What future for Children's Health Ireland?
The stream of controversies surrounding Children's Health Ireland (CHI) have placed the spotlight on the body which is charged with governing and operating the three paediatric hospitals in Dublin - Temple Street, Crumlin and the National Children's Hospital at Tallaght.
The events of recent months have shocked parents, the public and the political system.
A series of damning reports, the resignation of CHI's chairperson and four board members recently, plus several changes in the senior management, has placed a question mark over its future.
With further review reports to be published, more damaging revelations are expected.
Is CHI capable of managing the largest transformation project in the history of Irish healthcare, with the move to the new National Children's Hospital?
2019
CHI was established in 2018 as a statutory body and it took over governance of the three hospitals the following year. Its CEO reports to a 12-member board, which includes the chairperson. The board usually holds around 25 meetings a year, and a minimum of six.
Board members work on a voluntary basis and receive no remuneration, except for expenses if claimed. In 2023, only two members claimed expenses.
After the recent HIQA report into spinal operations, Prof Browne stood down as chairperson and in the past week, four other board members resigned; Dr Gavin Lavery, Brigid McManus, Catherine Guy and Mary Cryan.
That leaves Dr Ruben Diaz, Mary Donovan, Jim Frawley, Orla O'Brien, Eleanor O'Neill and Joe Quinn. On Thursday, Minister for Health Jennifer Carroll MacNeill appointed two members to the board, both of them existing board members of the HSE, Dr Yvonne Traynor and Anne Carrigy.
The last published annual report for CHI for 2023 shows that there were six meetings of the CHI Quality and Safety Committee during that year. The committee's role includes providing a level of assurance to the board on appropriate governance structures, processes, standards and controls relating to quality and patient safety.
The committee also has several external members.
Minister Carroll MacNeill has pointed out that the CHI Board is a different construct to anything she has seen in her time in public service. Of the 12 members, eight are appointed by the board itself and four by the minister. She has committed to looking at this issue.
Why was CHI established?
Usually in the health service, the HSE is responsible for running services for patients. However, it is the biggest public sector employer with over 130,000 staff and a massive budget of over €25m a year.
The rationale behind setting up CHI lay in the singular job of bringing the three children's hospitals in Dublin together, for the move to the long-delayed and costly new National Children's Hospital, due to open next summer. In itself, it is a mammoth task.
CHI is also responsible for an Urgent Care Centre for children open at Connolly Hospital in Blanchardstown and at Tallaght Hospital.
First Chief Executive Officer
The first CEO of CHI was Eilísh Hardiman, appointed in 2019. Last year, she left that post and moved over to a strategic role in CHI and was paid an equivalent salary to her CEO role.
The Public Accounts Committee (PAC) in the Dáil heard recently that CHI paid an undisclosed settlement to Ms Hardiman after she left her CEO post, even though her contract had come to an end. This is subject to a non-disclosure agreement.
The PAC was told the reason for keeping Ms Hardiman was that a change in leadership was coming at a critical time and it would be important to retain the knowledge of the previous chief executive.
The new CEO is Lucy Nugent who took up her post in January this year and had been CEO of Tallaght Hospital since 2019.
Governance concerns
Late last year, RTÉ News revealed details of a 2024 review of Operational Readiness at CHI, conducted by consultants KPMG. This was commissioned by the HSE.
It questioned the operational readiness to commission and operate the new National Children's Hospital at the St James's Hospital campus.
The report also pointed to gaps in senior leadership teams, a sub-optimal clinical governance structure, a lack of clarity around the future operating model and resourcing of the new hospital, plus the drift in expected completion dates.
KPMG found clearly marked differences in culture and organisational maturity across the three children's hospitals.
The report also found that pressures on the hospitals, in particular with waiting lists and patients waiting for scoliosis surgery, were placing considerable strain on key personnel and the organisation as a whole.
Plus, the absence of a permanent CEO at the time and the arrangement of having an acting CEO, who had to combine duties with a large element of her deputy CEO/COO portfolio, was a challenge.
Minister and the CHI Board
Minister Jennifer Carroll MacNeill explained this week how she has a different relationship with the CHI Board in statute, than any other minister has with most other boards.
She described it as "an unusual structure" and she does not have the authority to ask people to step down in the way that might normally be expected.
