Ireland's two children's intensive care units 'under strain' from severe overcrowding, audit finds

Report recommends urgent expansion of emergency transport for sick children to a 24/7 service due to the high number of crisis transfers from other hospitals.

The two children’s intensive care units in Ireland are “under strain” from severe overcrowding and staffing challenges, the National Office of Clinical Audit has found.

It has recommended urgent expansion of emergency transport for sick children to a 24/7 service due to the high number of crisis transfers from other hospitals.

The audit, published on Wednesday, found very high occupancy rates of over 95% during 2023 at the units in CHI at Temple Street and CHI at Crumlin hospitals.

There were 1,723 admissions, a 5% increase on the year before.

Respiratory illnesses were the most common, at 34% of admissions, with a “ a notable increase” of RSV cases, especially babies.

The overall survival rate for children was 97%. Among the children who died, four, aged between five and 15, donated organs.

Clinical lead for the audit Associate Professor Martina Healy highlighted the pressures.

“The data in this year’s report clearly show that while our paediatric critical care units deliver high-quality, life-saving care, the system is under strain,” she warned.

“We must continue to invest in staffing and develop regional paediatric high-dependency units to ensure safe and sustainable services.” 

The audit recommended Children’s Health Ireland publish a workforce plan for the new children's hospital, especially for the new critical care unit.

Some 68% of admissions were unplanned across both units. Some 60% of these at Temple Street came from other hospitals and 47% of Crumlin’s.

Meanwhile CHI said on legal advice it could not publish a report from 2021 on waiting list issues.

In a statement a CHI spokeswoman said they take the report “very seriously”.

“CHI considered the request to publish this report and sought legal advice, however, it is primarily a HR report where the confidentiality of those who participated and fair procedures need to be respected given the sensitive nature of the report,” she said.

She also raised questions about what she described as “inaccurate” issues reported, specifically “in relation to NTPF payments to a consultant". 

The National Treatment Purchase Fund pay for public patients on waiting lists to be treated in private healthcare facilities.

She said: “CHI can confirm that these clinics did not take place in the consultant’s private rooms. They occurred in a public clinic, in one of its hospitals, on a Saturday.

“It was a waiting list initiative for an outpatient appointment only. The NTPF funded the hospital for this waiting list initiative and there was no charge to patients. This was over and above the consultant’s contractual hours. There are no direct payments to CHI staff from NTPF.” 

CHI chief executive Lucy Nugent said her priority was “operational governance of our organisation, positive experiences and outcomes for our children and young people as well as the ongoing support of our dedicated staff”.

The state’s funding body for reducing hospital waiting lists on Tuesday suspended funding for insourcing of patient care at Children’s Health Ireland hospitals.

The move by the National Treatment Purchase Fund follows concerns a CHI consultant had breached regulations by allegedly referring his public patients to a clinic he was running.

The clinics were reported to have been funded under the insourcing system offered by NTPF, this is where they support public hospitals to provide extra treatment for patients on waiting lists who cannot be seen in the normal course of a unit or clinic’s work.

The NTPF also funds public patients who receive care in private healthcare facilities.

They said in a statement on Tuesday: “Following serious concerns raised over the 2021 CHI report, the NTPF immediately placed a temporary pause on all insourcing work with CHI.

“It has initiated a comprehensive review of all insourcing work with CHI to gather the necessary assurances regarding compliance, value for money and appropriate use of NTPF funding mechanisms.” A spokesman said the key criteria for insourcing include the patients must be among those waiting the longest, the activities must be outside of core activity and not displace existing services.

He said no costs already funded by the HSE including staff can be included in the reimbursement claims. Any staffing arrangements for this extra work must be in line with HSE and public pay policy.

The spokesman said: "The NTPF is liaising with CHI at the highest level to obtain and review these assurances and is in close contact with the Department and the HSE.”