The unpublished Children's Health Ireland (CHI) report into concerns at one of its hospitals concluded that "a root and branch review" of use of the NTPF and other waiting list initiatives "should be undertaken".
The report, which has been seen by RTÉ News, also said "the longest waiters were not seen at NTPF clinics" and that "45 children who required surgery did not receive a date for same and instead were placed back on one consultant's inpatient waiting list which has a significant wait time".
The report was first referenced by the Sunday Times last month, when it reported that a consultant who has since retired had breached guidelines by referring public patients to the doctor's own weekend clinics.
In a statement this morning, CHI said that the clinics did not take place in the consultant's private rooms, and that they instead occurred in a public clinic in one of its hospitals, on a Saturday as part of a waiting list initiative, with no charge to patients.
The 112-page CHI report focussed on two areas: access to services, and inter-personal relationships between staff.
On the question of access to services, it concluded: "A root and branch review of all access and waiting list initiatives, to include NTPF and referral management, should be undertaken.
"This should incorporate a review of governance structures and processes for approval and sign off, thus maximising patient's timely access to care, ensuring a fair and equitable service for all."
This is in reference to a summary of NTPF clinics related to the area of CHI being examined, which said "the clinics did not align to the insourcing principles outlined in the waiting list management protocol".
It said that the "longest waiters 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".
It said: "Placing these patients on a specific consultant's inpatient waiting list when it was known there were alternative options which would have ensured these patients could have been operated on sooner, appears not to be in the best interest of the child, and the specifics of each case warrant further examination".
"These patients could have been accommodated in a general surgery outpatient clinic during normal working hours, without the need for NTPF funding," it said.
It added: "The time slot afforded to each NTPF patient was 10 minutes. This is less than this consultant's average outpatient department clinic time slot for new patients.
"Indeed up to 48 patients were seen in the NTPF clinics, where one consultant was working alone, however this consultant's public clinic is capped at 23 patients, yet there would be at least one registrar supporting."
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'Inter-personal' difficulties between staff
The unpublished CHI report also focusses on what it describes as "inter-personal" difficulties between some members of staff.
The report states that in numerous interviews with members of staff at the facilities, it was raised that "challenging behaviours appear to be the norm" and that "from the outset significant concerns were raised from multiple participants" regarding inter-personal staff issues.
It said the service in question was given a "risk score of 20 out of 25" and referenced an alleged "lack of collaborative work" between some individuals.
It said those interviewed referred to a "negative and toxic culture that exists", which it said was having a "causative effect on culture, staff morale and effective operation" of the service.
The report said there were reported difficulties between individual consultants, and that between 2013 and 2020 there was "an exceptionally high rate" of departures by clinical nurse specialists from the service.
In a statement, the NTPF said: "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.
"The key criteria covered under the NTPF Memorandum of Understanding for insourcing programmes include:
- Insourcing programmes are targeted at longest waiting public patients
- All insourcing activities are being carried out strictly outside of core activity and are not displacing or overlapping with services already funded under the HSE national service plan
- No costs already funded by the HSE, including capital or core-funded staff costs, are being included in NTPF reimbursement claims
- All staffing arrangements are in line with public pay policy and comply with HSE consolidated pay scales for core hours, overtime, and premium payments
- 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."
Taoiseach calls for report to be published
Taoiseach Micheál Martin said the CHI report should be published, if possible.
Speaking in Co Meath, he said the "essence" of the report should be made public:
"I think the essence of it should be made public. It makes for very worrying reading, as I said in the Dáil last week."
Mr Martin was also asked about the future of CHI in terms of it continuing as a standalone entity separate to the HSE in the wake of recent controversies.
He said: "I think the immediate priority is to strengthen the governance at CHI in terms of the board, the board appointments, and the Minister [for Health] has appointed some nominees and people who have a lot of experience in the HSE to the board.
"The transition to the new hospital will be particularly important.
"So I see an evolving situation here, but I do believe that there's a number of areas that we need to not just examine but change and improve upon."
"It's very important that we get the governance right but we await proposals from the minister in that respect," he added.