The minister also said there were "toxic behaviours" within CHI that had been allowed to develop over time. She said these were individuals who were very defiant and who had not gone along with what the noard and the executive and the broader thrust of public policy has been.
Given that health staff at the three children's hospitals are paid by the public purse and have contractual obligations, this is a serious matter that needs to be resolved urgently by the employer in the public and patient interest.
Latest crisis
As a result of recent reviews, we now know that many hip surgeries on children at Temple Street and Cappagh Orthopaedic hospitals were not necessary. It is important to note that Crumlin was also included in the review, but it was found not to be conducting unnecessary hip operations.
Parents of around 1,800 children are being offered independent reviews and this process will take months.
There were serious spinal surgery incidents and use of unapproved springs by a consultant at Temple Street and Cappagh. This consultant is on leave. A separate review by UK expert, Mr Selvadurai Nayagam, into these matters is due to be completed soon.
And last weekend, the revelation that a consultant was referring public patients to his own private weekend clinics for work paid for by the National Treatment Purchase Fund (NTPF).
The NTPF has clarified that it only ever pays hospitals directly and never consultants.
The internal report by CHI into this affair is expected to be published soon.
Can CHI survive?
It is difficult to see CHI surviving in its current form, given these events and more very difficult reports to be published.
The Minister for Health has appointed two HSE Board members to the CHI Board to strengthen governance. But will that be enough?
Because the CEO of CHI reports to the board, a functional board is needed for CHI to properly operate and progress the move to the new children's hospital.
Opposition politicians have called for CHI to be subsumed into the HSE.
But there are questions as to whether the HSE could, or would, even want to absorb a body, with so many challenges ahead, given that the HSE is going through its own recent transitional reforms to six new health regions. So, this poses major challenges, with a year to go before the planned move to open the new National Children's Hospital.
I spoke to some medical staff for the purposes of this analysis. A common view is that the only way to sort the mess out is to work at an organisational level, to massively improve culture, corporate and clinical governance. Otherwise, the project could be in existential danger.
Some senior staff believe that realistically, the hospital may not open until around April 2027 and that it would be better to set that date now, rather than be endlessly adjusting. Staff planning is impossible with a moving target and the uncertainty can be corrosive.
Merger of hopsital
Merging hospitals with different cultures and staff is very difficult.
We have been here before a few times.
In the late 1990s, I covered the merger of the Meath, the Adelaide and the National Children's Hospital, Temple Street into what became Tallaght Hospital. It opened in summer 1998 and the first few years were fraught with difficulties. It takes a long time for a new hospital to bed down.
Before that, there was the merger of Jervis Street and the Richmond Hospitals which became Beaumont Hospital. It opened in November 1987 and faced its own teething problems and divisions.
Inevitably, bringing hospitals together and the personalities and competing departments within them will be testing. There are also concerns that a considerable number of staff could decide to leave in the transfer, if the situation looks gloomy.
The priority for the new National Children's Hospital must be the patients and their parents.
Also, staff have a right to work in a good safe, working environment, under transparent governance.
CHI will be coming before the Oireachtas Health Committee soon to answer many of the questions posed here.
Conclusion
The Government must bring clarity to the future of CHI quickly, as well as reassuring the public that the service is safe.
It will likely want to have receipt and publication of all of the reports before making final decisions.
The report by Mr Nayagam is likely to include findings and recommendations on governance also, so that will be very important too.
Strengthening the CHI Board with new appointments should also help and other board vacancies still need to be filled.
With just a year to go before the new national paediatric hospital is due to open, there is very limited time to get the operational structure right.
CHI has been faced with so many challenges that it has largely been focused on managing business as usual for the three hospitals, and has had little time for planning the big move.
The decisions facing the Government and the Minister for Health are incredibly serious, as on them hinge the future of healthcare for children, for the next decade and beyond.
