The Government is grappling with the question of what to do about Children’s Health Ireland (CHI) after a string of controversies. There is no single “ right” answer to this dilemma, with the various possible routes forward all having pluses and minuses. But it is clear that doing nothing is not an option for the Minister for Health, Jennifer Carroll MacNeill, who has already appointed a number of new members to the CHI board.
In moving forward, it will be important to keep a forensic focus on a few key issues which have emerged. This is a multi-faceted problem and there is no single, or easy, solution. And this was underlined by recent reports of a toxic culture in one CHI hospital, with multiple complaints about certain consultants.
An obvious issue is that the CHI governance structure has not operated properly, failing to spot problems and also not providing adequate information to the HSE and the Government. One option to tackle this is to bring CHI fully under the aegis of the HSE which, of course, has had its own problems. Whatever exact structure is chosen, it is essential that CHI is operated in a way that reflects its reliance on taxpayer funds.
A weakness of the voluntary hospital system, of which CHI is a part, is a lack of clarity about lines of accountability. This may even suit politicians and the HSE to some extent, as there is always someone else to blame. But it cannot continue.
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Whatever new structure emerges must deal with this. And it needs to recognise that appointees to board such as the CHI need to be adequately remunerated for the responsibilities they take on. Public service has driven many who have taken on such posts. But proper professional structures are important.
The controversies also raise questions about clinical governance in CHI, under new structures set up in 2008. This process is meant to ensure patient safety. Clearly, in the case of the use of unauthorised implants in spinal surgery and unnecessary hip operations, there were serious failures.
A separate clinical issue has emerged about one consultant’s use of the National Treatment Purchase Fund (NTPF). It is essential that, whatever checks are needed, this must not result in undue further delays in appointments and operations for children.
No doubt these separate incidents will also lead the Minister to reflect on the wider failure of the healthcare system to deliver an adequate return for increased spending, raising issues about productivity and also the overall system of clinical management.
There have been improvements in the healthcare system , but also areas where services are well below where they should be . And the recent string of disturbing scandals further underlines the need for reform.
