logo
Letters to the Editor, May 26th: On clinical governance, starlings and Leaving Cert weather

Letters to the Editor, May 26th: On clinical governance, starlings and Leaving Cert weather

Irish Times25-05-2025

Sir, –I have read the audit report of surgery for developmental dysplasia of the hip, in Crumlin, Temple Street and Cappagh, from an experienced UK-based paediatric surgeon. It makes for most disturbing reading.
In some ways the most disturbing feature is that a protected disclosure was required to draw this substantial variation in clinical practice to the attention of the Children's Health Ireland (CHI) board.
This seems to be another serious failure of clinical governance in Ireland. There are many similar audit reports over the last 30-plus years, into maternity services, CAMHS, disability services and others. In most cases, the matter was drawn to public attention by a whistleblower, some of whom suffered badly as a result. In many cases, though mercifully not here, people died. There is no comparable data on private services.
Health service boards have an absolute duty to ensure that there is good clinical governance in place, and that the necessary information on activity and outcomes is both collected, and used. All too often this has not been done, with adverse consequences for patients, their families, and health service staff.
READ MORE
It's time to do better across all of our health services, public and private.– Yours, etc,
ANTHONY STAINES,
Professor of Health Systems,School of Nursing,
Psychotherapy, and Community Health,
Dublin City University,
Dublin.
Weathering the Leaving Cert
Sir, – The continental weather of the past few weeks put a broad smile on our faces and presented us with a glorious opportunity to enjoy outdoor living at the beaches, lakes, parks and walkways. The good weather lifted our spirits and the whole country was an oasis of good humour, friendliness and joie de vivre.
However, parents and grandparents of students preparing for the state exams, which begin on the 4th June, were becoming increasingly concerned about the difficult conditions in which students were preparing for the exams.
The dawn-to-dusk sunshine must have tested the resolve of even the most conscientious student. But exam students are made of stern stuff and diligently attended classes, maintained their study schedule and covered themselves in sunblock when they were out and about. No student wants to face important exams with a sunburned body.
Students have done the hard work during the year and are determined to reap the rewards in the state exams. They deserve to do well and achieve the results that will enable them to progress to the next phase of their education or training.
At the risk of coming across to sun worshippers as a party pooper, I sincerely hope that the weather in the lead up to and during the exams period will be temperate. It's not easy for a student to thrive in a stifling exam centre in 20C plus temperature.
Best of luck to all students beginning state exams on 4th June. Go in there and give it welly as it's all to play for. Then, when it's all over, forget about it and enjoy the summer, whatever the weather. Carpe diem! – Yours, etc.
BILLY RYLE,
Spa,
Tralee.
Taxing vacant property
Sir, – In May 2023 Spain passed the Housing Law (Ley de Vivienda) in response to the serious social issue of a lack of affordable housing while many homes and premises were vacant.
Previously, owners of every Spanish property, occupied, vacant or derelict, paid a 0.4 per cent to 1.1 per cent tax on the rateable value of the property on December 31st every year. Now, owners of vacant or derelict properties, if vacant and derelict after two years, will pay a surcharge of 50 per cent, rising to 100 per cent after three years and 150 per cent if the owner has two or more properties.
In France, people have paid taxes on all their properties in various forms since Napoleonic times. In both countries, much of the considerable revenue so raised can go towards building social housing.
But in Ireland, derelict properties are somehow exempt from property tax. Your editorial (May 17th) argued that the collection of the new levies on derelict properties by local authorities takes an a la carte approach, with €20.5 million outstanding. Such behaviour would not be tolerated in Spain and France, and as few can afford to have derelict properties, there is a greater distribution of property and a more attractive living environment for all.
Our Revenue is very efficient, if not ruthless, collecting the Local Property Tax with 97 per cent compliance. Why shouldn't they collect the taxes on all properties? According to the 2022 census, there were 163,433 vacant homes in Ireland, 48,000 of whom were empty since 2016. This translates to over 10 potential homes for every single one of the 15, 378 men, women and children in Ireland today accessing emergency accommodation.
Finally, if we legislate to tax vacant and derelict properties, they will be cheaper for the struggling Buy and Renew Scheme, and the generous grants of up to €50,000 we give to owners to make their derelict properties viable, can come from the taxes they pay. – Your, etc,
DAMIEN MCLELLAN
Faithlegg,
Co Waterford.
Wrong role
Sir, – Friedrich Merz attended a 'role' call for soldiers in Vilnius (
Merz vows to defend Nato territory as German troops deploy in Lithuania,
