experts reveal a handy tip for sleeping on hot nights – it won't cost you a thing and only takes seconds

AS the scorching weather continues across the UK, many people have been finding it difficult to sleep. And as weather experts now say the heatwave is reaching its peak, a handy hack will help make your bedroom feel more comfortable tonight. 2 Avoid another night of tossing and turning in a sweltering room with this completely free step. A sleep specialist has revealed that the position of your door can significantly affect your night's sleep. Choosing the perfect angle can help to reduce bedroom temperatures during heatwaves, helping you to sleep through the hot summer nights. Dr. Jordan Burns from AmeriSleep explained that the way bedroom doors are positioned affects airflow patterns within sleeping spaces. This creates a cooling cross-ventilation or can trap even heat, depending on the angle chosen. "Most people focus solely on windows for cooling, but bedroom doors control how air circulates throughout your sleeping space," Dr. Burns said. "A properly positioned door can make the difference between restful sleep and hours of uncomfortable tossing and turning." The expert recommended keeping bedroom doors fully open during daytime hours if the rest of the home is cooler, allowing for maximum air exchange between spaces. This approach works particularly well for rooms that receive direct sunlight. "When outside temperatures climb higher than those inside your home, keeping your bedroom door wide open allows cooler air from north-facing rooms to circulate throughout," he said. "This creates a natural current that pushes hot air up and out while drawing cooler air in from below." For night-time cooling, however, he suggested a more precise approach to door positioning. "The optimal angle for a bedroom door at night is approximately 45 degrees," Dr. Burns explained. "This specific position creates what fluid dynamics calls a 'venturi effect' that accelerates airflow through the narrower opening, pulling hot air out more efficiently than a fully open door would." The sleep specialist points out that most people make the common mistake of either leaving doors completely open or fully closed during hot weather. The best sleep routine and environment Thomas Høegh Reisenhus, TEMPUR® sleep specialist & sleep counsellor, reveals the key components of a good bedtime routine and environment... A sure-fire way to facilitate a better night's sleep is to practice good sleep hygiene. Establish a sleep routine that works for you and stick to it. This will help your body establish a consistent, natural sleep-wake cycle which can do wonders for your overall sleep quality. As such, try to avoid making up for lost sleep with a lie-in. Instead of sleeping in, spend your morning reading a book in bed or having a leisurely coffee in the kitchen. Ensure that your bedroom, bedding, and sleepwear are fit for purpose too. The ideal sleep environment is dark, quiet, and cool – much like a cave. If you find unwelcome sources of light are keeping you up, consider investing in an eye mask or black-out curtains. Adding soft furnishings can be a great way to reduce noise, with the surfaces having an absorptive quality, but if this doesn't work, consider embracing a soothing soundtrack to block it out. In terms of temperature, try to keep your bedroom at 18°C. You can further reduce the risk of waking up due to overheating by ensuring that all your bedding and sleepwear is made with natural, breathable materials such as cotton and linen. Bear in mind that everyone is different; what might work for most, may not work for you! Whilst knowing how much sleep you should get, how to overcome common barriers, and practicing good sleep hygiene can facilitate a great night's sleep, if you continue to struggle with sleep or fatigue persistently, do not hesitate to visit a doctor or health professional for support. "A completely open door actually slows down airflow in many cases because the opening is too large to create the pressure differentials that drive air movement," he said. "Conversely, a fully closed door prevents any air exchange, trapping heat and moisture that build up while you sleep." According to Dr. Burns, door positioning must work together with window management for maximum cooling effect. "If your windows and door create a straight-line path, you'll generate the strongest possible airflow through your bedroom," he said. "The ideal setup in UK homes is having your bedroom door at 45 degrees with windows open on the opposite wall, creating a direct pathway for air movement." The expert also stressed the importance of furniture placement in relation to door positioning. "Keep furniture at least 30 centimetres away from the door swing path," Dr. Burns advised. "Tall wardrobes or dressers near doors can block airflow and create stagnant air pockets where heat accumulates." 2 For flats and apartments where cross-ventilation options are limited, Dr. Burns recommends changing door positions throughout the day based on sun exposure and temperature variations. "In single-aspect flats, try keeping your bedroom door closed during the day if that room receives direct sunlight," he said. "Then open it to precisely 45 degrees at night when the rest of the flat has cooled down." He suggested a simple method to test if your door positioning is working effectively for bedroom cooling. "Place a lightweight ribbon or tissue near the gap between the door and frame," he advised. "If it moves toward the door, you're successfully drawing air through the room. "If it remains still or moves away, adjust your window and door configuration until you achieve proper airflow. "Good sleep remains possible during hot weather if you understand how to control airflow in your home. "Door positioning is a cost-free intervention that can improve your sleeping environment while reducing both energy costs and environmental impact compared to mechanical cooling options."

