Ms Eilísh Hardiman:

I thank the committee for inviting Children's Health Ireland to attend this meeting. As client to the NPHDB for the new children’s hospital project, I welcome the opportunity to provide the committee with an update from CHI's perspective.

CHI was established as a statutory entity in January 2019 to govern and manage acute secondary paediatric services for the greater Dublin area as well as national tertiary and quaternary paediatric services, some of which are on an all-island basis. This saw the children’s hospitals at Temple Street, Tallaght and Crumlin merge to form CHI in preparation for the move into the new children’s hospital. In July 2019, we also opened the first of our two paediatric outpatient and urgent care centres at Connolly Hospital, Blanchardstown.

The NPHDB has advised that the second paediatric outpatient and emergency care centre building based at Tallaght University Hospital will be completed and handed over to CHI in September 2021. CHI is planning an eight-week operational commissioning period before opening services in this new building in November 2021.

I will turn to our service. In 2020, a total of 260,000 children and adolescents were treated in our services at Crumlin, Temple Street, Tallaght and Connolly hospitals. This was a reduction of just over 20% compared to the 2019 activity as a result of Covid-related service reductions. Timely and greater access to our services remains our single greatest operational challenge as a healthcare provider. CHI has several infrastructure and workforce constraints contributing to lengthy waiting lists and access challenges. These constraints are primarily in the theatres, radiology, critical care, laboratory and outpatient departments, and these have been exacerbated by the Covid-19 outbreak with the recent cyberattack adding further to this challenge. Opening of the new children’s hospital and the new facility at Tallaght will in time address these access challenges.

In March of this year, CHI was operating at 86% of its March 2019 activity. That was a significant improvement from March 2020 when services were severely restricted at the beginning of the pandemic. Since then we have innovated with virtual clinics. We had a significant reduction in emergency department attendances throughout 2020, which has since reversed in 2021. This has not resulted in an increase in emergency admissions, with patients being treated and discharged home from our emergency departments and urgent care centre. We have seen a significant increase in children and adolescents with mental health presentations coming to our hospitals, which we attribute to the pandemic. This has put pressures on our resources.

To meet infection prevention and control guidance of 2 m distancing between beds, CHI has had to repurpose spaces such as play rooms, family lounges and other communal spaces in our children’s hospitals into clinical spaces to accommodate beds displaced from our multiple occupancy wards, which are rooms with two to six beds in a room. The new children’s hospital with its single occupancy rooms, designed with infection prevention and control in mind, will significantly improve how we can treat and care for children even in a pandemic.

The criminal cyberattack on the healthcare system has had a material impact on our IT systems in CHI and our ability to deliver services to our patients and families. While most of our IT systems are back up they continue to be slow and not all are connected or linked to each other. Patient information from manual records over the past seven weeks are being uploaded into our IT systems and it will take weeks to get back to our starting point in May. Despite this, several initiatives are being progressed to improve access to care. As part of the first phase of access to care funding, CHI secured confirmation in late June of additional once-off funding of €1.9 million in 2021 to support specific initiatives to address long waiting times across 15 specialties. Discussions are also at an advanced stage with the HSE on expanding MRI capacity in Crumlin and Temple Street hospitals to address waiting times for this specialist imaging. These are welcome and required investments in acute paediatric care. CHI has consistently apologised to our patients and their families who are experiencing long waiting times. We acknowledge this can be a source of anxiety for parents, children and indeed for our staff and it is our primary operational priority to have this addressed.

CHI is entering the final stages of the electronic healthcare record procurement process using a competitive dialogue methodology. It is anticipated to have a preferred vendor selected by the fourth quarter of 2021 and approval secured to sign contract in the first quarter of 2022. It is planned to open the new children's hospital as a full digital hospital and alignment with the capital build programme is key to achieving this objective.

Expansion of services in CHI at Tallaght will enhance the delivery of secondary paediatric services in south county Dublin, Dublin south west, Dublin south city and the surrounding areas of Kildare and Wicklow by delivering the right care, as close to the child’s home as possible. These expanded services are in addition to inpatient and outpatient services currently at CHI Tallaght, which will remain there until the new children’s hospital opens. This new facility is purpose built for children and families and will deliver emergency care, outpatient services, radiology, medical forensic examination and child sexual assault counselling and therapy services. We will have more capacity to deliver short-stay care in emergency care so that children can have a consultant-led assessment and treatment and be discharged home without needing inpatient admission.

When fully operational this new facility in CHI Tallaght will provide 17,000 additional outpatient appointments predominantly in general paediatrics, specialist and orthopaedic clinics, and up to 25,000 emergency care attendances annually. We have seen a 65% reduction in the waiting list for general paediatrics since the opening of CHI Connolly and we expect to see this waiting list reduce further by the end of 2022 with these expanded services in CHI Tallaght. A public awareness campaign is planned for families, GPs and healthcare professionals in Dublin south, Dublin west, Kildare and Wicklow informing them on the expanded services in CHI Tallaght.

To conclude, the additional challenges in healthcare caused by a global pandemic and a cyberattack has only magnified the need for our new children’s hospital. Our staff experience difficulties daily in delivering acute paediatric care services to Ireland’s sickest children and adolescents in outdated facilities in our existing hospitals that have poor digital infrastructure and old equipment. I re-emphasise the criticality of the new hospital and the new Tallaght facility. Their space, digital infrastructure, modern equipment and enhanced workforce are at the core of our plans to enhance clinical outcomes and develop services provided to children, adolescents and their families. I wish to express my deep appreciation to the staff in CHI for their continued dedication, professionalism and innovation throughout the past challenging 17 months. We look forward to walking through the doors of our new children's hospital and delivering care and treatment there. In the meantime, we remain committed to reforming our services and prioritising investment and innovation to support improvement in paediatric services and child healthcare. I am happy to take any questions the committee has.