', Foreign news, May 23rd).
I wonder what play they were preparing for?
Yet another example of sloppy language which has become increasingly frequent in the paper of record.
Does nobody proof-read anymore? –Yours etc
Seamus MacGearailt,
Monkstown,
Co. Dublin.
Students have medical issues
Sir, I am a 4th year medical student, already most of my Irish classmates are talking about moving abroad, to Australia, Canada, The USA, and elsewhere. More than half of the students enrolled in my course are international students, the overwhelming majority of whom will return home.
As a result of this about a quarter of students trained under my program will remain in Ireland. What a complete waste of resources to train so many people for other countries healthcare systems. I believe Ireland would benefit greatly from retaining more doctors and I think that's obvious to anyone.
So what to do?
Maybe we should have optional incentives and agreements to keep Irish doctors at home, perhaps paid fees and/or provided accommodation in return for a few years working in the HSE post graduation. With my college turning a ¤30 million surplus last year, the financial cost of this is negligible, and well worth it for retention of our physicians. I know that many would accept an offer like this due to the personal saving in rent and fees.
Or perhaps, could the number of places in Irish medical schools for Irish students be more than half of the places? This completely baffles me. Clearly this is due to the vast sums of money gleaned from international students (€60,000 per annum) but since when were our third level institutions for profit companies?
There are obviously a plethora of reasons people leave, housing, work/life balance etc.
All of these need addressing urgently, for a long term solution, but these two things could be implemented now.
From a student sad to know most his friends will be leaving for the far side of the planet, could someone please do something? –Yours, etc,
CIAN SEARING
Maddenstown south,
Co Kildare
Starling service
Sir, – Seagulls have an awful reputation as aggressors, Starlings I would argue have a similar menacing intent. Today, having decided on an outdoor lunch, myself and one such bird did battle.
No sooner had I half a toastie unwrapped, he appeared. He was well practised and knew all the right positions from which to plan his attack. While I was successful in frightening him the first few times he came near, he grew with bold with confidence. He moved, I moved, matching move for move keeping his eye on the prize.
The attention of the outdoor area became fixed upon bird v human shadow boxing for a significant corner of a toastie. A passerby tried to scare him away to no avail.
I eventually conceded I would have to move indoors, so disputed corner of the toastie in hand,
I gathered book, phone, purse and remaining half, he seized his opportunity, dive bombing my hand to successful take some of the corner.
It didn't do much for my own confidence to have a tiny bird bully my lunch from me, but you'd have to admire the tenacity of the Starling all the same, a lesson to us all! – Yours etc,
NIAMH BYRNE,
Fairview,
Dublin 3.
Go whistle
Sir, –Having confirmed it wasn't the 1st of April, I enjoyed the headline on the piece (
Flute teacher to appeal WRC ruling he was not a whistleblower' - Irish Times 23rd May)
.
I wondered who compiled the ruling – the Recorder perhaps? – Yours, etc,
BRENDAN MURPHY,
Greenhills
Dublin 12.
Syria needs humanitarian aid
Sir, –The recent decision by the US administration to lift all sanctions on Syria is a welcome and historic development during a time of great uncertainty in the Middle East. This move, following similar actions by the EU and the UK, creates a significant opportunity.
Away from the capital Damascus and beyond some of the larger cities, Syria remains in ruins. The humanitarian needs are overwhelming.
Fourteen years on, GOAL's work in Syria continues and, as ever, has had to adapt to the humanitarian community's fresh challenges. Among our programmes, GOAL is currently working with local authorities to provide clean water to 500,000 people inside the country.
This involves the operation and maintenance of existing water supply networks and the provision of solar power for water pumping stations at a time when the current government is struggling to meet the demands of its people.
We are yet to witness a large-scale movement of Syrians displaced by the war from the northwest of the country to their homes elsewhere in Syria. Whilst security is a concern, the fact is that basic infrastructure is in dire straits and requires significant investment. This is a result of years of war, neglect, corruption, and sanctions – some of which had been in place since the mid-1970s.
Syrians who go back to visit often find that there is nothing to go back to in terms of housing, jobs, education, and basic services. Therefore, they are forced to stay in the places they were displaced.
The geopolitical importance of Syria can't be understated. The lifting of sanctions gives Syria a shot at peace and presents its neighbours, including Lebanon, with an opportunity to rid themselves of negative foreign interference.
The population of Syria and the wider Middle East region deserve better. – Yours, etc,
COLIN LEE.
Director of Programme
Operations,
GOAL.

