Ireland’s Latest Children’s Health Crisis

Children’s Health Ireland is the body responsible for overseeing paediatric healthcare services in Ireland. It is tasked with managing all major children’s hospitals including Temple Street, Crumlin, and Tallaght, and is in the process of preparing to operate the new, chronically delayed and exorbitantly priced, National Children’s Hospital.

Established in 2018 its role was to consolidate and improve paediatric care. However, since then CHI has faced repeated scrutiny for governance failures. Its most recent crisis involves the misuse of the National Treatment Purchase Fund (NTPF) and unnecessary hip surgeries on very young children, including toddler aged children.

These distressing revelations involving CHI centre on a consultant who, according to an unpublished 2021 internal report, is alleged to have prioritised patients for his private clinics using non-transparent criteria, bypassing those with more urgent clinical needs.

The NTPF, designed to reduce hospital waiting lists by funding private treatment for public patients, was allegedly misused to the tune of €35,800, according to reporting by numerous Irish media platforms.

These actions led to delays of up to three years for children requiring urgent care, a failure that opposition and Sinn Féin TD John Brady described as indicative of systemic issues in oversight and accountability. The consultant, now retired, has faced no disciplinary action to date. For many this is yet another instance of senior medical professionals evading consequences for serious breaches of good clinical practice

CHI’s CEO, Lucy Nugent, who assumed the role in January 2025, recently issued an apology to affected families, acknowledging that the organisation failed to deliver what she called a “consistent and excellent standard of care.” However, the apology has done little to quell concerns, particularly as the 2021 investigation was not disclosed to the Department of Health, the HSE, or the Oireachtas Committee of Public Accounts, raising further serious questions about transparency. Naturally it has also given rise to questions around the sincerity or credibility of the apology itself.

Health Minister Jennifer Carroll MacNeill has repeatedly described the governance at CHI as a “fiasco,” noting “toxic behaviours” at CHI Crumlin and expressing alarm at the lack of notification to relevant authorities. The “fiasco” has since deepened with the resignation of four board members (Mary Cryan, Dr Gavin Lavery, Brigid McManus, and Catherine Guy) further underscoring the depth of the crisis.

The CHI controversy extends beyond the NTPF misuse. A clinical audit revealed that between 2021 and 2023, nearly 80% of hip dysplasia surgeries at the National Orthopaedic Hospital Cappagh and 60% at Temple Street were unnecessary, as they did not meet the clinical threshold applied at CHI Crumlin.

This has left parents grappling with the possibility that their children underwent invasive procedures without justification, prompting calls for an independent external review. During a recent Dáil debate on the crisis, one opposition party member highlighted the plight of a constituent whose three children face uncertainty about the necessity of their surgeries, with one parent unable to afford a €700 third-party review. However, the HSE has promised to fund such reviews, but mechanisms for delivery remain unclear, adding to parental frustration.

What is almost incredible about this recent crisis for CHI, is the fact that it is not an isolated incident. Indeed, one could well argue that this latest series of bombshells is part of a disturbing pattern of systemic failures in Irish children’s healthcare since 2000.

The case of Michael Shine, a consultant surgeon at Our Lady of Lourdes Hospital in Drogheda, is a stark precedent here. Between the 1960s and 1990s, Shine sexually abused numerous young male patients, with allegations emerging in the early 2000s. A 2009 report by the Irish Medical Council and subsequent inquiries revealed a culture of silence and inadequate oversight, allowing Shine’s actions to persist unchecked for decades. Victims faced significant delays in justice, with Shine convicted only in 2019 for assaults committed in the 1970s.

Similarly, the Michael Neary scandal at Our Lady of Lourdes Hospital involved the unnecessary performance of hysterectomies and peripartum hysterectomies on women during the 1970s to 1990s. A 2006 inquiry by the Lourdes Hospital Inquiry Team found that Neary performed 129 peripartum hysterectomies, far exceeding typical rates, due to a lack of clinical justification and poor governance. The inquiry highlighted a “closed, hierarchical, and patriarchal” culture that stifled whistleblowing and accountability.

