Ms Lucy Nugent:

I thank the committee for the opportunity to address it today. I am pleased to be before the committee today representing Children’s Health Ireland and I will endeavour to answer members' questions to the best of my ability. I joined as chief executive five months ago tomorrow, and as I said to the members’ colleagues on the Committee of Public Accounts , I want to express how proud I am of our almost 5,000 staff, who work diligently at the front line of paediatric healthcare provision in CHI at Temple Street, Crumlin and Tallaght, and at our urgent care centre at Connolly.

I began my career as a nurse in Temple Street Children’s University Hospital and I appreciate the pressures and demands placed on our people on a 24-7 basis but also how rewarding our jobs are. 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. Exceptional care was delivered to these children, despite being in old and not-fit-for-purpose buildings. We continue to lead on paediatric research and innovation on an international stage because our children and young people deserve the best that medicine and science can offer.

We do not just provide healthcare - we provide support for children and families when they are at their most vulnerable and we respect that that is a privilege. We are a place of healing, a source of comfort and a community with a relentless dedication to paediatric healthcare – a message that is often lost, especially in the current climate. We want every patient and family who we meet to feel safe and cared for.

However, we need to do better. Despite all this good work, I am very aware of the impact of the past several years, months and weeks where revelations relating to our culture, governance and practices have led to great pain being inflicted upon some of those who were in our care. I say to the committee, to the children and families impacted and to the Irish people, that I am sorry. I am sorry on behalf of the management of Children’s Health Ireland and I am sorry on behalf of the entire organisation.

I am very aware that various issues that my organisation is grappling with - I will speak to each of those issues in due course this morning - have an enormously worrying impact on parents around the country and whether they can place their trust in us.

We want the best possible outcome for our children when they go into and leave hospital. When that does not happen, children are failed and trust is broken.

Our mission statement states that we in CHI aim to promote and provide child-centred, research-led, learning-informed healthcare to the highest standards of safety and excellence. On occasions, we have failed to do that. As the new CEO of this organisation, I am determined to ensure we can restore trust and faith in our national paediatric service.

With regard to the challenges with spinal surgery, as stated a couple of weeks ago at the public accounts committee, I acknowledge and give full recognition to the families impacted by the recent HIQA report relating to the use of unauthorised springs in three children. What happened should not have happened, and children should have been protected from harm. We are deeply and unreservedly sorry to those families. We do not underestimate the impact this has had and is having on the families affected and the distress it has caused to all patients and families in the spinal service. The HIQA review found that while corporate and clinical governance arrangements were in place in CHI, there were unclear lines of reporting and accountability to ensure the safe introduction and use of new surgical implants and implantable medical devices. It was found that supporting policies and procedures were either not in place, not fit for purpose or not followed. CHI has since introduced robust policies and processes, with training and awareness for staff ongoing.

In respect of CHI’s spinal surgery management unit, which was established in 2024 and is led by my colleague, Mr. David Moore, its aim is to build a safe and world-class spinal service, which treats children and young people in a timely and patient-centred way. Between January and May 2025, 254 procedures have been added to the spinal surgery wait list compared with 193 procedures added for the same period in 2024. While we are doing more spinal surgeries this year, with a total of 210 to date, we are also seeing more outpatients and adding more procedures to the waiting lists. I recognise, however, that these are just not numbers. Rather, they are children and young people.

The list is constantly changing. As children and young people have their surgeries and come off the list, new patients are added. Important progress is being made every month. The spinal surgery management unit has implemented initiatives which have reduced the waiting time for outpatient appointments, for example, by 40%. We acknowledge that waiting times for patients are still too long. We continue to work to reduce the length of time patients are waiting for appointments.

The report on developmental dysplasia of the hip is in the public domain, having been published by CHI on 23 May. I recognise the worry it has caused many more patients. The audit reviewed 147 random and anonymous cases across the three hospitals. Based on criteria that had been retrospectively applied for the purpose of the audit, it found that thresholds for recommending pelvic osteotomy procedures varied between CHI Crumlin, CHI Temple Street and the National Orthopaedic Hospital Cappagh. Children who had surgery at CHI Crumlin were found to have been appropriately selected for surgery based on the current international standards used by the auditor. A proportion of children, in the opinion of the auditor, did not meet the threshold for surgery based on the criteria used for the audit. Regrettably, the audit identified one case from the review sample where a child experienced complications due to the surgical approach recommended to them. This family has been contacted and supported through an open disclosure process.

