Latest news with #NationalTreatmentPurchaseFund
RTÉ News
03-07-2025
- Health
- RTÉ News
Legal advice on report must be respected, CHI says
Children's Health Ireland said it has not been evasive in relation to the publication of its internal audit which looked at a number of issues, including culture and the use of waiting list funds. Representatives from the Children's Health Ireland and the National Treatment Purchase Fund Board are before the Public Accounts Committee, which is examining their funding. CHI Chief Executive Lucy Nugent provided more detail about services provided under the National Treatment Purchase Fund (NTPF). Her comments comes after an unpublished Children's Health Ireland report into concerns at one of its hospitals concluded that "a root and branch review" of use of the NTPF and other waiting list initiatives "should be undertaken". The report, which has been seen by RTÉ News, said that a consultant who has since retired had breached guidelines by referring public patients to the doctor's own weekend clinics. In response, CHI said in a statement the clinics did not take place in the consultant's private rooms and instead occurred in a public clinic. Ms Nugent reiterated this at the PAC, saying "there was some misunderstanding in media reports" concerning NTPF payments "to a CHI consultant". "The clinics at the centre of the reports did not take place in the consultant's private rooms," she said. Ms Nugent said they happened in a public CHI hospital on a Saturday as part of a waiting list initiative for an "outpatient appointment only". She said that a longer term sustainable solution for referral management was put in place and the roll out of this system is ongoing. In response to a question posed by Labour TD Eoghan Kenny asking her what she thought of the Taoiseach and Tánaiste's calls for the full report to be published, Ms Nugent said: "I respect their opinion." But she noted that she had legal advice which must be considered, as must her obligation to treat staff fairly. She explained why an "anonymised report" would not make sense, saying the health community is very small and people could be identified. CHI, she said, is a statutory body and must respect the legal advice it receives and the moral imperative to protect the confidentiality of patients. Ms Nugent added CHI has a duty to see that matters are properly investigated and that due process is carried out. This, she said, does not mean CHI is not mindful of the "great upset" that such reports cause parents and children, and the gravity of the issues. The Chief Executive of the National Treatment Purchase Fund told PAC there are another two hospitals that have to provide further clarification on the use of waiting list funding from the public body. Fiona Brady said they have until tomorrow to respond with the information sought. A report on the review of all hospitals will then be completed. Already, three hospitals have been identified with waiting list issues - one CHI hospital, Beaumont and Naas. The Comptroller and Auditor General (C&AG) said Children's Health Ireland should have brought the findings of its internal audit to the attention of its own team in the course of the 2021 examination of financial statements, the Comptroller and Auditor General (C&AG) has said. Seamus McCarthy told the Public Accounts Committee that recently an internal examination by CHI in 2021/22 has come to public attention. The C&AG said his office was not provided with a copy of the report at the time it was finalised, or when the audit of the hospital's financial statements for 2021 was being undertaken. The C&AG told the committee that while the main focus of the CHI audit was on personnel management concerns in relation to a clinical department in part of the hospital, "it also raises some concerns around a number of financial risks". He said these include the controls over claims in respect of care paid for from the National Treatment Purchase Fund. Mr McCarthy said his office has received the report in recent weeks. CHI declined to publish the report citing legal advice and has published its summary of the audit. Mr McCarthy said that in 2023, CHI had a total income and expenditure of over €190 million, which has grown rapidly in recent years. The CHI board secures treatment and assessments for waiting list patients in private hospitals, and in public hospitals, which offer spare capacity to provide patient care. In 2023, it paid private hospitals €107m and public hospitals €72 - representing 60% reliance on private healthcare providers and 40% reliance on public healthcare providers.