Telegraph

4 hours ago

• Telegraph

How vaccine fears and summer holidays could trigger a measles surge

As the June heatwave begins and families prepare for a summer of festivals and flying off abroad, experts are warning that thousands may return home this year with an unwanted holiday souvenir. Measles – the highly infectious but preventable disease from the past – is making a concerning comeback. Already, a number of popular destinations – including France, Spain and Italy – have seen 'large' outbreaks, according to the UK Health Security Agency (UKHSA). Analysis by WHO Europe and Unicef reported 127,350 measles cases in the European region for 2024, double the number of cases reported for 2023. It is also the highest number since 1997. It's a similar story across the pond. Canada, which only recorded an average of 91 measles cases annually from 1998 to 2024, has 2,885 confirmed cases already this year. Meanwhile, there were more measles cases in the US during the first three months of 2025 than in all of 2024, according to the Centres for Disease Control and Prevention. 'It's essential that everyone, particularly parents of young children, check all family members are up to date with two MMR doses, especially if you are travelling this summer for holidays or visiting family,' says Dr Vanessa Saliba, a consultant epidemiologist at UKHSA. 'Measles cases are picking up again in England and outbreaks are happening in Europe and many countries with close links to the UK. 'Measles spreads very easily and can be a nasty disease, leading to complications like ear and chest infections and inflammation of the brain with some children tragically ending up in hospital and suffering life-long consequences. Nobody wants this for their child and it's not something you want to experience when away on holiday.' While cases are still lower in the UK than they were in 2024, experts are also worried that unvaccinated people could contract the disease at large-scale events such as Glastonbury – which starts next week. 'Festivals are the perfect place for measles to spread,' says Dr Alasdair Wood, a consultant in health protection at UKHSA South West. 'We want festival-goers to enjoy their time at Glastonbury and other festivals this year. Being aware of the current health risks will help those attending enjoy their time as much as possible. If you're not fully vaccinated against measles, mumps and rubella, please contact your GP to see if you can get an appointment before coming to the festival.' Vaccine hesitancy and the declining MMR vaccination rates – only 85 per cent of UK children are receiving two doses, well below the 95 per cent needed for herd immunity – may well be the reason why a surge in measles is being predicted later this year. Dr Hana Patel, a GP, says that although she hasn't seen any cases of measles this year so far in her surgery in south-east London, like most health professionals, she's concerned that the pandemic as well as other factors are to blame for the lack of vaccinations in some parts of the UK. 'There have always been some communities who are vaccine hesitant – there is evidence that traveller communities don't have access to the same information most people do, or patients from particular areas from Europe, where they don't have a vaccine schedule, are two examples,' she says. 'But after Covid, I've noticed more people – even some doctors – who seem quite complacent about vaccines. 'It's not always a family's fault. If you have a transient population, perhaps a family in temporary accommodation who are then moved to another area, they might miss their letter or appointment. Or then they will get an appointment and then forget about it because it's not on everyone's mind all the time. It's really important to find out the challenges in each particular area and target them with specific help. 'Other parents may not understand that it's not just one vaccination but you need two to be fully protected. Children in larger families may also be at risk because parents think one child has had it and so they think that protects the others or they can't remember if the others have had it. Speaking a different language may be another factor. 'I really hope that more people get the vaccine done, because long-term consequences such as meningitis and hearing loss, are incredibly serious. We also have to remember the risks to pregnant women of being exposed to measles too (contracting measles can lead to severe complications with pregnancy and birth). It's more than just the child who has been vaccinated, it's the people around them too.' Dr Naveed Asif, a GP from the London General Practice, says he has encountered a diverse spectrum of patients who have been influenced by the misinformation surrounding vaccines. 'One notable instance involved a well-educated couple who meticulously researched every decision they make regarding their children's health,' he says. 'They came to me with a palpable sense of uncertainty after reading a negative article about the MMR vaccine. Despite the wealth of positive data supporting its safety and efficacy, they were fixated on that one negative report. 'I've also treated patients from backgrounds where traditional beliefs about health are prevalent. For example, families from South Asian communities often rely heavily on parental advice and anecdotal experiences. They might argue that they've never needed vaccines in their lives and feel confident in their decision to forgo them. This reliance on peer opinion can lead to a strong sense of community validation, but it can also perpetuate hesitancy about vaccinations. 