The symphysiotomy scandal, spanning the 1940s to 1980s but only coming to public attention in the 2000s, further illustrates systemic failures.

This outdated childbirth procedure, performed without consent in many cases, caused lifelong pain and disability for hundreds of women. A 2014 government report acknowledged the lack of oversight and the failure to prioritise patient welfare, with redress schemes established only after significant public pressure.

More recently, the spinal surgery controversy at Temple Street involved the use of non-medical-grade springs in three children with scoliosis, as reported by the Health Information and Quality Authority (HIQA).

This incident, coupled with CHI’s underspending of funds allocated for spinal surgery waiting lists, led to prolonged suffering for children, as highlighted by the Orthokids Ireland advocacy group. These cases reflect recurring themes: inadequate governance, failure to act on whistleblower concerns, and a lack of transparency that delays justice and care for vulnerable patients.

The CHI crisis bears similarities to governance failures in other EU member states, notably the United Kingdom’s Bristol Royal Infirmary scandal (1990s–early 2000s). An inquiry into paediatric cardiac surgeries at the Bristol hospital revealed that between 1984 and 1995, up to 35 children died due to substandard care and poor clinical governance.

performed complex procedures without adequate training, and concerns raised by whistleblowers were ignored by hospital management. The 2001 Kennedy Report highlighted a “club culture” among clinicians and a lack of accountability, leading to systemic reforms in the UK’s National Health Service (NHS), including stronger clinical governance frameworks and mandatory reporting of adverse incidents.

In Sweden, the Karolinska University Hospital scandal (2010s) involved experimental tracheal transplant surgeries on patients, including children, using synthetic implants. The procedures, led by surgeon Paolo Macchiarini, resulted in multiple deaths due to inadequate testing and oversight. A 2016 inquiry found that the hospital’s leadership failed to act on whistleblower warnings and prioritised prestige over patient safety, echoing the CHI’s failure to address the 2021 NTPF misuse report promptly. Sweden responded by tightening ethical oversight for experimental procedures and enhancing whistleblower protections.

The CHI crisis, like its historical and EU counterparts, underscores a systemic failure to prioritise patient safety and transparency. The misuse of the NTPF reflects a broader issue of perverse incentives within Ireland’s mixed public-private healthcare system, where consultants can profit by delaying public care to funnel patients into private clinics. Minister Carroll MacNeill has advocated for a public-only consultant contract to eliminate such conflicts of interest, a move that aligns with calls for reform following the Neary and Shine scandals.

The lack of transparency in CHI’s handling of the 2021 report mirrors the silence that enabled Shine’s abuses and Neary’s unnecessary surgeries. During the recent Dáil debate Irish opposition politicians called for an independent, international audit. There was a clear sense that this reflects a recognition that internal reviews may lack credibility. It also aligns with lessons learned from the Bristol inquiry’s insistence on external oversight. Similarly, the Karolinska scandal highlighted the need for robust whistleblower protections.

Several additional and constructive points were made during the debate that took place on this issue in late May.

Key among these were the urgent need to restore public confidence. Immediate and long-term action were suggested such as having the HSE clarify and implement mechanisms for funding third-party reviews, ensuring parents can access independent assessments without financial burden.

Second, the proposed amalgamation of CHI into the HSE, as suggested by opposition TDs is being given serious consideration. However, as one Independent politician has rightly observed, if CHI were to be brought under the remit of the HSE, this would not necessarily guarantee outcomes in which underlying cultural issues would be addressed. Given the HSE’s own history of governance failures, this seems like a reasonable point to make.

Third, it is now broadly recognised, at least politically, that Ireland must establish clear national guidelines for complex paediatric procedures, such as pelvic osteotomy, to prevent arbitrary clinical decisions.

The absence of such standards, as noted by some Irish politicians is a critical gap.

Finally, strengthening whistleblower protections and fostering a culture of openness is essential to, if not prevent, then at least limit future such crises emerging.