Mounting concerns for Children’s Health Ireland

The controversies surrounding Children’s Health Ireland (CHI) show no sign of abating. Less than two months after HIQA released its damning report into experimental spinal procedures at CHI at Temple Street, another critical publication has followed: A clinical audit examining hip surgery thresholds for children with developmental dysplasia of the hip (DDH).

The audit was triggered by a protected disclosure raising concerns that CHI at Crumlin, CHI at Temple Street, and the National Orthopaedic Hospital Cappagh (NOHC) may have used differing criteria to determine whether DDH surgery was required.

In July 2024, CHI and NOHC announced a joint clinical audit of a random, anonymised sample of DDH surgeries performed between 2021 and 2023. The audit was carried out by a UK-based paediatric orthopaedic consultant with specialist expertise in this area and the results were published at the end of May.

The audit reviewed 147 anonymised cases across the three hospitals. Applying retrospective criteria for evaluation, it found significant variation in the thresholds used to recommend pelvic osteotomy procedures. The auditor raised concerns about the indications for surgery in many cases at CHI at Temple Street and NOHC.

In contrast, children who underwent surgery at CHI at Crumlin were found to have been appropriately selected for the procedure, according to current international standards.

The audit identified one case in which a child experienced complications due to the surgical approach taken. The family has been contacted and supported through an open disclosure process.

The HSE will now oversee the implementation of the recommendations. This will include the establishment of an expert panel or panels to respond to queries which may arise from patients and their families in relation to their individual procedures and whether they were necessary.

A plan has been developed to review approximately 1,800 children and young adults who underwent this surgery at CHI at Temple Street and NOHC since 2010, with follow-up continuing until they reach skeletal maturity. The audit also recommends long-term monitoring for all children who undergo pelvic osteotomy and clinical teams at CHI and NOHC are now working to implement this guidance.

“There is little doubt that the findings of this audit raise significant concern,” according to HSE CEO
Mr Bernard Gloster.

“Focus on follow-up and putting in place a mechanism to ensure this kind of variation can’t recur is central to our next steps.” 

In addition to the audit, a separate CHI internal investigation, recently reported on by The Sunday Times, questioned the manner in which public patients were referred to a private clinic through the National Treatment Purchase Fund.

Mr Gloster said he was “shocked” by the revelation and that any evidence of misuse of public funds will be referred to the gardaí.

In the wake of these controversies, a number of members have resigned from the CHI board.

And with the news that the opening of the New Children’s Hospital has been delayed yet again, political scrutiny of our paediatric services is only likely to intensify.