Ms Lucy Nugent:

I thank the Chair, and good morning. I thank the committee for the opportunity to address it today about CHI’s financial statements for 2023 and to give members an update on service delivery across our children’s hospitals as well as an update on the commissioning programme for the new children’s hospital, which includes an extensive integration and transformation programme. I note the committee has also referenced other areas it would like to discuss and I hope our correspondence submitted was of use.

I am the recently appointed chief executive of CHI. I am joined by my colleagues: Mr. John Fitzpatrick, interim chief financial officer; Ms Julia Lewis, CHI’s transformation director, who is charged with leading CHI’s efforts to be ready and able to move into and open the new children’s hospital; and Dr. Ike Okafor, one of our three clinical directors who manage the 39 specialties across our services. I regret that CHI was not in a position to accept the invitation to attend the previous meeting of the Committee of Public Accounts but we welcome the opportunity to appear before members today. I will endeavour to answer all of their questions to the best of my ability.

I assumed the position of chief executive four months ago. Having started my career as a nurse in what was formerly Temple Street Children’s University Hospital, I am conscious of both the privilege and responsibility I have as CEO to ensure that we at CHI provide the highest quality care to the children who come to us when they are at their sickest.

Last year, CHI treated more than 148,000 children who attended our emergency departments. Almost 29,000 children underwent day case procedures, more than 17,000 children underwent theatre procedures and almost 29,000 children and young people had an inpatient stay with us. Specialised care was delivered to these children despite being in old and not-for-purpose buildings. We continue to lead on paediatric research and innovation on an international stage because we strongly believe our children and young people deserve the best that medicine and science can offer.

I am very proud to lead our almost 5,000 staff, who work at the front line of paediatric care provision across our four sites in CHI at Temple Street, Crumlin and Tallaght, and at our urgent care centre at Connolly Hospital.

We are a place of excellence in paediatric healthcare and we have dedicated and diligent staff – a message that is sometimes lost and especially in the current climate. We want every child, patient and family who meet us to feel safe and cared for. Acknowledging when things go wrong in healthcare is essential for building trust, learning and ultimately improving patient safety and outcomes. We are committed to transparency and openness with the children, young people and families we care for. In that regard, I acknowledge the children and families who were impacted by the events highlighted in the recent HIQA report. What happened should not have happened and children should have been protected from harm. We are deeply and unreservedly sorry to those families. CHI fully accepts the recommendations of the HIQA report and we will publish updates to our resulting quality improvement plan on our website to ensure transparency and openness around improvements to services.

I also acknowledge those families impacted by other issues related to the orthopaedic service, specifically where reports are awaited. I know families are anxiously awaiting the publication of these reports. The committee will appreciate that the most important people with regard to this audit are the families involved and they will be communicated with in the first instance.

Since being appointed to my role, I have prioritised the delivery of safe and excellent care, fostering an open and supportive culture for children, families and staff and strengthening all aspects of our governance. The events I referenced have broken trust with our families, staff and stakeholders. I am committed to rebuilding that trust and leading a wonderful team of people across CHI.

The financial statements before the committee have been audited by the Office of the Comptroller and Auditor General for the year ended 2023. The committee will note CHI returned a deficit of €7.8 million for 2023. This compared with a deficit of €0.9 million in 2022. The increase reflects the net impact of the incremental cost of provision of services as offset by increased funding received from the HSE by CHI. The cumulative deficit at 31 December 2023 amounted to €18 million. This includes the €7.8 million deficit for 2023, just referred to, and a substantial element of the balance relates to legacy deficits incurred prior to the establishment of CHI.

In relation to governance and risk management, we have a detailed governance statement provided as per the requirements of the code of practice for State bodies. We also draw the committee's attention to the statement on internal control in which CHI confirms it has undertaken an annual review of internal control and makes specific disclosures regarding procurement non-compliance and rejected insurance claims.

As the client for the new children’s hospital, I welcome the opportunity to provide this committee with an update from CHI’s perspective about this wonderful and exciting project. Together with the NPHDB, we are focused on doing all that we can to ensure the hospital opens as soon as possible and is operational to international standards. In line with Sláintecare principles, the national model of care for paediatric healthcare services will ensure a child is treated as close to home as possible. This will put the new hospital at the epicentre of a network of care, in collaborative partnership with our colleagues in regional centres, to deliver comprehensive paediatric care for Ireland’s children and young people.

The new hospital will also support an all island of Ireland approach to the delivery of paediatric care, building on the success of the all-island congenital heart disease network, and will stand with our two satellite centres at Tallaght and Connolly hospitals, ensuring children receive the right care, in the right place, at the right time. However, a building does not provide care - people do - and we must ensure our staff are fully prepared and supported through this process. Delivery of this project of exceptional transformation, digitalisation, integration and change is the largest in the history of the Irish healthcare system. I am committed to ensuring that CHI delivers a return on this investment by the state with our vision of healthier children and young people throughout Ireland underpinned by living our values to be “child-centred, compassionate, progressive and we will act with respect, excellence and integrity”.

All of this activity will take place while 36,000 pieces of equipment are placed, installed and commissioned in 6,000 rooms and spaces while we continue to deliver essential services for children and young people on existing sites. It is a complex operation requiring meticulous planning, which is well advanced.

In finishing, our primary focus in CHI is, at all times, to deliver timely access to quality, safe care to children and young people. The journey to the new hospital is a once-in-a-generation change, and we are working hard to make sure everything is safe, ready, and right for patients, families, and staff so that we can maximise the impact that this wonderful new hospital will have on those we care for.