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RTÉ News
2 days ago
- Health
- RTÉ News
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.
RTÉ News
3 days ago
- Health
- RTÉ News
Two new members appointed to CHI board after resignations
Two new board members have been appointed to the Children's Health Ireland (CHI) board. It follows the resignations of four members in the past week. Minister for Health, Jennifer Carroll MacNeill has appointed Dr Yvonne Traynor and Dr Anne Carrigy. Dr Traynor has been a member of the Health Service Executive (HSE) board since June 2019. She was vice president of Regulatory & Scientific Affairs with the Kerry Group. Dr Carrigy has been a member of the HSE board since March 2021. She is a nurse and joined the HSE as Director of the Serious Incident Management Team and later became National Lead, Acute Hospital Services HSE. Minister Carroll MacNeill said the appointments would strengthen governance and oversight at CHI. It comes as Ms Carroll MacNeill announced the resignation of three CHI board members on Tuesday, while another member resigned last week. Speaking on RTÉ's News at One, Ms Carroll MacNeill said she had made it clear that she had "strong questions about the governance of CHI and its direction towards the future". "We've had three resignations from the board. These would be individuals who have worked on the board, worked in [a] volunteer capacity on the board since 2018," she added. The three members are Dr Gavin Lavery, Brigid McManus and Catherine Guy. Mary Cryan also resigned last week. Ms Carroll MacNeill said she had not asked the members to resign, as she does not have the authority to. "I have a different relationship with the CHI board in statute than any other minister really has with most other boards. It is an unusual structure, and I don't have the authority to ask people to step down in the way that you normally might expect," she said. "I want to thank those people for the service that they have given to the public because we recognise that these are voluntary positions, and we are asking people to step out of their other lives to perform a public service in this measure," she added. Taoiseach Micheál Martin said it is "absolutely critical" that there is fundamental reform at the CHI, to ensure there is a multi-disciplinary approach across all areas of medicine which it is responsible for. Speaking in the Dáil, the Taoiseach said there will be an external and independent clinical audit to give assurances to both family and patients. He said there had to be "accountability", given that recent revelations were "deeply deeply worrying".
RTÉ News
5 days ago
- Health
- RTÉ News
Four members of CHI board have resigned in last week
Clip • 6 Mins • 28 MAY • Morning Ireland Ivana Bacik, leader of the Labour Party, calls for Children's Health Ireland to come under the remit of the HSE.
Irish Daily Mirror
7 days ago
- Health
- Irish Daily Mirror
Teen with severe scoliosis will die without 'urgent medical care', parents warn
The parents of a teenager with severe scoliosis have warned that if their son 'doesn't get urgent medical care, he will die'. Mikey Henry-Benson, 17, has been fighting for scoliosis surgery for nearly three years but has not been able to get surgery through Children's Health Ireland for his condition. While he will receive a GP referral to meet consultants at Great Ormond Street Hospital in London to see if they can perform the life-changing surgery, the HSE has confirmed to this newspaper that a consultant's referral is required in order to benefit from any treatment abroad scheme. At nine months old, Mikey, from Ballina, Co Mayo, was diagnosed with a neurological condition called schizencephaly. His parents, Penny Henry and Michael Benson, were told his 'life wouldn't be like other children' and that he would have developmental delays and wouldn't be able to walk or talk. His mother describes Mikey as a 'happy and funny' teenager who loves his friends, school and music. Mikey was not born with scoliosis but the family started noticing a curvature in his spine in 2022. An X-ray showed he had developed scoliosis, and in November 2022, teams in Tallaght told the family he would need surgery. Ms Henry explained: 'Because of the X-ray, they could see the curve starting to get worse. 'We were told that both quality of life and life expectancy are improved if the curve is treated. '[The doctor] said they would get Mikey assessed with a multi-disciplinary team and an anesthesist. But no date was given. 'In February [2024], I raised concerns about Mikey again, and I got a response telling me that there still is no date for Mikey's surgery. 'He was not monitored. His lungs were not monitored. His spine wasn't monitored.' In March 2024, there was still no date for Mikey's surgery and he continued to be monitored at home by his parents, who found that his oxygen levels were very low. At the end of May, he was admitted to Mayo General Hospital and later transferred to Crumlin Children's Hospital, where a pre-op assessment was done. It was found that his lungs were damaged and he had chronic type 2 respiratory failure. Doctors in CHI said they could not do the surgery. Mr Benson stated that as early as June, they asked about how they could transfer to Great Ormond Street in London. Ms Henry said they believe Mikey was treatable when he was in the hospital last summer. Now, they do not know if he is. In April, Mikey and his parents met an American paediatric surgeon in Dublin. They hoped this doctor would