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Irish Examiner
41 minutes ago
- Irish Examiner
Sex File: Sex while trying to conceive is becoming a chore rather than pleasure
My wife and I are trying to have a second child, but more than a year in, sex has become a chore rather than a pleasure. How can we make things fun again? Especially with a toddler on the loose. There is a ton of information online about how much sex you ought to have to get pregnant but a lot of it merits a pinch of salt. The HSE advises sex every two to three days, but that's a lot of sex. Results from the most recent National Surveys of Sexual Attitudes and Lifestyles (Natsal) in 2019 show that the median number of times couples in Britain have sex a month is three. The median is not to be confused with the mean, which is an average including people having no sex and those who are at it five times a night. The median is less susceptible to outliers, making it a more accurate reflection of what most people are doing. Natsal data suggests that couples have sex about 36 times a year, which seems very low. In contrast, the HSE suggests upping that figure to a minimum of 104 times if you want to conceive. No wonder you are finding it all a chore. A year is a long time, and I can understand why you might be concerned, but you've got a toddler, so you've got enough on your plate already without putting extra pressure on yourselves. I know many parents want their children to be close in age, but medical advice is that women should wait at least 18 months between giving birth and getting pregnant. Most couples (about 84%) will conceive naturally within a year if they have regular unprotected sex, and the HSE advises those who don't to consult their GP. However, unless your wife's age is an issue, I suspect your GP would simply tell you both to relax. Although that might sound patronising, there is a lot of research to support the fact that chilling out is beneficial for human fertility. In 2011 the statistician and epidemiologist Germaine Buck Louis tested the saliva of 274 women aged 18 to 40 for biomarkers of stress across six menstrual cycles. The study showed that stress significantly reduces the probability of conception on each and every day during the fertile window. In 2014, the results of a similar experiment, which followed 501 couples for up to a year as they tried to conceive, showed that the most stressed women had a 29% reduction in fertility. I won't bore you with the studies that have shown male stress can impair libido and reduce fertility, sperm count and sperm mobility, but the point is, you have had 12 months of hope, anxiety, disappointment and disillusionment, on top of the exhaustion of parenting, so it is time you and your wife had some fun. I suggest getting away without your toddler. Enlist the help of grandparents and tell them that if they want more grandchildren, they need to step up and give you a break. A study of 2,800 women by BabyCenter in the US said that nearly 50% of those who took so-called conception-moons got pregnant. While no one can guarantee that being able to stay up late, having fun, then lying in the next morning, having sex will lead to pregnancy, I do know that it will reset the dial by reducing stress levels, and that's got to be a good thing. Send your queries to
Irish Examiner
2 hours ago
- Irish Examiner
'No faith in the system' as mother waits year for epilepsy drug inquiry
Debbie Adams has been waiting a year to address an inquiry into the prescribing of epilepsy medicine containing Valproate to pregnant women. Her daughters, aged 13 and 11, were diagnosed with Fetal Valproate Syndrome (FVS) in 2020. This came after years of diagnosis for individual symptoms. Their youngest daughter also had double surgery for hip dysplasia at Temple Street Hospital. A letter advising that she needs a review as part of investigations into these surgeries has only added to the worries for Debbie and her husband. Last June, an inquiry was launched into the prescribing of valproate, which can cause serious birth defects and development disorders. Families were told the inquiry would begin "within weeks" but there is still no sign of it starting. Debbie chose not to attend the launch event. 'I wanted to get excited but the pessimistic side of me said 'how long are we going to be waiting?' and that's probably why I didn't go," she said. One year on, she is just tired. 'I've no faith in the system,' she said. This should not have happened. This has changed the trajectory of our family's life. She wants answers: why does she have a wall-planner in the kitchen covered with therapy appointments? 'The children have grown up like this and they think everybody's life is like this. We had different dreams for them,' she said, tearfully. The HSE now advises if a woman or girl becomes pregnant while taking valproate (brand name Epilim), their baby is at risk of serious birth defects and developmental and learning disorders. Debbie, who has been taking Epilim to control her epilepsy seizures, recalled speaking with her neurologist when pregnant with Isobelle. Debbie Adams took Epilim to control her epilepsy seizures. Picture: Moya Nolan 'I was warned about spina bifida and cleft lip and palate; they were the two things that I was aware of,' she said. She was relieved early scans showed no signs of these but does not recall discussion of wider risks under Fetal Valproate Syndrome (FVS). Isobelle and her sister Isla, who uses a mobility scooter, faced similar challenges as babies. 'My youngest was showing all the same delays — not crawling, not walking, not speaking, and I said this can't be normal to happen twice in the one house,' she said. She was reassured during a neurology appointment about any potential links to her medication. But soon afterwards, while in Portugal at a family wedding, she saw a report from the British parliament on Sky News. Devastating information They were talking about FVS, and she recalls racing out to find her husband to share the devastating information. Returning home, they met up with Karen Keely, founder of patient group OACS Ireland, which represents more than 130 families. 'It's a horrible reality,' she told the Irish Examiner,sitting in Karen's kitchen. 'You live in fear for them [the children] for when you're gone.' She pointed out that despite pledges to support affected families, they still had to battle long waiting lists and delays for therapies. She is aware of recent High Court cases taken by other families struggling for answers. 'For me that was like validation, it's happened, acknowledgement somewhere has taken place,' she said. Ms Keely said families feel "absolutely disgusted' by the delays to the inquiry. She said people want 'acknowledgement this has happened; harm has happened'. The Department of Health said when work on data protection issues are finished, 'it is anticipated that the public-facing elements of the inquiry will commence shortly thereafter". No definitive timeframe was given.