RTÉ News
18-06-2025
- Health
- RTÉ News
Health committee to hear CHI apology over practices
Executives and senior clinicians from Children's Health Ireland are appearing before the Health Committee this morning to update politicians on spinal surgeries, the recent hip surgery review and other governance issues at CHI. Chief Executive Lucy Nugent will apologise to the children and families impacted by recent revelations about CHI's culture, governance and practices, which she says have "led to great pain being inflicted upon some of those who were in our care". Ms Nugent is in her current post five months, having started her career as a nurse in CHI Temple Street. In recent months, members of the opposition have detailed what they called "unnecessary" hip surgeries from an unpublished report into practices at three CHI hospitals. The review into Developmental Dysplasia of the Hip, or DDH, found that the majority of children who had pelvic osteotomy surgery at CHI Temple Street and the National Orthopaedic Hospital in Cappagh did not meet the threshold for surgery based on the criteria used for the audit. Children who had surgery at Crumlin were found to have met the threshold. Ms Nugent will tell the committee that the family of one child they identified who experienced complications due to surgery has been contacted and supported through an open disclosure process. She will also say that all families have now been contacted about the next steps, and if their child was part of the audit. Multidisciplinary team review clinics have begun seeing patients, with 60 seen so far. CHI has said the aim of the review clinics is to assess complications only, and it hopes to have all children seen within six months. Ms Nugent will say she does "not underestimate the stress and anxiety that families are rightfully feeling throughout this audit process." "To one family in particular, whose child experienced complications during their care in Children's Health Ireland, I extend my heartfelt apology. I would like to give my assurance to all of the families affected, that they will be directly supported and are being contacted with follow up information and the next steps." Separately, the HSE is currently developing an independent review into hip surgeries going back to 2010, to determine if harm has occurred for any child, as the original audit does not establish this. Going forward, any child who is listed for hip surgery with CHI will have their case discussed at multidisciplinary team meetings. On the recent report into culture and governance issues at CHI and the use of the National Treatment Purchase Fund, Ms Nugent will apologise for not being at liberty to publish the report, saying it is her legal duty not to do so, despite media reports. Executives at CHI will also update the committee on progress in paediatric spinal surgery services. At the start of June, 48 patients were waiting over four months for surgery, a decrease since the start of the year. CHI will also say that 223 spinal procedures have been completed in the year to date, up on 196 such operations at the same point last year. An additional Consultant Orthopaedic Spinal Surgeon is due to start in August, with recruitment under way for a further three consultant orthopaedic surgeons.
Irish Independent
16-06-2025
- Health
- Irish Independent
Parents whose children were centre of concern in CHI internal review not informed, summary reveals
The revelation emerged in a summary of the findings of an internal CHI report into the handling of extra clinics, paid for by the National Treatment Purchase Fund (NTPF) to reduce waiting lists. It said the review found that patients seen in the outpatient clinic who required ongoing treatment were placed on an already long inpatient waiting list without consideration of redistribution of patients to colleagues with a shorter waiting list. 'The examination raised the issue as to the possibility that this could have led to any negative outcomes for patients,' it said. However, the summary, which also includes follow-up actions, said an examination of the relevant inpatient waiting list later took place and patients were re-distributed across the department to ensure equitable access to treatment. 'This action was closed out in September 2022.' It said 'open disclosure' – informing parents about the concerns raised in the report – was not carried out 'as there is no significant scientific evidence that delaying treatment will equate to patient harm in this patient cohort'. CHI, which has declined to publish the full report for legal reasons, said it was an internal examination commissioned by the CHI Executive. The hospital involved has been previously identified as Crumlin Hospital by CHI chief Lucy Nugent. During meetings (2020/2021) between employees in this clinical department and members of the CHI Executive, it became evident that multiple legacy and deep-rooted issues existed that regular meetings could not address, it added. It became clear that a more robust process was required to identify the issues that needed to be addressed 'In early 2021, an operational lead was assigned to look into these issues. However, it became clear that a more robust process was required to identify the issues that needed to be addressed.' It led to the examination taking four months. It said that a number of issues were raised in relation to an NTPF outpatient waiting list initiative. The NTPF funds hospitals to carry out extra clinics and procedures. The examination suggested that based on the documentation review, certain NTPF-funded clinics did not adhere to NTPF standards of chronological scheduling – seeing the longest-waiting patients first. Data suggested that some of these patients could have been seen by other departmental colleagues within the existing day-to-day service and potentially managed in a more proactive way. 'Patients seen in the outpatient clinic who required ongoing treatment were placed on an already long inpatient waiting list without consideration of redistribution of patients to colleagues with a shorter waiting list. The examination raised the issue as to the possibility that this could have led to any negative outcomes for patients,' it said. 'The above raised concerns relating to the prudent and beneficial management of NTPF funding and lack of oversight of access initiatives.' It found that interpersonal difficulties among team members led to poor working relationships and a challenging working environment. There was a high attrition rate among support staff due to bullying issues. A significant risk was identified where only one employee managed the needs of a complex tertiary speciality. This level of dependency on one individual for a critical service is not in line with best practice and created a vulnerability in this specialty. The report also sets out a series of actions that were taken on foot of the report. 'A cross-city CHI Central Referral's Office was established. This system manages referrals centrally to ensure equitable distribution. Efficiencies have been gained, and this process is being rolled out across all CHI specialties,' it said. CHI now has a robust process for NTPF-funded waiting-list initiatives 'CHI now has a robust process for NTPF-funded waiting-list initiatives which requires multiple internal stakeholder approvals both clinical and financial. CHI is regularly audited by the NTPF.' It added: 'A review of all CHI Hospital sites leadership roles and responsibilities was commenced to provide clarity around delineation of accountability at site and executive level – this work has continued as the transformation programme has evolved in preparation for the move to the new children's hospital.' The original report stated that a negative culture can impact service delivery, department dynamics and staff experience and has the potential to put patients at risk. It said that CHI is a learning organisation and service improvements through internal reviews and clinical audits, which are an essential tool to support this, will continue to be a priority. 'CHI recognises the importance of transparency and the interests of the broader public in relation to the issues identified in the report,' it said.
