People are being asked not to attend outpatient appointments at children's hospitals unless they have been contacted to say they should.

Children's Health Ireland said the three main paediatric hospitals are still having difficulties following the cyber attack on the HSE's IT system.

The group's CEO Eilish Hardiman said almost 80% of the total IT infrastructure was infected by the attack, some systems were 100% infected.

Ms Hardiman said communications is a challenge and they have had to resort to pen and paper which has meant delays for patients and extra work for staff.

"Staff have had to order x-rays and lab results using paper and then when the results are analysed they need to be phoned back and checked by two people or a paper actually sent," she said.

"We have extra staff assigned, around the clock 24 hours, 7 days a week to ensure those paper processes are flowing," she added

Ms Hardiman said this has resulted in services being reduced.

While emergency departments at the children's hospitals are open for urgent treatment people are being asked to go to their GP, pharmacist or local healthcare service if possible.

Outpatient public and private clinics are cancelled at Temple Street, Crumlin and Tallaght hospitals.

Eilish Hardiman said only people who have been contacted by the hospitals should attend.

She said the emergency departments are busy, "it's trauma season, that when all the kids are out and the sun is out again".

She said progress is being made but it will be weeks before the system is fully up and running again.

Dr Carol Blackburn, Consultant in Paediatric Medicine at Crumlin hospital, said the cyber attack has had a very significant impact on the hospital.

She said: "In Crumlin we have a lot of patients who are complex and chronic patients, if they present with a problem new or old they expect, very reasonably, that we should be able to see their previous history or attendances."

"At the moment we are struggling with that, if they don't have their old pre-existing hospital number when they present we have to generate a new one to carry out any tests they need on any given day.

"We have a really great bunch of staff who are enthusiastic and very resilient but for this latest challenge to arise after a good 14 months of Covid it has really required a lot of our reserves to pick up and go again."

She stressed that the emergency department is open for urgent care.

Eilish Hardiman said the process of assessing, repairing, restoring and replacing the IT system is around 50% complete.

Ms Hardiman said that the IT infrastructure is very old and it is slow and laborious work, and that the Defence Forces and the HSE are assisting in the work.

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HSE performing cyber attack repairs in line with clinical priority
The anatomy of the health service cyber attack


Listen to Joan O'Sullivan's Morning Ireland report from Temple Street Children's University Hospital

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Meanwhile, management at Letterkenny University Hospital say initial progress has been made to restore some hospital services at Letterkenny University Hospital following the ransomware attack on the HSE IT systems.

Tomorrow and Friday of this week some planned surgery will go ahead and a number of outpatient clinics will also proceed with the patients concerned being contacted directly.

General Manager at LUH Seán Murphy said: "Work is ongoing to get essential systems such as radiology, diagnostic/laboratory and patient information back functioning fully.

"We have been able to keep our maternity services, dialysis appointments, physiotherapy appointments and most chemotherapy treatments going throughout the IT systems outage and patients should continue to come to their appointments for these services.

"Unfortunately", he said, " patients attending the Emergency Department are still facing extremely long delays because essential services like blood tests and diagnostic services are taking much longer than usual."

Additional reporting Eileen Magnier