Irish Examiner
2 hours ago
- Irish Examiner
Life Hack: How to deep clean a bathtub for a sparkling soak
It's where we wash ourselves, but when was the last time you gave your bath a decent deep clean? You may think a regular flow of running water keeps things clean but there's more dirt lurking in a bathtub than you may expect. After bathing or showering, you should rinse away any residue immediately. Leftover soap and shampoo as well as oils and dirt from your body can stick to the surface, drying to form grime and soap scum. Similarly, the items you leave around the bath can harbour bacteria. The pieces to be aware of include bath mats, loofahs, razors and even the shampoo and body wash bottles that remain wet and sit on the surface of the bath – these can trap moisture and soap beneath them, allowing bacteria, mildew and mould to develop in those damp conditions. An occasional quick cleanup won't cut it if you're skipping deep cleaning. In particular, hard water residue can cause stubborn stains if not monitored and cleaned regularly. How to clean a bath First, remove all bottles, mats, accessories and toys from the bath area. These should also be cleaned separately or else you could be returning dirt to your freshly cleansed bath. With hot water, rinse the bath to wash away any loose dirt. To tackle soap scum and general grime, you can mix together a cleaning paste with bicarbonate of soda (baking soda) and washing up liquid. Mix together a 50/50 ratio of these, with a few drops of vinegar if needed, and apply the paste all over the tub. Focus particularly on stains, around the drain, and where water gathers. Let the mixture sit for half an hour. Using a non-scratch sponge or brush, work the mixture into the surface. Pay particular attention to corners and any awkward gaps and crevices, as well as around the tap and drain, and also any grout around the area. For hard-to-reach areas, use an old toothbrush to scrub. Hard water is a common issue in Irish homes and it can cause mineral stains around your tub. If you are trying to remove these, spray them with vinegar and let it sit for 15 minutes before scrubbing. Another frequent problem caused by the damp atmosphere of a bathroom is mould and mildew. For these, bleach will be the moost effective treatment. Add ne part bleach to 10 parts water and apply this to the mouldy area. Let it sit for 15 minutes before rinsing it away thoroughly. Once you have finished deep cleaning the surface, rinse off all cleaning agents and residue with hot water. Wipe down the surfaces with a microfibre cloth to dry them and prevent water spots from forming. You can use some glass cleaner on chrome fixtures to restore extra shine. Clearing drains Don't forget to give your bathtub's drain some TLC while you're cleaning. You can pour baking soda and vinegar down the drain, followed by hot water to dislodge any blockages. If you still have a slow drain of water, you can use a drain cleaner: a long wire with a small brush attached at the end. Feed the brush end into the drain, twisting and pulling regularly to dislodge debris like hair that may be causing a blockage. Cleaning accessories Now that your bath is squeaky clean, you won't want to return grimy accessories to it. As mentioned above, your bath mat may be harbouring lots of bacteria. While cleaning your bath, you can soak it in vinegar and water to disinfect it. Rinse it and return it to the bath. Similarly, a shower curtain can become damp and mildewy. Luckily, this is easily cleaned: just pop it into your washing machine with your towels on a gentle cycle to refresh it. Give those shampoo bottles a clean too before returning them to the area, and if you have any bath toys for the smallies, as these are generally made of plastic, they can be popped into the dishwasher on the top rack to be cleaned.