Orange background

Try Our AI Features

Explore what Daily8 AI can do for you:

Comments

No comments yet...

Related Articles

Children's health crisis will roll on until there is transparency about how public money is spent
Children's health crisis will roll on until there is transparency about how public money is spent

Irish Times

time5 hours ago

  • Irish Times

Children's health crisis will roll on until there is transparency about how public money is spent

The fallout concerning the use of funding from the National Treatment Purchase Fund (NTPF) in a Children's Health Ireland (CHI) hospital continues. The story that emerged in the media over a week ago painted a picture of a rolling crisis, after a confidential internal report raised concerns about abuse of waiting lists and a toxic work culture . That report will now be referred to gardaí by the HSE. The report in question focused on five special weekend outpatient clinics for 179 children carried out by a consultant at a public hospital. These clinics were funded by the NTPF and the consultant received €35,800 for seeing the patients. However, the report questions whether the young patients could have been seen during the consultant's HSE contracted hours or referred to his colleagues. There were also concerns about potential clinical failures regarding vulnerable children, who may have been left waiting longer than they should have been for important treatment. READ MORE And yet again, the report raises serious questions about professional ethics, conduct and clinical care in CHI, coming hot on the heels of the publication of two separate damning reports on children's orthopaedic surgery failures. We still know don't exactly what actions were taken to address the alleged potential misuse of NTPF funds and whether there may be further similar cases in CHI. The news that the report has been referred to gardaí – amid temporary pausing of NTPF funding, which is now due to be lifted 'imminently' – and promises of action and reviews, as well as the 'ongoing' roll-out of a new central referral management system for all services in CHI, suggests that there is much more to come. Whatever happens, it is unacceptable if the Department of Health , the Minister, the NTPF and the HSE were left in the dark about the whole affair until it was reported in the media, as has been suggested. We are expected to accept promises that it won't happen again, that action is being taken, and – well, you know the drill. But what about the bigger picture – oversight and transparency on how we are spending our healthcare budget, and, crucially, if it is being best used to provide care for patients? This year the HSE has a record €26.9 billion in funding , and staffing levels have increased by 23 per cent in the last five years. There are many new services, and bed numbers are continuing to grow to meet escalating demand. Our population is now 5.3 million. The Irish health system seems inexplicably reluctant to carry out routine audits and set standardised targets, as the continued large variations in productivity between services, gaps in basic performance data, and resistance to many oversight initiatives shows The question is whether we are getting the best value for money and access to services commensurate with these increases in resources. And where does the NTPF fit into all this? It was set up over 20 years ago to help relieve waiting list pressure in the public system, and was regarded by some as a sort of pressure safety valve to get public patients seen, diagnosed and treated faster; and by others as a sticking plaster for inadequate public capacity. Its budget for this year is an increased €230 million. Last year it facilitated outpatient appointments, diagnostic scans and procedures for approximately 251,000 public patients. It initially purchased appointments in the private sector for patients waiting too long on public waiting lists – known as outsourcing – but in recent years it has moved towards increased use of 'insourcing'. This is essentially overtime: using spare capacity in public hospitals over and above core activity. All governance for insourcing remains with the treating hospital, the NTPF took pains to point out last week. So it, and by extension the HSE itself, claims no responsibility for how its – or rather public – money is spent, once the forms are filled in. The NTPF does publish data on how many procedures and appointments it has paid for, which is more information than many of our health services publicly provide. And now it has written to all public hospitals with whom it funds insourcing work to obtain further confirmation that all work is carried out in line with agreed terms. There has always been the potential for abuse of NTPF funding as consultants can refer their own public patients to their private clinics, or public overtime. There is supposed to be data collection on how often this occurs, with the appropriate governance applied. And in cases where there are only one or two consultants in a highly specialised disease or geographic area, it makes sense to allow them to see these patients in a private/public overtime capacity if they are on a very long waiting list, to ensure timely access where needed and longer-term continuity of care. But surely audit and inspections of the use of NTPF funding in individual institutions should be routine? Each hospital should always be able to fully account for the need for insourcing funds, proving that its own resources, and staffing time, have been maximised under allocated HSE funding. Newer contracts for various healthcare staff allow for longer core weekday working hours and weekend work as normal, but implementation has been piecemeal in some specialities and services, despite the increased cost and staffing numbers. [ 'Fear and distrust': why children's healthcare is in crisis Opens in new window ] In this case, was the CHI hospital paying attention to how many patients were on individual consultant lists? How many they were seeing, and how long were individuals waiting before signing off the NTPF funding applications? The Irish health system seems inexplicably reluctant to carry out routine audits and set standardised targets, as the continued large variations in productivity between services, gaps in basic performance data, and resistance to many oversight initiatives shows. Last year, then-Minister for Health Stephen Donnelly presented data to the HSE board showing a significant drop in the average number of patients seen per consultant, with obvious ramifications for our long waiting lists. And in correspondence on the 2025 HSE budget, he asked the HSE to apply a standardised approach to maximising productivity through agreeing outpatient clinic targets for individual consultants, departments and specialities, and sharing data on outpatient numbers between consultants. A health minister should not have to specifically request what should be done as a matter of course. Our complicated public healthcare system, comprising public, voluntary and private overlapping services – and a combination of old and new working contracts – continues to muddy the waters of accountability and transparency. A key underpinning element of Sláintecare is the unpicking of the various conflicts and competing interests within our health service, increased governance and standardisation. Until its full implementation, whenever that is, far more oversight of all publicly funded services must be applied.

