Children’s Health Ireland (CHI) has published a summary of the 2021 report which found that one hospital’s workplace culture had the “potential to put patients at risk.”
The confidential, internal report was widely leaked in recent weeks, prompting CHI to publish a summary on Monday, with the statutory body saying they are legally constrained from releasing the document in full.
Following the leak at the beginning of June, Lucy Nugent, the new chief executive of CHI, was criticised as being “tone deaf” for sending a memo to staff to say it is “dispiriting when internal matters are leaked to the media” as was the case with the report. Nugent is set to appear before the Oireachtas health committee this week to answer questions on the controversy which has cast a dark cloud over CHI.
Earlier this month, a meeting of the Cabinet committee on Health heard that the report was to be referred to An Garda Síochána by the Health Service Executive. The document, of which details were first revealed by The Sunday Times, detailed an array of cover-ups, wrongdoings, and disregard for the treatment of sick children.
The new summary outlines the recommendations made and actions taken after the 2021 internal report. According to the summary, the concerns identified focused on behaviours and culture, access and waiting list management, and leadership and governance at the unnamed hospital.
It stresses that the internal examination commissioned by the CHI Executive was “never intended to be made public or published to ensure that staff felt safe to participate in a confidential process, in an open manner, given the sensitivity of the issues under examination.”
CHI said that the intended purpose was to understand issues which were understood to exist in a particular clinical department, to implement recommendations which would address any issues identified, and to improve quality of patient care and to brief the Executive and Board of CHI. It said employees had participated confidentially so that issues could be examined, and that some of those employees involved no longer work for CHI.
It states: “While the Examination did identify serious issues of concern, where possible, these were to be addressed through the appropriate internal policies and processes. The majority of the recommendations arising from this Examination have been implemented with the aim of ensuring that similar issues cannot reoccur in the future. Measures that have been adopted and are continuing also help to support a culture of respect, openness and transparency.”
According to CHI, during meetings between employees in the clinical department and members of the CHI Executive, multiple legacy and deep-rooted issues were uncovered that “regular meetings could not address.”
BULLYING ISSUES IDENTIFIED
According to the report, the culture at CHI “lacked governance and robust processes, and was influenced by strong and challenging personalities”, which resulted in a “[high] attrition rate among support staff due to bullying issues”.
“The report stated that a negative culture can impact service delivery, department dynamics and staff experience and has the potential to put patients at risk,” it added.
According to the summary, a “significant risk was identified where only one employee managed the needs of a complex tertiary speciality.”
“This level of dependency on one individual for a critical service is not in line with best practice and created a vulnerability in this specialty,” it notes.
Inconsistencies in managing staff contracts was also identified, while half of medical trainees described the learning environment as not conducive to learning.
“As a reflection of this, The training body had indicated that there would be no intake of any new trainees or Specialist Registrars (SpRs) into the programme in 2022 due to concerns about the trainee experience which was reputationally damaging for CHI,” the summary said.
It acknowledged that a negative culture can impact service delivery, department dynamics and staff experience and “has the potential to put patients at risk.”
WAITING LISTS
A number of issues were also raised in relation to a NTPF outpatient waiting list initiative, with the Examination suggesting that based on the documentation review, certain NTPF-funded clinics did not adhere to NTPF standards of chronological scheduling (i.e. seeing the longest waiting patients first).
“Data suggested that some of these patients could have been seen by other departmental colleagues within the existing day to day service and potentially managed in a more proactive way,” the review says,
“Patients seen in the outpatient clinic who required ongoing treatment were placed on an already long inpatient waiting list without consideration of redistribution of patients to colleagues with a shorter waiting list. The examination raised the issue as to the possibility that this could have led to any negative outcomes for patients.
“The above raised concerns relating to the prudent and beneficial management of NTPF funding and lack of oversight of access initiatives.”
LACK OF STRONG LEADERSHIP
A lack of strong site leadership was also flagged as a “substantial and persistent message,” along with poor operational oversight and accountability. Further, the review details consistent feedback given regarding the “challenging behaviours of some staff” – something that was “not adequately addressed by the site leadership team,” leading to a number of unresolved personal issues between employees.
The management of a particular cohort of patients was inequitable across CHI Hospitals, the review notes.
The Office of the Comptroller and Auditor General is examining CHI’s accounts in the wake of the concerns.
The report, which has been seen in full by RTÉ, said that children waiting the longest were “not seen at these NTPF clinics” and that “there were 45 children who required surgery but did not receive an [appointment] date and instead were placed back on one consultant’s inpatient waiting list, which has a significant wait time”.