An unpublished Children's Health Ireland report, into concerns at one of its hospitals, is to be referred to An Garda Síochána by the Health Service Executive.
It is understood the issue was discussed at the Cabinet Committee on Health, which was attended by Taoiseach Micheál Martin, Tánaiste Simon Harris, Minister for Health Jennifer Carroll MacNeill and others.
Once the report has been received, gardaí will assess whether an investigation should be commenced and, ultimately, if a report should be sent to the Director of Public Prosecutions.
The unpublished report has caused shock in government circles, with Mr Martin saying yesterday that the "essence" of the report should be made public given the disquiet it has triggered.
The report, which has been seen by RTÉ News, concluded that "a root and branch review" of use of the National Treatment Purchase Fund and other waiting list initiatives "should be undertaken".
It 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.
Watch: Political Correspondent Paul Cunningham on the latest developments in CHI controversy
In a statement yesterday, 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 focused 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."
'Inter-personal' difficulties
The unpublished CHI report also focuses 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:
"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."
We need your consent to load this rte-player contentWe use rte-player to manage extra content that can set cookies on your device and collect data about your activity. Please review their details and accept them to load the content.Manage Preferences
CHI funding suspension 'right thing to do' - Taoiseach
The Taoiseach has said he believes the temporary suspension of funding by the National Treatment Purchase Fund (NTPF) to Children's Health Ireland (CHI) was the right thing to do.
The State fund placed a pause on all insourcing work with CHI after "serious concerns" were raised over a 2021 report.
Speaking on his way into a Cabinet meeting this morning, Mr Martin said the temporary suspension "is the correct decision", adding that "it represents a small portion of the overall funding".
He said: "I fully accept the decision at the NTPF. It's a temporary suspension, and hopefully they can work out agreements with CHI that fulfil the guidelines and the rules of how the fund is meant to operate in the first instance.
"That report was very, very worrying on a number of fronts, and it is important that actions happen as a consequence of the highlighting of such situations."
Earlier, Minister Carroll MacNeill acknowledged that the construct of the NTPF, which pays hospitals and consultants more to see those patients who should have been seen earlier, does potentially have the ability to reward inefficiency.
"However, I think it is more pertinent to ask what public consultants are doing in public time and the productivity within that," the minister said.
"I want to see a public system that's maximum productivity, and I want to remove those incentives that may create perversions of the kind that's described there," she added.
Read more:
Audit finds two CHI paediatric critical care units are 'under strain'
Ms Carroll MacNeill reassured patients the existing scheduled surgeries would not be impacted by the current pause on funding.
She asked parents to "sit with her and the NTPF" for the next week to ten days while the NTPF gets the assurances it needs from CHI in order to allow the funding suspension to be lifted.
Speaking on RTÉ's Morning Ireland: "It's my understanding that the NTPF only found out about allegations concerning a consultant two weeks ago...and it's really important that the underlying concerns the NTPF have are addressed."
These include concerns that children should be receiving care at an earlier stage in the general public system, she said.
Ms Carroll MacNeill said: "That is a very serious issue, because for two reasons. One: children should be getting the most timely surgery or medical interventions that they need, and the failure to provide that service across the board; whether it's in this this section, or any other section, impacts patient safety and patient outcomes."
