Children’s Health Ireland (CHI) is, to use the well-worn phrase, no stranger to controversy. The voluntary body, in charge of children’s healthcare in the Dublin region, is again in the spotlight following a report about unnecessary hip operations in two hospitals – Temple Street and Cappagh.
The audit of these operations exposes an extraordinary situation, where children were put through unnecessary, painful, procedures. It goes without saying that clinical follow up must be comprehensive and further inquiries need to establish how and why this happened. And to examine, as the audit recommended, the evidence going back as far as 2010. Unfortunately, there is almost certainly more to come in this saga.
As with the use of non-approved springs in spinal surgeries in CHI Temple Street, outlined early this year in a HIQA report, the latest audit points to a major failure in surgical oversight. We need clear answers about why the system in CHI failed so completely.
A wider review of the operation of the clinical director system, introduced in the 2008 consultant contract, is also now appropriate. The idea itself has merit, giving clinicians responsibility at management level for the delivery of safe and quality care. But is it doing enough to guarantee not only safe but also efficient services?
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The Minister for Health, Jennifer Carroll MacNeill, also needs to reflect on the future of the CHI structure, due now to take over the running of the new children’s hospital. The CHI has been hit by a string of controversies – in relation to the building of the hospital and planning for its operation, the long waiting lists for scoliosis patients and how funding allocated for this was spent, and delays in the appointment of a chief executive.
Last year the then health minister, Stephen Donnelly, asked for legal advice on whether the State could take over the functions of the CHI, which would mean it coming under the control of the HSE. At the moment it has a separate board and management. The advice was that this could only happen if an independent report provided evidence of serious governance or other failings.
The failings outlined in the audit – and last year’s HIQA report –are clearly significant. And it is unacceptable that the head of the HSE can – as happened on Sunday – be asked on RTÉ about a report on a surgeon who allegedly transferred patients from a pubic to a private list, and say he was never informed by the CHI about it.
The CHI is part of a voluntary hospital structures which is largely State funded, but jealously guards its independence. It is an opaque structure, with no adequate accountability. There is no reason to question the motivations of those charged with running the CHI – and board volunteers will be scarce – or the good work of the vast bulk of its staff. But change is needed.