'From my personal experience, I often see sick children presenting to their GP first, and I have encountered significantly unwell children whose parents have chosen not to vaccinate. These families often find themselves reliant on more invasive, distressing and intensive resources to support their child's illness. I firmly believe that exposing children to vaccines early, rather than keeping them unprotected, is more likely to build immunity and contribute to healthier, stronger adults overall.' But vaccine hesitancy is not the only factor. Although the figures for measles were low during the Covid pandemic, the lockdowns appear to have exacerbated the current increase in measles figures, with over 1.8 million infants in the WHO European region missing their vaccinations between 2020 and 2022. England had already experienced 2,911 laboratory-confirmed measles cases in 2024, the highest number of cases recorded annually since 2012. One young person was confirmed to have died in the UK last year of the disease. 'We have seen a steady decline in vaccination coverage for children over the past 10 years and we now find ourselves in a situation where the UK does not meet the WHO target of 95 per cent coverage for any routine childhood immunisations,' says Dr Helen Stewart, the officer for health improvement at the Royal College of Paediatrics and Child Health. 'The result of this trend is being felt already, with measles outbreaks occurring across the UK, increasing cases of whooping cough and poliovirus being found in sewage samples in London. 'Because the MMR vaccine has been so successful in preventing outbreaks, many parents and caregivers today have never witnessed the sometimes devastating impact measles can have on children and babies. Measles is one of the more contagious diseases – more transmissible than even Covid – and poses a serious threat, especially to children under the age of five. 'Paediatricians are particularly concerned about current and potential outbreaks in the UK, especially during the upcoming winter period. This is already an extremely tough time for health care professionals, with high surges in respiratory syncytial virus (RSV) and influenza, as well as circulating Covid and group A streptococcus (GAS). To have another highly contagious, dangerous and preventable disease, making children sick, would be disastrous. Not only could it put other young patients at serious risk, it could also add further pressure to paediatric wards. 'We understand that vaccine hesitancy may be an issue in some instances, but evidence shows that accessibility and availability of health appointments plays a huge role in low uptake. We urge the UK Government to take forward the commitments of the NHS's vaccine strategy and work towards reversing this dangerous trend.' Six decades ago, up to more than half a million people in the UK could be affected by measles each year, and around 100 people would die annually. Author Roald Dahl's seven-year-old daughter was one such victim, dying of complications from the disease in 1962. Thousands were left with respiratory, brain or hearing problems. But the MMR vaccine changed everything. Introduced in 1968, it's thought to have prevented over 20 million measles cases and 4,500 deaths in the UK. When offered to all children in 1988 (and the second dose MMR vaccine was brought in for preschoolers in 1996), the number of cases in the UK fell dramatically. So much so that in 2017, WHO confirmed that the UK had achieved 'measles elimination status', something the US had already achieved in 2000. Despite the UK losing this status shortly afterwards, it regained it again in 2021 after the Covid pandemic. Yet now, doctors are facing real fears that it has taken a foothold once again. 'The challenge is not anecdotal, it is very real,' says Dr Benjamin Kasstan-Dabush of the London School of Hygiene and Tropical Medicine. 'There has been a global rise in measles cases, and two unvaccinated children died from measles in Texas this year, reminding us of just how dangerous this preventable disease is. 'High vaccination coverage helps to prevent the spread of disease, but rates are just not as high as they need to be. It is likely that the number of confirmed cases of measles does not reflect the actual burden of illness. 'This is particularly worrying because a child infected with measles can deteriorate rapidly, and there is always a risk of them developing encephalitis (inflammation of the brain). So, we should all be concerned about a predicted surge in measles cases.' Since January this year, 420 lab-confirmed measles cases have been reported in England, with London reporting almost half of all cases in the past four weeks. Outside the capital, Bristol has seen the highest number of cases, with 47 so far this year, followed by Leeds (29) and Essex (22). A number of other regions are also reporting outbreaks, with 25 per cent of cases in the North West, and 11 per cent in the West Midlands. Earlier this month, UKHSA published its monthly update showing there were 109 confirmed cases in April and 86 so far in May – most have been in unvaccinated children aged 10 years and under. 'We have seen a small increase in the number of measles cases in Birmingham over recent weeks,' says Dr Clara Day, the chief medical officer for NHS Birmingham and Solihull. 'We know how easy it is for viruses like this to spread within our communities, especially where we know there is a high number of unvaccinated people. 'Unfortunately we know that misinformation surrounding the MMR immunisation is prevalent, but it is safe, effective and the only protection we have against these illnesses. Measles in particular can be deadly in the most serious of cases, so I would encourage all parents to make informed decisions about whether to get their child immunised.'