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RTÉ News
3 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.
Irish Independent
27-05-2025
- Health
- Irish Independent
Three members of CHI board resign, Health Minister Jennifer Carroll MacNeill confirms
Ms Carroll MacNeill said the three members, Dr Gavin Lavery, Brigid McManus and Catherine Guy, held voluntary positions on the CHI board. The resignations comes following a number of controversies surrounding CHI. A report published on Friday found a number of children had undergone unnecessary hip surgeries in two Dublin hospitals. The majority of cases reviewed at the Temple Street and Cappagh National Orthopaedic Hospitals found the threshold for surgery treating hip dysplasia in children was lower than that at Crumlin Children's Hospital. "We've had three resignations from the board this morning. These would be individuals who have worked on the board, worked in a volunteer capacity on the board since 2018 and who have provided a very strong service in bringing the hospitals from where they were,' Ms Carroll MacNeill told RTÉ's News At One. The Health Minister said she has 'strong questions about the governance of CHI and its direction towards the future'. "This is something that I've referenced a number of times in the Dáil and I've said that very clearly, we need to have a functional governance structure to enable us to get to the opening of the Children's Hospital and to deal with the very many issues in children's health. "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.' The independent review found 40pc of the surgeries reviewed at Temple Street met the criteria, while the figure for Cappagh was just 21pc. Separately, The Sunday Times revealed an unpublished report which found a consultant was paid more than €35,000 through the National Treatment Purchase Fund (NTPF), a scheme aimed at reducing waiting times in the public health system by paying for patients to be treated privately. Ms Carroll MacNeill said she and senior Department of Health officials have read the report and she was written to CHI with a 'detailed series of questions'. ADVERTISEMENT Learn more 'I am trying to gather information, and I am trying, it's very important to say, to work at the legal parameters around how I would publish this report. 'I do think it will be important that it is published, but I need to make sure that I take the correct steps. There are important issues in this report. Number one for patient safety first and foremost.' She said the report outlines issues around the scheduling of operations and 'very toxic behaviours' at Crumlin Hospital. 'That is not the first time that we have heard about this across the surgical system in CHI, some of the other reports relating to hips and other issues detail very, very difficult working circumstances. 'So, this is an issue that is not confined to Temple Street nor to Crumlin, but there has been a historical issue in CHI that very clearly needs very close attention.' Payments through the NTPF are normally made to hospitals 'more broadly' she said, rather than to any individual consultant, with the sole purpose of reducing the amount of time public patients are on waiting lists. She said she will wait until the publication of the report to determine if the NTPF was misused, and the Department of Health should have been aware of its findings sooner.
