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Extra.ie
4 days ago
- Health
- Extra.ie
‘CHI's lack of leadership fed a culture of bullying': Audit summary lambasts poor management
A lack of 'strong leadership and good governance' at Children's Health Ireland (CHI) fed a culture of bullying within the body and allowed for the mismanagement of the National Treatment Purchase Fund (NTPF), an internal audit has found. A summary of a 2022 review into CHI, published yesterday, found certain clinics funded by the NTPF did not adhere to the standard of seeing the longest-waiting patients first. It indicated patients at CHI hospitals could have been seen by other departmental colleagues within the existing day-to-day services and 'potentially managed in a more proactive way'. Pic: Getty Images The report also highlights that 'interpersonal difficulties among team members led to poor working relationships and a challenging working environment' within CHI, which had the potential to put children receiving treatment at risk. The NTPF was established to help tackle lengthy waiting lists for public hospitals by arranging external treatments or insourcing within hospitals themselves. It has come under intense scrutiny after it emerged that a CHI consultant breached HSE guidelines by referring some of his public patients to his weekend private clinics. It is understood he earned up to €35,800 through the NTPF in the process. Pic: File The finding was contained in an unpublished review at CHI, which was leaked to the media. CHI said that it cannot publish the full internal investigation, citing legal advice. Auditors uncovered several issues in relation to an NTPF outpatient waiting-list initiative over the course of the probe. 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. The examination raised the issue as to the possibility that this could have led to any negative outcomes for patients. The review also found a high attrition rate among support staff due to bullying issues. Most of those interviewed described a culture where change was slow, lacked governance and robust processes, and was influenced by strong and challenging personalities. Sinn Féin's health spokesman said the 'shocking' details of the report must be put on the public record, adding: 'The summary is not enough'. 'Public trust in CHI is at an all-time low. The identity of individuals who contributed to the report can and should be protected where appropriate but not used as an excuse to keep the details under wraps,' the Waterford TD said. On choosing to publish a summary, CHI 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.
Irish Independent
5 days ago
- Health
- Irish Independent
Parents whose children were centre of concern in CHI internal review not informed, summary reveals
The revelation emerged in a summary of the findings of an internal CHI report into the handling of extra clinics, paid for by the National Treatment Purchase Fund (NTPF) to reduce waiting lists. It said the review found that 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. 'The examination raised the issue as to the possibility that this could have led to any negative outcomes for patients,' it said. However, the summary, which also includes follow-up actions, said an examination of the relevant inpatient waiting list later took place and patients were re-distributed across the department to ensure equitable access to treatment. 'This action was closed out in September 2022.' It said 'open disclosure' – informing parents about the concerns raised in the report – was not carried out 'as there is no significant scientific evidence that delaying treatment will equate to patient harm in this patient cohort'. CHI, which has declined to publish the full report for legal reasons, said it was an internal examination commissioned by the CHI Executive. The hospital involved has been previously identified as Crumlin Hospital by CHI chief Lucy Nugent. During meetings (2020/2021) between employees in this clinical department and members of the CHI Executive, it became evident that multiple legacy and deep-rooted issues existed that regular meetings could not address, it added. It became clear that a more robust process was required to identify the issues that needed to be addressed 'In early 2021, an operational lead was assigned to look into these issues. However, it became clear that a more robust process was required to identify the issues that needed to be addressed.' It led to the examination taking four months. It said that a number of issues were raised in relation to an NTPF outpatient waiting list initiative. The NTPF funds hospitals to carry out extra clinics and procedures. The examination suggested that based on the documentation review, certain NTPF-funded clinics did not adhere to NTPF standards of chronological scheduling – seeing the longest-waiting patients first. Data suggested that some of these patients could have been seen by other departmental colleagues within the existing day-to-day service and potentially managed in a more proactive way. '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. The examination raised the issue as to the possibility that this could have led to any negative outcomes for patients,' it said. 'The above raised concerns relating to the prudent and beneficial management of NTPF funding and lack of oversight of access initiatives.' It found that interpersonal difficulties among team members led to poor working relationships and a challenging working environment. There was a high attrition rate among support staff due to bullying issues. A significant risk was identified where only one employee managed the needs of a complex tertiary speciality. This level of dependency on one individual for a critical service is not in line with best practice and created a vulnerability in this specialty. The report also sets out a series of actions that were taken on foot of the report. 'A cross-city CHI Central Referral's Office was established. This system manages referrals centrally to ensure equitable distribution. Efficiencies have been gained, and this process is being rolled out across all CHI specialties,' it said. CHI now has a robust process for NTPF-funded waiting-list initiatives 'CHI now has a robust process for NTPF-funded waiting-list initiatives which requires multiple internal stakeholder approvals both clinical and financial. CHI is regularly audited by the NTPF.' It added: 'A review of all CHI Hospital sites leadership roles and responsibilities was commenced to provide clarity around delineation of accountability at site and executive level – this work has continued as the transformation programme has evolved in preparation for the move to the new children's hospital.' The original report stated that a negative culture can impact service delivery, department dynamics and staff experience and has the potential to put patients at risk. It said that CHI is a learning organisation and service improvements through internal reviews and clinical audits, which are an essential tool to support this, will continue to be a priority. 'CHI recognises the importance of transparency and the interests of the broader public in relation to the issues identified in the report,' it said.
