LAST UPDATE | 25 May

THE CEO OF the HSE has said that the more than 2,200 children who received hip surgery over a 15-year period will be “clinically reviewed”.

An independent review into hip surgeries in children who had developmental dysplasia of the hip (DDH) surgery was announced last year and published earlier this week.

An anonymised sample of the hip surgeries, between 2021 and 2023, had been undertaken into operations that took place at CHI hospital sites, as well as the National Orthopaedic Hospital, Cappagh.

The audit found that a lower threshold was used by surgeons in Temple Street and Cappagh Hospital, though this issue wasn’t identified in CHI Crumlin, which was also examined in the audit. 

The independent expert found that in Temple Street roughly 40% of the surgeries the audit reviewed were indicated to have met the criteria; in Cappagh 21% were indicated, and in Crumlin virtually all of the surgeries fell under the criteria. 

Speaking on RTÉ’s This Week, HSE CEO Bernard Gloster acknowledged that a “level of anxiety and concern will prevail for some time” following the independent audit.

When asked why a lower threshold was applied in Temple Street and Cappagh Hospital, Gloster said this was a “novel procedure where the belief was that the surgical intervention at an earlier stage would prevent significant problems later”.

He added: “Novel procedures, when they’re adopted, must be done in the strictest of conditions, with appropriate follow-up and with published papers that are peer reviewed.

“Unfortunately, in this case, the extreme nature of the variance and the rationale offered by some of the surgeons was not found to be reasonable by the auditor.”

Gloster said that while the auditor was looking at a three-year period, the HSE will go “right back to 2010 when this novel procedure first came about”.

He added that the “most important thing is that these children are followed up”.

“So there is quite a bit of work to be done,” said Gloster, “but all 2,259 children comprehended by the issues raised in this audit will be followed up comprehensively.

“Then there will be further expert assessment as to whether or not the surgery was actually indicated as necessary in each individual child’s case.”

He said each child will be “clinically reviewed to establish how they are now” to establish “whether or not child has any difficulties today”.

“The second part that will happen will be conducted by experts and that will involve an option for parents to have a specific examination to make a definitive assessment; was the surgery necessary in their child’s case or not, and whether or not there was any consequential impact resulting from that.”

He also noted that the HSE will commission to “expert analysis” and that if parent’s wish to avail of their own second opinion, the HSE will “assist them with that and fund the cost”.

All 2,259 will begin to receive further correspondence next week and Gloster said this needs to be “speedy but also accurate”.

He said the clinical reviews will take around six months to complete.

The audit was commissioned after whistleblower revelations and Gloster said he is “delighted that when the whistleblower expressed the concern, the CHI took the decision to conduct this audit”.

“That does give me some sense of hope in the midst of this most concerning situation.”

When asked if subsuming CHI back into the HSE is being considered, Gloster said “all of the options are being considered” but that this is not the only option on the table.

2021 inquiry

Meanwhile, Gloster was asked about reports that an internal investigation at CHI found that a consultant abused the waiting list system while also delaying operations for sick children up to three years.

The Sunday Times today reported on unpublished findings which found a consultant breached HSE guidelines by referring patients he was seeing in his public practice to weekend clinics that he was operating separately.

The consultant was paid €35,800 via the National Treatment Purchase Fund (NTPF), which aims to cut waiting times by paying private practices to treat patients on public waiting lists.

However, the Sunday Times reports that a 2021 inquiry found the patients selected had not waited longest, and so did not qualify for the consultant’s appointments.

Gloster said he was “shocked” by the report and “even more shocked because nobody has told me about it”.

Lucy Nugent was appointed as the new CEO of CHI in November and Gloster remarked: “That’s not her fault, I’m not sure how much she has been told.

“I did speak to her briefly today, I believe a number of the issues around culture and other stuff that went on there were addressed, because the report was about more than that.”

Gloster said the report “should be published in the public interest”.

“If any question arises of anything connected with, or near connected with, alleged people ingratiating themselves financially in the public health system, the first step I’ll be taking is to refer that matter to the gardaí.”

Labour Party Health spokesperson Marie Sherlock remarked that the “dripfeed of information regarding CHI over recent days is deeply concerning”.

“Public money appears to have been abused though the misuse of the NTPF and, most distressingly, children who could have been treated within six months if the correct procedures were followed, instead ended up on a 13 month waiting list,” she added.

She too called on CHI to publish the internal inquiry “immediately in order to confirm the veracity of these reports”.

“Bernard Gloster has confirmed that he too had no knowledge of what was happening at CHI,” said Sherlock.

“He also indicated that the current chairperson of CHI may have had either no knowledge or partial knowledge. This is really incredible.

“It beyond disgraceful that this internal review would not have been disclosed to those at the top of the HSE and the Department of Health.”

Sherlock also called for a “Scally review type of inquiry into how overall systems can be improved across CHI”.

“To date, the various reports have only looked into individual departments within hospitals in the CHI group,” said Sherlock. “It appears that a system wide review is now warranted.”

Sinn Féin’s health spokesperson David Cullinane said in response to the Sunday Times report: “The complete report needs to be published in full. It is incredible that this was not referred onto the HSE chief executive Bernard Gloster.

“It again demonstrates dysfunction at the heart of CHI. It is not yet clear if the Minister for Health was informed. There may well need to be a criminal investigation.

“The clinical governance and management failures at CHI are beyond belief, shocking and unacceptable.”