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CHI noted that the original review was meant to be private, confidential, and not for publication.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The Sunday Times also reported on unpublished findings that a consultant breached HSE guidelines by referring patients he was seeing in his public practice to weekend clinics that he was operating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. 

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.