In April 2022 more than a dozen senior officials from Children’s Health Ireland gathered for an ad hoc meeting where a lengthy conversation took place about the contents of a report that would be described in the discussion as “abhorrent”.
A former senior CHI official told the meeting that an internal investigation had uncovered “multiple, deep-rooted issues”. The report, the board of CHI was told, focused on three areas: behaviour and culture; waiting list management; and governance.
We now know that this report uncovered evidence of professional misconduct, unethical behaviour and potential negligence. It also zeroed in on the actions of a consultant who allegedly abused the state’s waiting list system while delaying operations for sick children.
In that April meeting board members were clearly shocked by what they were hearing. Questions were asked about the kind of harm that patients might have experienced, and whether patients and their families had been made aware of the potential future harm that might be inflicted by delays in access to care. The answer was not yet.
The board believed that patients had a moral right to be told what had happened. A possible transparency and communications plan was also discussed. This newspaper understands that board members were also told that the National Treatment Purchase Fund (NTPF) had been engaged to conduct an audit of waiting list practices.
In response to queries this weekend, an NTPF spokesman said it “did not receive a request from CHI to complete an external audit on compliance with waiting list procedures concerning the content of CHI’s 2021 report. The NTPF first learnt of the report and its findings through recent media reporting”.
The report became a standing item for CHI, meaning it was raised in many further internal meetings.
Despite the serious and consequential issues that were being worked through, it appears that alarm bells were not ringing in the wider health service umbrella, not among staff in the Department of Health or the HSE.
Bernard Gloster, the HSE chief executive, was forthright on RTE Radio 1 about clamping down on any possible abuses revealed in the CHI report
The emergence now, three years later, of the final report arising from that 2021 investigation has created a palpable level of shock and fury across the political and health system.
The contents of the report — first disclosed by The Sunday Times — has precipitated a crisis resulting in a stopper being put on a huge tranche of waiting list funding; a possible garda investigation; and political recriminations that could threaten the very existence of CHI itself.
What has become clear in the past two weeks is that the relationship between the government and CHI has become extremely fraught, and behind the scenes tensions and paranoia are at an all-time high.
A number of senior government sources who spoke to The Sunday Times this week said it was their view that trust in CHI was on the floor, and that there was a serious dearth in confidence about how the organisation was operating.
Within CHI, there is a feeling that it is unfairly being put under siege for issues that staff believe have been addressed, with pressure building from all sides.
In fact, these relationships have been strained for a number of years.
There is a view within government that CHI was set up as a standalone entity that became increasingly insular, even when money was being poured into services. The controversy over lengthy waiting lists for children with scoliosis became a long-running political sore between ministers and CHI, and it seems many relationships have yet to recover from that.
Then came a series of damning reports into the use of unauthorised springs in children’s spinal surgeries and another audit which found that, over a three-year period, 60 per cent of hip dysplasia surgeries in Temple Street and 79 per cent in National Orthopaedic Hospital Cappagh did not meet the clinical threshold for surgical intervention. The emergence then of the unpublished 2021 report has put the situation, as one source described it, on a “political knife-edge”.
One particular incident last week exemplified this continuing tension. After more than a week of intense media focus on the actions of the consultant who allegedly abused the state’s waiting list system while delaying operations for sick children — and also on the toxic work environment in the hospital — CHI released a media statement late on the bank holiday Monday.
In that statement, the organisation said that the issues raised in the 2021 report had been addressed, the team was working well, and that the file in question was primarily a human resources report.
Despite calls from the taoiseach, health minister and head of the HSE for the report to be published, the import of the CHI statement was that publication of the report was not on the cards, with the organisation citing legal advice it had received.
Jennifer Carroll MacNeill, the health minister, has been told she cannot legally publish the CHI report herself
NIALL CARSON/PA
Political sources claim that they were completely blindsided by the statement, and that the Department of Health was not given advance warning that it would be sent out.
Instead, they were sent a copy of the statement after it was sent to the media. The view within the government was that the statement was “ill-judged”. That has not been the end of the matter, however. It is understood CHI has this week come under unrelenting pressure to find a way to publish a redacted version of the report.
