Strain of merging three children’s hospitals a factor in Children’s Health Ireland crisis, says Hiqa

The planned merger into the new children’s hospital was described as 'probably the biggest change management project in the entire country at this time'. File photo: Leah Farrell / © RollingNews.ie

The pressure staff are under to merge the three children’s hospitals into one is “definitely” a factor in the crisis facing Children’s Health Ireland now, Hiqa has warned.

A report from the regulator on implanting of unapproved metal springs into children’s spines during operations described by a surgeon as “bespoke and experimental” also raises serious concerns about governance at CHI generally.

Sean Egan, Hiqa director of healthcare regulation, described the planned merger into the new children’s hospital as “probably the biggest change management project in the entire country at this time”.

He recalled interviewing clinical directors who “reeled off” lists of new responsibilities they have thanks to the new hospital on top of their patients’ care. Each had “upwards of 100 consultants” reporting to them.

“That’s a phenomenal amount of change for any organisation to address, and I think it is definitely a factor here in terms of the difficulties CHI have had with this,” he said.

The report describes new ways of working since 2021 across the three sites as “increasingly complex and unwieldy” for staff to manage.

Sean Egan, Hiqa director of healthcare regulation, stressed the importance of having clinical staff in leadership roles, but said this review recommends more support is needed. This includes clinical specialist leads acting as ‘middle management’.

Some key roles were moved away from CHI at Temple Street, the hospital where the surgeon under investigation had worked. Gaps in oversight systems ultimately resulted in use of springs made from a metal which corrodes in water in three children without alarms raised.

He stressed the importance of having clinical staff in leadership roles, but said this review recommends more support is needed. This includes clinical specialist leads acting as ‘middle management’, he said.

“One of the key findings from this review is the pre-existing arrangements are actually pretty weak compared to where they need to be,” he warned.

Hiqa also said the HSE needs to improve how it supports health services in the middle of large changes.

Meanwhile, Taoiseach Micheál Martin has insisted further resignations from the CHI board would not help “in any shape or form”.

This follows calls by families and opposition politicians for the board to go. On Tuesday, chairman Dr Jim Brown resigned and apologised to children.

Speaking in the Dail on Wednesday, Mr Martin said: "There needs to be a new chairperson appointed - you actually need a board to do that.

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"And I know that some people have called to just disband the board. That would not help the situation right now, in any shape or form.

"That will weaken governance even further and could lead to further difficulties and challenges."

Labour leader Ivana Bacik said of the 233 children waiting for spinal surgeries by February, 43 had been waiting more than six months - with 15 waiting over a year.

Mr Martin said there had been increased activity and a reduction in waiting times, but added there is a need to do more. He said there has to be "absolute focus" on optimising the transition to the new children's hospital.