The Journal
16-06-2025
- Health
- The Journal
Children's Health Ireland publishes summary of 2021 report, identifies 'bullying issues'
CHILDREN'S HEALTH IRELAND (CHI) has today published a summary of the 2021 report into the organisation's culture, the use of NTPF funded clinics, and the standard of care it offered to children. CHI noted that the original review was meant to be private, confidential, and not for publication. The Health Minister Jennifer Carroll MacNeill has repeatedly called for it to be published after large parts of it were leaked to the media and politicians. CHI has been in charge of children's health services in Ireland since 2019. It has been scandal hit over the last year, over the use of unauthorised implants in children's spinal surgeries, and unwarranted hip surgeries being carried out on children, which was initially reported by The Ditch. The Sunday Times also reported on unpublished findings that a consultant breached HSE guidelines by referring patients he was seeing in his public practice to weekend clinics that he was operating separately. The consultant was paid €35,800 via the National Treatment Purchase Fund (NTPF), which aims to cut waiting times by paying private practices to treat patients on public waiting lists. A summary of the 2021 report published today says that 'serious issues of concern' were identified within CHI, including 'bullying issues' and a poor working environment as a result. It further said HR processes ensued as a result of the initial report. The summary states that there was a high level of dependence on one employee who managed the needs of a complex speciality, and that this was not in line with best practice. It also says that the NTPF funded waiting list initiative did not follow guidelines on chronological scheduling, meaning patients who were on the waiting list the longest were not seen first. CHI today said that no open disclosure to the families of children with undescended testes who faced a delay in their care, as there is 'no scientific evidence' that they were harmed as a result. Advertisement CHI said that patients seen in a weekend outpatient clinic, which was funded by the National Treatment Purchase Fund, were placed on an 'already long' inpatient waiting list 'without consideration of redistribution of patients to colleagues with a shorter waiting list'. The 2021 internal review raised the possibility that this practice could have led to 'negative outcomes for patients'. The 2021 report said that patients with undescended testes, who required orchidopexy surgery, were at that time waiting 'far in excess' of the recommended time frame for treatment, placing them at a 'real and known risk for fertility issues and or cancer later in life'. It said that these patients were being placed on a long inpatient waiting list when there was an alternative cohort of experienced general surgery consultants who could have managed their care 'in a much shorter time frame', which would have mitigated or eliminated the risks. 'There are numerous studies and guidelines which outline that optimum timing for undertaking orchidopexy is between 6 months and 18 months of age,' the report said. It further stated that at the time of the report, there were ten patients on a urology inpatient waiting list, referred through the NTPF clinics, who required the surgery. 'These children are beyond the threshold of 18 months as were referred for care and treatment in 2019,' it added. The report noted that as of 7 October 2021, were an additional 20 patients referred with undescended testes. The summary report published by CHI today said that a review of the relevant inpatient waiting list took place and patients were redistributed across the department to ensure 'equitable access to treatment'. 'This action was closed out in September 2022. Open disclosure was not carried out as there is no significant scientific evidence that delaying treatment will equate to patient harm in this patient cohort,' CHI said in its report today. 'CHI now has a robust process for NTPF funded waiting list initiatives which requires multiple internal stakeholder approvals both clinical and financial. CHI is regularly audited by the NTPF,' it added. Senator Tom Clonan today said that he has become aware of 'dozens of disabled children becoming infertile due to a lack of routine surgical intervention'. 'This is de facto sterilisation in Ireland,' he said. Readers like you are keeping these stories free for everyone... A mix of advertising and supporting contributions helps keep paywalls away from valuable information like this article. Over 5,000 readers like you have already stepped up and support us with a monthly payment or a once-off donation. Learn More Support The Journal
Irish Independent
16-06-2025
- Health
- Irish Independent