“There is a frustration there. So many media outlets now have it, and have reported on it. And yet not everyone has seen it. There is ongoing engagement with the CHI to see what is possible — that’s where it sits now. At the end of the day all of this should have gone through the usual channels, but it did not,” one well-placed government source said.
At the heart of this particular row between the various parties is this exact point: that there was no heads-up about what was coming down the tracks, and that, even when the story emerged, getting answers was an issue.
When the story appeared on May 25, Bernard Gloster, head of the HSE, was already scheduled to appear on RTE Radio 1’s This Week. He was on the programme to discuss the audit on child hip surgery but towards the end of his segment was asked about the unpublished 2021 report — and his tone was forthright.
“I want to be very clear: I have asked for a copy of the report myself. I have said to the CEO of the CHI that I expect her and her board, save for highly personal information, that the report should be published in the public interest,” he said.
“I have made it clear that I reserve my position based on what I see in that report as to whether or not further questions arise — and if any questions arise, can I assure you, if anything connected with or near-connected with alleged people ingratiating themselves financially in the public health system, the first step I will be taking is to refer that matter to the gardai.”
A health service source said there was significant anger on this day both within the HSE but also the Department of Health.
“We were operating in a vacuum. Bernard didn’t know anything about it until he saw the newspaper that morning. The minister didn’t know anything about it. Actually getting that report, seeing it, became the issue. Jennifer Carroll MacNeill didn’t get it until 3.30pm the following day, on Monday.”
When the report did land, Carroll MacNeill, the health minister, read it and took a few hours to digest what it said. By the following morning, she had arranged a meeting with the attorney-general to get advice on whether she could publish it.
She was told that while she had possession of the report legally, she could not legally publish it herself. Later that day in the Dail chamber, she sat near the edge of her chair listening intently to the response of Micheál Martin, the taoiseach.
Martin said it “made for shocking reading of the most profound kind”, which “raises very fundamental concerns”. By lunchtime, three members of the board had resigned, the NTPF had issued a statement expressing its concern, and opposition parties were raising questions in the Dail.
Ivana Bacik, the Labour Party leader, said she wanted to know what was going to change in CHI on foot of the revelations. This remains a key question.
Lucy Nugent is said to have the confidence of the government as the new CHI chief executive
“None of the options on the table are easy here,” a source said this week. “The first thing is to bolster the team around the new CEO, Lucy Nugent. She has the confidence of the government. We need to make sure there is a strong management team around her. It may be hard, though, to get the right people in place, given everything that has happened.
“Then there are the options for a change in governance, but none of those options are simple either. Abolishing the CHI and subsuming it into the HSE would be a huge piece of infrastructural work. And more than this, it would be extremely distracting at a time when something huge lies in the near future, which is the opening of the new national children’s hospital, this massive project. There is a feeling that the credibility of the CHI has been undermined, though.”
In the meantime, the HSE is finalising the terms of reference for a full audit of the governance and practices at CHI. The audit is expected to be extensive and far-reaching, with timelines being worked out. The media focus on the findings of the report continued throughout last week, with two further key developments.
The first was that the NTPF has temporarily paused special funding to CHI while assurances are sought. The second is that the unpublished report has been referred by the HSE to the gardai. This emerged during a meeting of ministers at a cabinet committee on health last Wednesday, when Carroll MacNeill provided a “deep dive” on all of the issues for her colleagues. And all of this in the June Dail recess, normally a quiet week in politics.
Within CHI, it appears the pressure is on. It is understood that Seamus McCarthy, the comptroller and auditor-general, was in the CHI premises this week examining the minutes of the various meetings that took place in 2022. He sits on the public accounts committee, where TDs are likely to ask him for an update on the situation. The NTPF will also be asked to appear.
Padraig Rice, the Social Democrats TD who chairs the Oireachtas health committee, has also said the committee’s “priority” now is hearing from CHI. That meeting could happen as soon as next week, on June 17 or 18.
All of this guarantees that the issues at the heart of this controversy will remain the subject of intense national public interest for the foreseeable future.
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