Two HSE staff suspended with pay or on administrative leave for 11 years
Two HSE staff suspended with pay or on administrative leave for 11 years

Irish Times

time5 hours ago

  • Irish Times

Two HSE staff suspended with pay or on administrative leave for 11 years

Two employees in the health service have been suspended with pay or have been on administrative leave for 11 years. Another HSE staff member has been suspended with pay or on administrative leave since 2017 and another since 2018. HSE figures suggested that in 2014-2024 a total of 42 staff were suspended with pay or placed on paid administrative leave. The figures were set out by the HSE in reply to a parliamentary question tabled by Sinn Féin health spokesman David Cullinane. READ MORE Mr Cullinane told The Irish Times he did not know why the HSE personnel had been suspended or on paid administrative leave for so long. He said he would be interested in seeing an explanation from the HSE. The HSE told Mr Cullinane in its reply that 'the cases identified are under active investigation or have some other action pending'. There are more than 130,000 staff working across the public health system in Ireland. The two cases dating to 2014 relate to personnel working in the acute hospital sector and the mental health service. A person suspended or on administrative leave since 2017 also worked in the mental health area, the table provided by the HSE indicates. A staff member suspended or placed on administrative leave since 2018 was based in the acute hospital part of the health service. Asked by The Irish Times for more details on the cases that have been under investigation in some instances since 2014 and why the processes involved have proved to be so lengthy, the HSE said it endeavoured to carry out all investigations as expediently as possible. It said this was in line with the terms of the relevant HR procedures and policies. 'Factors such as legal matters, safety, or other issues can arise which can impact the timelines. 'To maintain the privacy of the individuals involved, the HSE cannot comment on any individual case.'