The Journal
5 days ago
- Health
- The Journal
Children's Health Ireland publishes summary of 2021 report, identifies 'bullying issues'
CHILDREN'S HEALTH IRELAND (CHI) has today published a summary of the 2021 report into the organisation's culture, the use of NTPF funded clinics, and the standard of care it offered to children. CHI noted that the original review was meant to be private, confidential, and not for publication. The Health Minister Jennifer Carroll MacNeill has repeatedly called for it to be published after large parts of it were leaked to the media and politicians. CHI has been in charge of children's health services in Ireland since 2019. It has been scandal hit over the last year, over the use of unauthorised implants in children's spinal surgeries, and unwarranted hip surgeries being carried out on children, which was initially reported by The Ditch. The Sunday Times also reported on unpublished findings that a consultant breached HSE guidelines by referring patients he was seeing in his public practice to weekend clinics that he was operating separately. The consultant was paid €35,800 via the National Treatment Purchase Fund (NTPF), which aims to cut waiting times by paying private practices to treat patients on public waiting lists. A summary of the 2021 report published today says that 'serious issues of concern' were identified within CHI, including 'bullying issues' and a poor working environment as a result. It further said HR processes ensued as a result of the initial report. The summary states that there was a high level of dependence on one employee who managed the needs of a complex speciality, and that this was not in line with best practice. It also says that the NTPF funded waiting list initiative did not follow guidelines on chronological scheduling, meaning patients who were on the waiting list the longest were not seen first. CHI today said that no open disclosure to the families of children with undescended testes who faced a delay in their care, as there is 'no scientific evidence' that they were harmed as a result. Advertisement CHI said that patients seen in a weekend outpatient clinic, which was funded by the National Treatment Purchase Fund, were placed on an 'already long' inpatient waiting list 'without consideration of redistribution of patients to colleagues with a shorter waiting list'. The 2021 internal review raised the possibility that this practice could have led to 'negative outcomes for patients'. The 2021 report said that patients with undescended testes, who required orchidopexy surgery, were at that time waiting 'far in excess' of the recommended time frame for treatment, placing them at a 'real and known risk for fertility issues and or cancer later in life'. It said that these patients were being placed on a long inpatient waiting list when there was an alternative cohort of experienced general surgery consultants who could have managed their care 'in a much shorter time frame', which would have mitigated or eliminated the risks. 'There are numerous studies and guidelines which outline that optimum timing for undertaking orchidopexy is between 6 months and 18 months of age,' the report said. It further stated that at the time of the report, there were ten patients on a urology inpatient waiting list, referred through the NTPF clinics, who required the surgery. 'These children are beyond the threshold of 18 months as were referred for care and treatment in 2019,' it added. The report noted that as of 7 October 2021, were an additional 20 patients referred with undescended testes. The summary report published by CHI today said that a review of the relevant inpatient waiting list took place and patients were redistributed across the department to ensure 'equitable access to treatment'. 'This action was closed out in September 2022. Open disclosure was not carried out as there is no significant scientific evidence that delaying treatment will equate to patient harm in this patient cohort,' CHI said in its report today. 'CHI now has a robust process for NTPF funded waiting list initiatives which requires multiple internal stakeholder approvals both clinical and financial. CHI is regularly audited by the NTPF,' it added. Senator Tom Clonan today said that he has become aware of 'dozens of disabled children becoming infertile due to a lack of routine surgical intervention'. 'This is de facto sterilisation in Ireland,' he said. Readers like you are keeping these stories free for everyone... A mix of advertising and supporting contributions helps keep paywalls away from valuable information like this article. Over 5,000 readers like you have already stepped up and support us with a monthly payment or a once-off donation. Learn More Support The Journal
BreakingNews.ie
5 days ago
- Health
- BreakingNews.ie
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. Advertisement 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. Advertisement 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.' Advertisement 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. Advertisement 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. Advertisement 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.'
