David Cullinane (Waterford, Sinn Fein) | Oireachtas source

There are many exceptional individuals working tirelessly in CHI to deliver the best care that they can for our children. I have met many of them; I meet them all the time. I applaud and salute them because I know that they are as frustrated as Sinn Féin and I are with the failings of CHI as an organisation. Unfortunately, there are very serious problems at CHI, which make it impossible for Sinn Féin to have confidence in that organisation's ability to take charge of the new children's hospital.

The story of CHI has been a sorry saga of dysfunction and crisis. Children’s Health Ireland was formally established in 2018 by then Minister for Health, Deputy Simon Harris, under the Children’s Health Act. It was established to improve and integrate governance of several children’s hospitals in Dublin and to provide a single and modernised national structure for the delivery of hospital-based specialist children’s care. It took control of these hospitals in 2019. In 2017, as we know, the then Minister gave his infamous broken promise that no child would be waiting longer than four months for a scoliosis procedure by the end of that year. CHI is the organisation responsible for delivering that, and it failed, as did the Government. Resources were committed and treatment abroad was started but then it stopped with no explanation and the waiting lists continued to grow. Then we had the former health Minister, Stephen Donnelly. More investment was announced, treatment abroad started again and we were told late last year that there would be no more than 20 children waiting longer than four months for a date for their procedure by the end of last year. As we speak today, there are still more than 50 children waiting longer than four months and a total of 137 children are waiting for a date for their surgery. In fact, 18 of them are waiting more than a year just for a date.

The Minister mentioned capacity. There are fewer spinal consultants and surgeons working in CHI today than there were in 2022. That is a very serious problem. In 2023, very serious concerns came to light about the quality of orthopaedic care at Children’s Health Ireland. These concerns were first brought forward by parents and advocate groups. They felt that they were not listened to, that they were silenced, that they were ignored and they feel very badly let down. They raised concerns regarding a high level of infections and returns to surgery, which raised alarm bells, and very serious questions were being asked of the quality of theatre infrastructure and care delivered at Temple Street hospital in particular. In the middle of this, it transpired that non-medical grade springs had been inserted into three children, which then began to disintegrate. This led to several major investigations, namely, the Boston review, the now-live Nayagam review, the HIQA review and a financial audit. We have yet to receive Dr. Nayagam’s report on clinical practice.

Seven years on from the establishment of CHI, however, we have received a scathing report from HIQA, which has laid bare the extreme and severe institutional and governance failures that allowed children under CHI’s care to be harmed. HIQA examined the end-to-end process by which non-medical grade springs were ordered and, in the end, placed into three vulnerable children, from whom they have since been removed. The report by HIQA can be summed up by a single sentence: “Children were not protected from the risk of harm.” That is a staggering finding, and HIQA’s report leaves no doubt that there were individual wrongdoings, but they should have been stopped by CHI. However, CHI was so poorly run that it did not have control or oversight of what was happening in its hospitals. The report found that non-medical grade springs were ordered and procured through Children’s Health Ireland, prepared by Children’s Health Ireland and placed into children under the care of Children’s Health Ireland. At no point in the process did anyone say, "Stop". In fact, HIQA’s investigation found that not only did CHI fail to pick up on and stop the use of non-medical grade springs, but that CHI had totally failed to properly implement the regulations that should have stopped this from happening. The report states: "HIQA found that a comprehensive suite of procedures for the introduction and management of all aspects of the Medical Device Regulations (MDR), or the previous regulatory framework which applied from 1994 to 2021, was not in place across CHI."

Strikingly, HIQA concluded that at CHI Temple Street there was "no committee in place to approve and oversee the introduction of class III medical devices, including implantable medical devices". That is simply astonishing. Not only was CHI not following the rules, CHI was implementing rules that go back 30 years. The vital safeguard, which is a committee to approve and oversee the use of implantable medical devices, which would have and should have protected these children, simply did not exist at CHI.

The dysfunction in CHI unfortunately did not stop there. The HIQA report paints a picture of a chaotic organisation that has failed at its fundamental task of improving and modernising governance of children's healthcare. In reviewing the new governance structures implemented at CHI in recent years, HIQA found that "these arrangements were complex and did not lend themselves to clear and accountable governance and may have affected the ability for those responsible for the service to effectively oversee the delivery of care". The report went on to state: "These arrangements did not lend themselves to clear lines of reporting and oversight of operations on a day-to-day basis at each of the hospital sites for the delivery of high-quality, safe care." HIQA's report is a study in how not to run a hospital. HIQA found that each hospital site operated with a separate procurement process. While there were local decontamination structures and processes in place the structures and processes for decontamination were not standardised across both sites. At the time of the review there was no standardised processes in place across CHI relating to governance for the introduction and use of medical devices in practice, there were no controls in place to carry out any type of safety and technical checks on the springs and there was "an absence of structures and processes to support clear and adequate communication between Surgeon A and the Decontamination Manager around the details on the sterilisation process for the springs". There was failure after failure. These concerns alone show why many families and advocates have been raising concerns themselves about CHI for years, why trust in CHI has been shattered, and why many of us - those parents and advocacy groups across the State and those of us in opposition - will have a view that the board of CHI should be stood down and a new team should be put in place.

If these scandals were not enough, it seems that the biggest scandal in children's healthcare in a long time has come to light. Potentially hundreds or even thousands of children have been given unnecessary hip surgeries at CHI going back over a decade. This scandal came to the Government's attention a year ago but the then Minister for Health, Stephen Donnelly, who was informed in May, did not take the appropriate action. Concerns were hidden from parents until the news broke. That was the wrong way to treat parents and children. Parents only found out after The Ditch published the draft audit report back in March. Then a flurry of letters was sent out to parents, which has only raised more concerns and heightened the fear. The letters said there was nothing to worry about and that follow-up appointments would be scheduled. The follow-up appointments, however, are not happening. Parents have contacted me about surgeries that took place as far back as 2010. I received one message from a parent today where a child had a surgery back in 2010. We are told the audit covers a time period from 2021 to 2023, yet letters are being sent to parents of children concerning procedures going back as far as 2010 and possibly further. This parent said that the child had received no follow-up care over the years and she does not know what happened to her child.

There are other instances where people got second opinions. We have had many examples of that. They went privately, got a second opinion and were told not only did the child not need any surgery but the child did not have the condition at all. We have a lot of those. This paints a very dark picture and a really big problem.

Parents feel in the dark. They are worried about their children. They are worried about unnecessary and traumatic surgeries. This creates uncertainty, worry and fear. We all depend on good governance and good management. For those of us who use the health service, we have to put our faith in clinicians, we have to put our faith in doctors, and we have to put our faith in a government that will make sure systems are fit for purpose so that children in particular get the very best health care. When trust breaks down in a hospital, it is a real problem and a real challenge because parents do not know what to do. They do not know if they can accept the opinion they are getting. Parents tell me all the time that they need a second opinion because they simply cannot rely on the information they have received because of all the scandals in the hospital. This is a real difficulty.

I will just make one final appeal to the Minister. The HIQA report looked at the use of non-medical grade springs. It pointed out some very serious management and governance failures in CHI. These issues need to be grappled with and dealt with. There has to be accountability for individual wrongdoing and for institutional wrongdoing but there also has to be political accountability. I want the new hospital built as quickly as possible but we must make sure we get it right. We have to do much better by the children of the State.

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