Letters to the Editor, June 9th:  On relatives in Gaza, minding your manners and Elvis
Letters to the Editor, June 9th:  On relatives in Gaza, minding your manners and Elvis

Irish Times

time10 hours ago

  • Irish Times

Letters to the Editor, June 9th: On relatives in Gaza, minding your manners and Elvis

Sir, – Each morning after digesting updates of the relentless escalation of massacres in Gaza I go to work to continue my job as a junior doctor. I paint a smile on my face and feign optimism to help those in our hospitals with their own illnesses. I tell myself that I am doing all I can to help those around me, both here and abroad. I push the thoughts of the inhumane killing of thousands of babies out of my mind, while I focus on what, and who, is in front of me. I reassure myself that this is the right thing to do; the patients here also require my care and attention. As I greet my colleagues throughout the morning I cannot but be ashamed when looking in the eyes of one particular friend and colleague. This young doctor is from Palestine and moved to Ireland a number of years ago while his family remain trapped in Gaza. READ MORE I once again suppress the anger and disgust that I feel for our Government by our lack of action. Why should this young doctor continue to treat and care for our families while we are sitting watching his burn? – Yours, etc, GRÁINNE YOUNG, Ranelagh, Dublin 6. Sir, – Paul Kearns's article (' The beaches here in Israel are full. Just an hour's drive away, Palestinians are starving', June 7th,) is telling, frightening and saddening. The evidence he cites from his conversations with his Israeli friends about what is going on in Gaza displays a powerful ideological complex at work. Many Israelis, on Mr Kearns's evidence, believe that there 'are no innocents in Gaza', 18,000 dead children notwithstanding. Many Israelis believe that Hamas uses 'human shields' and they deduce from this that Palestinians and Hamas in particular do not value human life as much as Israel does. Even if that is the case, how then does one explain the ferocious ratio the Israel Defense Forces (IDF) is prepared to tolerate of civilian to combatant deaths. Dozens, even hundreds, of Palestinian deaths are permissible to kill one Hamas leader. One is led to conclude, with the great American philosopher Judith Butler, that Palestinian lives are much less valuable than Israeli lives. Many Israelis believe that Hamas 'brought this upon themselves'. This 'argument' does two kinds of work. It detaches the current catastrophe from the longer history of the Gaza Strip and of the Occupation. And it exculpates Israel. This exculpation has been around for a long time. One remembers that Golda Meir, prime minister of Israel in the early 1970s, reckoned that none of the wars Israel fought were its fault. One remembers her declaration that there is no such thing as Palestinians. And one remembers her statement that 'we will perhaps in time be able to forgive the Arabs for killing our sons, but it will be harder for us to forgive them for having forced us to kill their sons'. Israel kills tens of thousands of people but it's the fault of those people. – Yours, etc, CONOR McCARTHY, Valletta, Malta. Standards of care Sir,– For families, the recent disclosures about poor standards of care for sick children in Ireland raises concerns about trust in our healthcare system. For families of children with intellectual disability it is a double whammy. Not only is their child a sick child requiring State care and services for life, but also intellectually disabled children are disproportionately included among the numbers affected by the series of revelations about hip and spinal surgeries. For children with intellectual disability and, in particular, children with cerebral palsy, hip and spine problems are significant issues causing pain and complications which reduce quality of life. Surgery has been the primary treatment for hip dysplasia related to muscle spasticity and for scoliosis of the spine in children with cerebral palsy. Intellectually disabled children and their families are one of the most vulnerable groups in Ireland, and depend on many forms of State service, including the very limited therapeutic interventions, day and respite services and residential care. Families are continuously campaigning for improved services. Following on from the HSE failure to meet the demand for assessment of need, the revelations from Children's Health Ireland (CHI) about unacceptable standards of surgery adds a further burden to the worries and stresses of families of disabled children. Furthermore, it has taken up to 10 months for families to be informed. It is now time for accountability and transparency on how the huge variation in clinical practices have continued for so long. Families need to be reassured about future clinical