The audit made a number of recommendations, which are fully accepted and will be implemented across CHI. All families have been sent a letter which details if their child was part of the audit and what the next steps will be. Multidisciplinary team review clinics have started. This is a once-off review to assess complications only and determine the current clinical state of each patient. After this, patients enter the recommended normal follow-up process. To date, 105 appointments have been offered, with 60 patients seen in CHI and a further number of patients seen at the National Orthopaedic Hospital Cappagh . We are arranging these clinics as quickly as possible and hope to have seen all children within six months.

Multidisciplinary team meetings have started to include surgeons across all sites. Any child who is listed for a hip surgery with CHI is now discussed at this multidisciplinary team prior to surgery in order that all children and young people who come to CHI for care will receive the same standard and care across our hospitals. Two international experts currently support this multidisciplinary team. Families will be involved in a thorough and transparent discussion of decision-making, including risks and benefits, in order to make informed decisions with and for their children. Any complications identified during the follow-up reviews will be acknowledged and discussed with families and appropriate action will be taken. The purpose of these reviews is to ensure that patients are doing well following surgery. Should any concerns be identified, they will be discussed along with any recommended course of action.

The care and well-being of our children is our absolute priority for CHI. I am sorry that impacted families were not offered one consistent and excellent standard of care across our developmental dysplasia service. I do not underestimate the stress and anxiety families are rightfully feeling throughout this audit process. To one family whose child experienced complications during their care with CHI, I extend my heartfelt apologies.

I give my assurance to all affected families that they will be directly supported and are being contacted with follow-up information and next steps. We are standardising care across all CHI sites in order that all children receive the same high-quality treatment no matter where they are seen. Also, it is important that we act swiftly to review developmental dysplasia surgery patients to enable us to answer outstanding questions raised by this audit. This will be done openly and transparently. The independent HSE review will determine whether surgery was required and will assess the appropriateness of the original decision-making. This review is in development by my HSE colleagues. We have had dedicated supports in place for families who wish to contact us about this report since March of this year. Every family has been responded to in a timely manner, although I accept that families want more detailed information and that this is a stressful time for them.

As with the issue that was the subject of the HIQA report, I assure the committee and the public of the absolute priority I, as CEO, am giving to ensuring robust governance and processes in CHI and as fostering a caring, open and supportive culture for children, families and staff.

With regard to the recent unpublished report, members will be aware of the recent internal report relating to a number of interpersonal and process matters which has been the subject of much media attention. First, I apologise for the fact that I, as CEO, and CHI, as an organisation, are not at liberty to publish this report. It is not in any way our intention to hide the truth or to hide behind legalities to avoid disclosure. While a redacted or pseudonymised version of the report was considered, it would not have made sense to those who had not seen the leaked confidential report. In addition, the CHI board and executive team wanted to inform the public of the actions that have been taken. It is simply our legal duty not to publish the report, regardless of what is in the media. I hope the committee notes that we have provided it with a summary of the report which ensures compliance with our legal advice while at the same time providing as much detail as possible relating to the report’s contents and, importantly, the action taken on foot of the internal examination.

We take our accountability to the public and the families extremely seriously. We are committed to learning, improving and ensuring that every child who comes through our doors receives the highest standard of care. Our patients and their families are at the heart of everything we do. That must remain our central focus.

While the myriad of issues I have just spoken of are naturally of the greatest concern to members of the committee, we should not allow today’s interaction to go by without referencing the fact that we will soon be moving into the new children’s hospital. As expressed by my consultant colleagues in a recent letter to The Irish Times:

... this project is the culmination of decades of work and hope for what we can deliver for children. It represents a transformative opportunity to deliver world-class paediatric care, and we are focused on building a positive, inclusive and forward-looking culture as the one team, working together for the children and families we are privileged to serve.

We are looking forward to playing our part in ensuring that the new hospital becomes a centre of excellence defined not just by its infrastructure, but by the spirit of partnership and patient-centred care that underpins everything we do.

Once the National Paediatric Hospital Development Board hands over a substantially completed building, CHI will commission the building for it to be operational to international standards. We have been working for many years on integrating services, functions and teams across facilities to become a single organisation with one governance and management structure and one culture, which is being progressed in preparation to move into the new children’s hospital. As is obvious, this has not always been easy. However, it is continues to be done. We will continue to ensure and progress CHI’s readiness as an organisation to move into the new hospital and we will be ready and able to take over the new facility.

In line with Sláintecare principles, the national model of care for paediatric healthcare services will ensure that children are 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-----