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Extra.ie
5 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 Pic: File The finding was contained in an unpublished review at CHI, which was leaked to the media.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
6 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.
Irish Independent
6 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.
RTÉ News
6 days ago
- Health
- RTÉ News
'Serious issues of concern' at Dublin children's hospital
A confidential, internal report into a children's hospital in Dublin uncovered "bullying", "significant risk" and "serious issues of concern". The review of Children's Health Ireland (CHI) found that the unnamed hospital's workplace culture had "the potential to put patients at risk". The report was compiled in 2021 and completed the following year. It has been widely leaked in recent weeks. A summary was published today with CHI saying they are legally constrained from releasing the entire document. "The findings primarily focused on issues related to interpersonal relationships, training programmes, patient management, professional conduct and adherence to standards," the summary stated. The summary noted that the report "was never intended to be made public", but the summary is being made available "to ensure that a wider audience" can examine it, while "balancing the needs of a confidential process". "The 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 added. NTPF issues identified The culture "lacked governance and robust processes, and was influenced by strong and challenging personalities", which resulted in 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", the summary reveals, noting that this "created a vulnerability in this specialty," it said. The report also flagged "a number of issues in relation to a National Treatment Purchase Fund (NTPF) outpatient waiting list initiative". "Certain NTPF-funded clinics did not adhere to NTPF standards of chronological scheduling (i.e. seeing the longest waiting patients first)," it siad. The summary said that some patients "could have been the existing day-to-day service" had matters been handled in a "more proactive way". It noted "the possibility that this could have led to any negative outcomes for patients".
Belfast Telegraph
11-06-2025
- Health
- Belfast Telegraph
NTPF funding halted at second hospital over ‘potential financial irregularities'
The National Treatment Purchase Fund (NTPF) said it had suspended all insourcing work at the public hospital since April 11 and immediately informed the Department of Health and Health Service Executive (HSE). The matter had been referred to the HSE's internal audit team. 'The board and executive of the NTPF take their responsibilities very seriously and will take whatever actions are necessary to ensure our spend with public hospitals is fully protected for the benefit of public patients,' NTPF chief executive Fiona Brady said. 'Any proven misuse of public money by public institutions will be treated with the gravity it deserves.' The NTPF, which is a body that arranges external treatments for patients on public hospital waiting lists, has come under scrutiny in recent weeks. It was reported in the Sunday Times that a 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 newspaper said the consultant was paid thousands of euro through the NTPF, and the details were uncovered by an internal investigation by Children's Health Ireland (CHI). The NTPF said on Wednesday that following a meeting of its board, it would immediately recommence insourcing work with CHI after a review of its assurances. But it said that the board and executive 'remain deeply concerned' that there had been a breach of its processes by another public body. It said governance and oversight across its insourcing work with public hospitals – who until now have been responsible for this internal governance – would increase. As well as notifying the Department of Health and HSE of its decision, the NTPF had also written to all public hospitals with whom it funds insourcing work to obtain further confirmation that all work is carried out in line with the NTPF's processes and procedures. A deadline of Monday June 16 has been given for the completion of these replies. 'Insourcing work through the NTPF has delivered benefits to thousands of patients in recent years and has a demonstrable impact on waiting times and waiting-list numbers,' Ms Brady said. 'However, it is vital there is public trust and confidence around insourcing with public hospitals. 'It must be remembered that these public hospitals already have clear and established lines of reporting and accountability within the public system and clear obligations to comply with the terms of the signed memorandum of understanding in respect of NTPF-funded work. 'We will now work urgently with the Department of Health and HSE on any additional measures that may be needed to ensure that necessary controls of NTPF-funded initiatives are in place in the public hospitals.'