oversight and governance. It is unacceptable and very unfair that intellectually disabled children are so disenfranchised in terms of all forms of State services, and any outcomes of the CHI inquiries and reports must acknowledge this and make special provision for vulnerable children. – Yours, etc, PROF SEAMUS COWMAN, Inspire, Trustee and board member, Castleknock, Dublin. Exceptional service Sir, – I unfortunately had to visit a major Dublin hospital very recently through the emergency department. From the first person I met and throughout my stay and treatment the care I received can only be said to have been exceptional. Our health service often gets rough press and undoubtedly there are issues mainly in management and governance. But at floor level, on the ward you could not be in a better place. About 90 per cent of the staff who cared for me were not originally from Ireland but have made it their home. I believe we need them even more than they need us. Literally our lives depend on them. Keep it in mind when you meet them on the street. I am sure many have had the same experience as I have had. On my way home now but thank you St Vincent's and all your wonderful staff. – Yours, etc, PAUL MULLIGAN, Dublin 6. Minding your manners Sir, – I am over 66 years of age and entitled to free travel which I regularly avail of and enjoy. Last year I boarded the busy Maynooth train which had no seats available. I didn't mind and was happy to stand with my earphones in, listening to music. I vaguely noted the young man beside me raising his voice. He did so a second time and I heard him say: 'Is nobody going to give the old lady a seat?' I looked around and was horrified to realise that he was referring to me. He repeated his plea a third time and a passenger got up and gave me the seat. My young man looked at me and said: 'There you are love. Your feet must be killing you.' I was mildly amused and regaled my friends with the story for weeks afterwards. Last week I returned from a hillwalking holiday in England and boarded the packed Maynooth train again. I was overdressed for the hot Irish afternoon, wearing my hiking boots, hiking coat and long trousers. Once again there was no seat available. My wheelie case and small backpack were a nuisance at every stop and I was hot and bothered. To add insult to injury a young woman beat me to a seat which became vacant along the route. I reflected on my experience a year ago and wondered where my gallant hero was when I needed him. – Yours, etc, MARY FOLEY, Leixlip, Co Kildare. Sir, – As I approach my 68th birthday this August, I find myself reflecting on an incident that occurred this week aboard the Luas. I took the last available seat, only to be loudly berated by a young woman in her early 20s for, in her words, 'not being a gentleman'. Over the years, like many others, I've tried to be considerate – offering my seat when someone clearly needed it more. But now, with age making its presence felt in my knees, back and balance, I wonder at what age is a man allowed to sit down without being judged? Courtesy should go both ways. Perhaps we should teach our young people that respect isn't just something to be demanded – it's also something to be given, especially to those who've earned it over a lifetime. – Yours, etc, DONAL McKENNA, Naas, Co Kildare. Trump and Musk Sir, – As a self-professed empathetic, honourable, peace-loving, self-aware but mostly super smart person, Donald Trump erred bigly when he gave Elon Musk the house key. But if they kiss and make up, which in their mutual interest they surely must, I suggest they fulfil their stated desire to go to Mars. For all our sakes let it be a one-way ticket. – Yours, etc, EITHNE MacFADDEN, Carrigart, Co Donegal. Elvis is back in the building Sir, – My tenacity has finally paid off and my 18-inch statue of Elvis at 13, previously owned by Priscilla Presley, is now on show in the U2 room of the Little Museum of Dublin. The original life-sized bronze statue of Elvis at 13 is located quite close to Elvis's birthplace in Tupelo, Mississippi, at my suggestion in a letter to the mayor, Larry Otis. A great coup for Ireland. The story appeared in The Irish Times and the Daily Journal of Tupelo etc, way back in 2002. So forgive me Bono. Elvis is back in the building. – Yours, etc, MAURICE COLGAN, Swords, Co Dublin. Planning regulations Sir , – I refer to Margaret Farrell's letter of June 7th, complaining bitterly about the proposed relaxation of some planning regulations. I suggest if she was a 30 year old still living in her childhood bedroom, she might have a different view. – Yours, etc, JOHN LOMBARD, Goatstown, Dublin 14.

DOWNLOAD THE APP

Get Started Now: Download the App

Ready to dive into the world of global news and events? Download our app today from your preferred app store and start exploring.
app-storeplay-store