Irish Independent
5 days ago
- Health
- Irish Independent
Parents whose children were centre of concern in CHI internal review not informed, summary reveals
The revelation emerged in a summary of the findings of an internal CHI report into the handling of extra clinics, paid for by the National Treatment Purchase Fund (NTPF) to reduce waiting lists. It said the review found that 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. 'The examination raised the issue as to the possibility that this could have led to any negative outcomes for patients,' it said. However, the summary, which also includes follow-up actions, said an examination of the relevant inpatient waiting list later took place and patients were re-distributed across the department to ensure equitable access to treatment. 'This action was closed out in September 2022.' It said 'open disclosure' – informing parents about the concerns raised in the report – was not carried out 'as there is no significant scientific evidence that delaying treatment will equate to patient harm in this patient cohort'. CHI, which has declined to publish the full report for legal reasons, said it was an internal examination commissioned by the CHI Executive. The hospital involved has been previously identified as Crumlin Hospital by CHI chief Lucy Nugent. During meetings (2020/2021) between employees in this clinical department and members of the CHI Executive, it became evident that multiple legacy and deep-rooted issues existed that regular meetings could not address, it added. It became clear that a more robust process was required to identify the issues that needed to be addressed 'In early 2021, an operational lead was assigned to look into these issues. However, it became clear that a more robust process was required to identify the issues that needed to be addressed.' It led to the examination taking four months. ADVERTISEMENT It said that a number of issues were raised in relation to an NTPF outpatient waiting list initiative. The NTPF funds hospitals to carry out extra clinics and procedures. The examination suggested that based on the documentation review, certain NTPF-funded clinics did not adhere to NTPF standards of chronological scheduling – seeing the longest-waiting patients first. Data suggested that some of these patients could have been seen by other departmental colleagues within the existing day-to-day service and potentially managed in a more proactive way. '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. The examination raised the issue as to the possibility that this could have led to any negative outcomes for patients,' it said. 'The above raised concerns relating to the prudent and beneficial management of NTPF funding and lack of oversight of access initiatives.' It found that interpersonal difficulties among team members led to poor working relationships and a challenging working environment. There was a high attrition rate among support staff due to bullying issues. A significant risk was identified where only one employee managed the needs of a complex tertiary speciality. This level of dependency on one individual for a critical service is not in line with best practice and created a vulnerability in this specialty. The report also sets out a series of actions that were taken on foot of the report. 'A cross-city CHI Central Referral's Office was established. This system manages referrals centrally to ensure equitable distribution. Efficiencies have been gained, and this process is being rolled out across all CHI specialties,' it said. CHI now has a robust process for NTPF-funded waiting-list initiatives 'CHI now has a robust process for NTPF-funded waiting-list initiatives which requires multiple internal stakeholder approvals both clinical and financial. CHI is regularly audited by the NTPF.' It added: 'A review of all CHI Hospital sites leadership roles and responsibilities was commenced to provide clarity around delineation of accountability at site and executive level – this work has continued as the transformation programme has evolved in preparation for the move to the new children's hospital.' The original report stated that a negative culture can impact service delivery, department dynamics and staff experience and has the potential to put patients at risk. It said that CHI is a learning organisation and service improvements through internal reviews and clinical audits, which are an essential tool to support this, will continue to be a priority. 'CHI recognises the importance of transparency and the interests of the broader public in relation to the issues identified in the report,' it said.