Parents whose children were centre of concern in CHI internal review not informed, summary reveals
The revelation emerged in a summary of the findings of an internal CHI report into the handling of extra clinics, paid for by the National Treatment Purchase Fund (NTPF) to reduce waiting lists. It said the review found that patients seen in the outpatient clinic who required ongoing treatment were placed on an already long inpatient waiting list without consideration of redistribution of patients to colleagues with a shorter waiting list. 'The examination raised the issue as to the possibility that this could have led to any negative outcomes for patients,' it said. However, the summary, which also includes follow-up actions, said an examination of the relevant inpatient waiting list later took place and patients were re-distributed across the department to ensure equitable access to treatment. 'This action was closed out in September 2022.' It said 'open disclosure' – informing parents about the concerns raised in the report – was not carried out 'as there is no significant scientific evidence that delaying treatment will equate to patient harm in this patient cohort'. CHI, which has declined to publish the full report for legal reasons, said it was an internal examination commissioned by the CHI Executive. The hospital involved has been previously identified as Crumlin Hospital by CHI chief Lucy Nugent. During meetings (2020/2021) between employees in this clinical department and members of the CHI Executive, it became evident that multiple legacy and deep-rooted issues existed that regular meetings could not address, it added. It became clear that a more robust process was required to identify the issues that needed to be addressed 'In early 2021, an operational lead was assigned to look into these issues. However, it became clear that a more robust process was required to identify the issues that needed to be addressed.' It led to the examination taking four months. ADVERTISEMENT It said that a number of issues were raised in relation to an NTPF outpatient waiting list initiative. The NTPF funds hospitals to carry out extra clinics and procedures. The examination suggested that based on the documentation review, certain NTPF-funded clinics did not adhere to NTPF standards of chronological scheduling – seeing the longest-waiting patients first. Data suggested that some of these patients could have been seen by other departmental colleagues within the existing day-to-day service and potentially managed in a more proactive way. 'Patients seen in the outpatient clinic who required ongoing treatment were placed on an already long inpatient waiting list without consideration of redistribution of patients to colleagues with a shorter waiting list. The examination raised the issue as to the possibility that this could have led to any negative outcomes for patients,' it said. 'The above raised concerns relating to the prudent and beneficial management of NTPF funding and lack of oversight of access initiatives.' It found that interpersonal difficulties among team members led to poor working relationships and a challenging working environment. There was a high attrition rate among support staff due to bullying issues. A significant risk was identified where only one employee managed the needs of a complex tertiary speciality. This level of dependency on one individual for a critical service is not in line with best practice and created a vulnerability in this specialty. The report also sets out a series of actions that were taken on foot of the report. 'A cross-city CHI Central Referral's Office was established. This system manages referrals centrally to ensure equitable distribution. Efficiencies have been gained, and this process is being rolled out across all CHI specialties,' it said. CHI now has a robust process for NTPF-funded waiting-list initiatives 'CHI now has a robust process for NTPF-funded waiting-list initiatives which requires multiple internal stakeholder approvals both clinical and financial. CHI is regularly audited by the NTPF.' It added: 'A review of all CHI Hospital sites leadership roles and responsibilities was commenced to provide clarity around delineation of accountability at site and executive level – this work has continued as the transformation programme has evolved in preparation for the move to the new children's hospital.' The original report stated that a negative culture can impact service delivery, department dynamics and staff experience and has the potential to put patients at risk. It said that CHI is a learning organisation and service improvements through internal reviews and clinical audits, which are an essential tool to support this, will continue to be a priority. 'CHI recognises the importance of transparency and the interests of the broader public in relation to the issues identified in the report,' it said.
