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Irish Times
a day ago
- Health
- 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.
RTÉ News
2 days ago
- Health
- RTÉ News
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.
Irish Examiner
2 days ago
- Health
- Irish Examiner
'Trust is broken': Committee hears of calamity and failures by CHI over children's surgery controversy
Calamity, failures in care, broken trust, and stonewalling of parents were raised during an emotional Oireachtas Health Committee with Children's Health Ireland (CHI) which left many questions unanswered. The discussion focused on unnecessary hip surgeries at Temple Street and Cappagh hospitals, unapproved springs in spinal surgery, a toxic work culture, and delays in care identified in an unpublished report from 2021. Only 72 out of about 1,800 children affected by the hip surgery controversy have so far been seen, CHI clinical director Ike Okefor confirmed. He expects it will meet the six-month deadline. He apologised for how the opening review clinics were run, with one case involving a five-and-a-half-hour appointment. Sinn Féin health spokesman David Cullinane asked specific questions about care in oncology and urology in light of the unpublished 2021 report. He asked if parents of children referred to in that document as 'Crumlin orphans' were told about the alleged sup-optimal care outlined. Parents feel, he said, 'stonewalled, they feel they are meeting with a wall of resistance, they say they are being failed". When he was told information was not given to them, he said it is a "failure". CHI CEO Lucy Nugent said its legal advice remains not to publish the report. A HSE official – Kate Killeen White, regional executive officer for Dublin Midlands – said she referred concerns in that report about use of public money to gardaí. She said CHI had not considered the problems had met the threshold for garda involvement. Senator Tom Clonan and others asked about potential risks of infertility for children waiting too long for treatment of undescended testes, as described in that unpublished report. CHI was unable to say how many were affected. Ms Nugent said it sought advice on the potential impacts. 'They did not meet the threshold for open disclosure,' she said. Senator Maria Byrne raised the issue of national oversight for hip dysplasia care, asking why a Health Information and Quality Authority (Hiqa) review into this last year had not led to a national universal screening programme. HSE chief clinical officer Dr Colm Henry said Hiqa advised a more targeted screening programme, but said the HSE is 'trying to finalise a proposal' for universal screening. There is selected screening at 16 centres, he said, adding the HSE 'will certainly be making the case' for expansion to the National Screening Advisory Committee. Questions were asked about oversight of devices in light of Hiqa's report in April on use of unapproved springs in surgeries. Former CEO Eilish Hardiman was asked to comment in light of her continuing key role in the moves to the new hospital. 'Part of the accountability is being here today and answering the questions to the best of my ability,' she said. 'I accept that there were weaknesses, and I've apologised for those particular weaknesses, we have put in structures and processes to try and address them.' These changes include improvements in procurement. Committee chair Padraig Rice said he was not satisfied in general and particularly on the non-publishing of reports. He asked CHI to share their legal advice on the 2021 report. 'Trust is broken,' he said. Ms Nugent and Ms Hardiman apologised to families repeatedly during heated discussions, with the new CEO pledging a new culture will take them into the national children's hospital.
Irish Daily Mirror
2 days ago
- Health
- Irish Daily Mirror
CHI admits parents not told kids could have fertility issues due to delayed care
Parents with children at risk of fertility issues and cancer due to delayed procedures have not been told of the risks to their children, Children's Health Ireland has admitted. Lucy Nugent, Chief Executive of Children's Health Ireland (CHI), also told the Oireachtas Health Committee that parents were not told about concerns in the oncology department or that their children with spina bifida were being referred to as 'Crumlin Orphans' and were receiving "sub-optimal care". The concerns were raised in a 2021 report by CHI, which has been seen by the Irish Mirror but has not been published by CHI due to legal advice. CHI attended the Oireachtas Health Committee on Thursday to apologise for the litany of scandals engulfing the body, including the unauthorised use of springs in children's spinal surgeries, hip dysplasia surgeries and reports on staff in CHI hospitals. A 2021 CHI report, seen by the Irish Mirror, highlights several issues relating to the timely treatment of children and culture within CHI. The report stated that "some patients, who were placed on the inpatient waiting list, were confirmed as having undescended testes, a condition which requires surgical intervention within a specific timeframe". It continued: "Placing these patients on a specific consultant's inpatient waiting list, when it was known there were alternative options which would have ensured these patients could have been operated on sooner, appears not to be in the best interest of [the] child and the specifics of each case warrant further examination." In a section on urology general surgery waiting lists, the report stated that there were 10 patients on an inpatient waiting list in 2021 requiring a surgery called orchidopexy for this issue. It noted that they were "at risk if their wait time extends past their first birthday". Sinn Féin's David Cullinane told the Health Committee that patients who are waiting "far in excess of the recommended timeframe