provide an independent assessment and refer them to Great Ormond Street. However, no referral was forthcoming. Last week, the family's GP in Mayo said they would refer Mikey to Great Ormond Street Hospital, but the HSE told us a GP's referral would not be enough. Ms Henry said funding had been put aside for scoliosis patients who need treatment in the US or the UK. She said the Government must ensure Mikey can avail of this when he is referred to Great Ormond Street and that he 'shouldn't be left out'. A HSE spokeswoman said patients wishing to access healthcare/treatment abroad, including scoliosis treatment, can use three mechanisms: Treatment Abroad Scheme, the Northern Ireland Healthcare Scheme and the Cross Border Directive. She added: 'A GP referral letter for a consultation is accepted under the CBD and NIPHS, but these schemes do not cover Great Britain [England, Scotland and Wales]. 'Access to treatment in Great Britain is within the scope of the TAS. To access TAS, a public hospital consultant in Ireland must refer you – we do not accept referrals from GPs or self-referrals.' A scheme is in place through CHI to allow children to get their surgery in international facilities. They include Morgan Stanley Children's Hospital in New York and Great Ormond Street in London. But this is only available to 'children who meet the criteria to be deemed clinically suitable, whose consultant in CHI has approved their travel and agreed to take them back on return to Ireland, and the treating hospital abroad have approved their suitability'. Mr Benson added: 'There's one thing for certain – if Mikey doesn't get urgent medical care, he will die. That's for certain.' CHI said they cannot comment on an individual patient's case.
Irish Examiner
26-05-2025
- Health
- Irish Examiner
Novel hip dysplasia surgery risks not properly explained, say parents
Some parents whose children had a novel hip surgery at Children's Health Ireland (CHI) were not offered conventional treatment or told of risks from double-hip surgeries, a solicitor has warned. Several families have now taken legal advice as they are unsure what will happen next. This follows a shocking audit, published on Friday, which showed 79% of hip dysplasia surgeries at the National Orthopaedic Hospital, Cappagh, and 60% in CHI at Temple St did not meet required criteria. A six-month process of review has begun for more than 2,200 children. Ciaran Tansey, a partner with Damien Tansey Solicitors LLP, said parents are worried about how long this might take in reality. 'In terms of the families we represent, it doesn't appear that proper and appropriate prevention of risks were gone through with the families as to the options that were open to them,' Mr Tansey said. This includes options, he said, on 'unilateral or bilateral surgery, or a novel technique, or a more conservative technique'. Parents said they were not told what the novel treatment involved versus what the traditional treatment involved. Some are also concerned their child may have had two hips operated upon when only one was needed. Unilateral hip surgery is for one hip, and bilateral means both hips are operated upon. The audit report said: 'Some surgeons' samples indicated a very high rate of bilateral, rather than unilateral, pelvic osteotomies.' International data shows one third of surgeries for hip dysplasia will be on both hips, the audit states. 'High rates' However, these two hospitals had 'high rates' of bilateral operations above this predicted rate. The audit does not directly address informed consent, but it does say a 'proper process of consent' should be given in future. It gives specific examples of what parents should be told. Mr Tansey said: 'It's almost like Groundhog Day again. We're again looking at orthopaedic services being provided for kids in the main children's hospitals in Ireland. It might be that a lot of the public are lumping these crises together, assuming it's the same crisis 'In reality, it's a parallel crisis in the same hospitals.' Mr Tansey also continues to represent the family of Dollceanna Carter, 10, who was a Temple St hospital patient. The little girl had spina bifida and scoliosis. She died in September 2022, and her death was the subject of a coroner's review and a serious incident investigation by CHI. While CHI's former CEO Eilish Hardiman had pledged this review would be complete by October 2023, it has not yet been published. On Sunday evening, families worried about the hip surgeries met in a Zoom meeting with the Spina Bifida and Hydrocephalus Paediatric Advocacy Group (SPHPAG) and the Scoliosis Advocacy Network. Amanda Coughlan Santry, the co-founder of the advocacy group, said many children with these conditions have had this surgery, but the crisis affects a wider group of children also. 'Parents are terrified now, they don't know what to do or where to go to get information,' she warned. This comes as the Sunday Times reported a consultant working in CHI breached HSE guidelines by referring his own public patients to private clinics he was funded to run at weekends. It was reported that an internal inquiry dating back to 2021 discovered this doctor was paid €38,000 by the State's National Treatment Purchase Fund to do this extra work. It was also reported that this may have delayed care for very young and vulnerable children. The story does not name the speciality of care involved at the CHI hospital concerned. Read More Situation for children needing scoliosis surgery critical, says ombudsman for children