for that treatment" were placed at "real and known risk for fertility issues or cancer". When asked if these patients had been identified and their parents contacted, Ms Nugent said open disclosure was "discussed at the time with the clinical experts". She said: "They did not meet the threshold for open disclosure." Senator Tom Clonan told CHI that if it were "running Tayto Park, I wouldn't let my children go there". In response to his questions about how many children were at risk of infertility due to delayed urology procedures, CHI Chief Medical Officer Dr Allan Goldman stated that it was "impossible to say". Senator Clonan responded: "That is an ongoing, systemic and systematic failure of our children, disabled children, being de facto sterilised for lack of intervention on your watch." Deputy Cullinane also asked about the concerns raised in the report about oncology services. He stated that an August 2021 risk assessment scored these services 20 out of 25, or "high risk". Deputy Cullinane read from the report: "Pediatric oncology patients have a poor experience or are harmed due to the inability of CHI to deliver international best practice standards. Again, it talks about prolonged recoveries." Ms Nugent said "to the best of her knowledge", these concerns were not relayed to parents. Similarly, the report raised issues about 'Crumlin Orphans'. These children were not transferred to Temple Street Children's Hospital when the service was moved and the CHI report said they received "sub-optimal care." Ms Nugent stated that these parents were also not notified of these issues or given another unpublished report on the issue, called the Dixon Report. Kate Killeen White, HSE Regional Executive Officer, confirmed to the Health Committee that she referred the 2021 CHI report to the Gardaí earlier this month. She stated that the HSE only became aware of the report on May 25, the same day details of it were published in the Sunday Times. Ms Killeen White said that both before and after the report was referred to gardaí, CHI expressed their belief that it "did not meet the threshold for criminality". Fine Gael's Brian Brennan, who declined to get hip dysplasia for his son, warned that the scandals engulfing CHI would become 'one of the biggest medical malpractices in the history of the State". Fianna Fáil TD Martin Daly, who was a doctor for 40 years before entering politics, said, "There is absolutely zero confidence in CHI, zero confidence in the management." He continued: "I am speaking as a medical professional who would be inclined to try and tease out the nuances of this? There are no nuances." As Deputy Daly stated that he did not believe Ms Nugent's opening statement conveyed the gravity of the situation, the CHI Chief said: "It keeps me awake."
Irish Independent
2 days ago
- Health
- Irish Independent
CHI boss apologises to children and families in opening statement to Oireachtas Committee
LATEST: CHI chief apologises to children and families over practices and governance issues Children's Health Ireland (CHI) CEO Lucy Nugent apologised this morning to children and families impacted by recent revelations about the charity. In her opening statement this morning to the Oireachtas Committee on Health, she said: "I am sorry on behalf of the management of Children's Health Ireland and I am sorry on behalf of the entire organisation. "I am very aware that various issues that my organisation is grappling with - and I will speak to each of those issues in due course this morning - have an enormously worrying impact on parents around the country, and whether they can place their trust in us." Only 60 of the more than 2,200 children caught up in the controversy over potentially needless hip dysplasia surgeries have been seen for a review of their care so far, the Oireachtas Health Committee will be told today. CHI chief Lucy Nugent will say 105 appointments have been offered, and will acknowledge the 'worry it has caused to many parents'. A random audit of 147 children who had hip dysplasia surgeries across Temple Street, Crumlin and Cappagh hospitals was published in recent weeks. High numbers in Temple Street and Cappagh were found to have possibly not needed the surgery because the threshold for intervention was lower than international standards. About 2,200 families whose children had the surgery since 2010 were written to and told they would be offered a medical review. The vast majority are waiting for an appointment. Ms Nugent said the random audit by a British surgeon 'regrettably identified one case from the review sample where a child experienced complications due to the surgical approach recommended to them'. 'This family has been contacted and supported through an open disclosure process,' she added. 'Multi-disciplinary team review clinics have started. This is a once-off review to assess complications only and determine the current clinical state of each patient. 'After this, patients enter the recommended normal follow-up process.' Ms Nugent will say CHI is arranging these clinics as quickly as possible and hopes to have seen all children within six months. Along with her predecessor Eilish Hardiman, Ms Nugent will be questioned about a series of scandals, including the use of experimental springs during spinal surgery on three children. Referring to the hip dysplasia review, Ms Nugent said: 'I would like to give my assurance to all of the families affected that they will be directly supported and are being contacted with follow-up information and the next steps.' Figures provided by the hospital will also show that as of June 4 there were 48 patients waiting over four months on CHI's active waiting list. This is despite a pledge by Simon Harris, when health minister, that no child would face such a delay. The report says this is a decrease since the beginning of this year. Eilish O'Regan
