Paul Murphy: Audit Exposes Children's Waiting List Failures
Paul Murphy addresses findings from an audit he commissioned into equity of access and waiting list management at CHI. He outlines governance failings, data limitations, and the real impact on children and families, and explains why private clinics in public hospitals must be wound down.
Audit findings and limitations
Paul Murphy summarises the independent audit and accompanying qualitative work into CHI waiting lists. The report found no clear evidence of systematic inequity between public and private patients but flagged recurrent delays against clinical timeframes, inconsistent documentation, and significant data limitations that constrain some conclusions.
Patients and families
The speech highlights patient and family feedback gathered separately to capture lived experience beyond the numbers. Murphy stresses the emotional and health impacts on children and parents, noting specific examples in spinal, urology and orthopaedic services and a case where a child waited seven years for routine surgery.
Governance and management response
Murphy describes meetings with HSE and CHI leadership and says senior management attitude and responsiveness have improved over the last year. He emphasises the need for better waiting list management, clearer documentation and timely care to avoid harm.
Private practice in a public hospital
The address confronts the role of private practice within CHI and the new National Children's Hospital. Murphy states a clear preference for public provision, explains contractual constraints that require temporary private space for some consultants, and says private clinics will be wound down over time as public consultant hiring increases.
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Minister, you have said that you believe in equality for every baby being born in the context of our public maternity hospitals, and I agree absolutely. But the EY report into CHI shows children whose parents can afford to go private are being prioritised for essential surgery in our public hospitals. Surely the same equality should apply to children as well. I was very, very concerned about this, specifically about the management of waiting lists, particularly for spinal surgeries. Because of that, I initiated, along with the former HSE CEO, an audit into equity of access and waiting list management in CHI, recognising the challenges that families have faced regarding paediatric services. We also took a separate qualitative piece of work to try to capture their experiences away from the strict terms of the counting audit, as it were, to capture their experiences and to ensure their voices inform the development of services. The audit took much longer than I wanted it to. It took much longer than anticipated, and I was correctly questioned about that in here. But that time was essential to ensure that the findings, the conclusions in the overall report, were accurate and robust. The report found no clear evidence of inequity between public and private patients, but it did outline important findings in governance, including recurrent delays against clinical recommended timeframes and inconsistent documentation in relation to waiting list management, neither of which is acceptable. Importantly, though, as well, the patient and family feedback reveals, as though it doesn't need to reveal it to anybody here, we were already aware of significant dissatisfaction with waiting list management, with significant emotional and health impacts, not just for the children, but also for the parents. Families want to be informed, involved, and treated with empathy and respect, and those findings were, I think it's fair to say, capable of being anticipated. Otherwise, I wouldn't have initiated it did we not have these shared concerns. But nevertheless, they're disappointing, and we do need to provide a better experience for the children and their families. I've met with HSE and CHI, and I am more satisfied than I would have been this time 12 months ago that there is a different attitude in the senior management and CHI in terms of the responsiveness and the care around this. I'm not saying that every situation is perfect, I certainly wouldn't say that, but I can see a real change in relation to the reaction and the response of senior CHI management to this audit and qualitative report, which I think is important. Thanks. I mean, I thought there was some incredible spin, and some sections of the media absolutely fell for it, suggesting that, oh, this report proves that there is no evidence of inequity in access, and obviously you said that there. That's the first finding, but the sentence continues, let's be clear. No evidence of inequity was identified. However, this conclusion is constrained by significant limitations in data availability, classification, and sample size, and it is essentially exploiting perhaps deliberately poor record keeping to claim that preferential access cannot be proved. But it doesn't change the fact that preferential access was found in the report. I mean, it's there in black and white, page 109 in terms of urology, Urology Consultant 2, 20 public patients, average wait time 12.4, 10 private patients, average wait time 1.84 months, and the other consultants, they're not as bad, but there's a discrepancy between private and public. The same applies as well when you go into orthopedics, take Consultant 6, public waiting 12 patients, average waiting time 1.7 months, three private, average waiting times zero, and there are other examples. Yeah, Deputy, I reject this question of trying to present this in any particular way. I commissioned the audit because of my concerns around this, and specifically I think when I drill into those a little bit more, but there's no question that I was uncomfortable with what was being found overall, but there isn't a systemic problem there that I can see. What I did see and what I was concerned about was that less complex procedures were being moved too easily to private facilities, resulting in the more complex procedures remaining there, and I think what you've described there in terms of some of those figures reflects some of that. I do think there's a bigger complexity to what you've presented there, but look, this is why I initiated it. This was my concern, and my concern was in particular that this was much more endemic than the report ultimately gives credit for, and you're right, there is a limitation in data, but there's no question that this audit was done with the best of intent, the best of good faith. It certainly was, but I think where we see more real experiences in the qualitative piece that Lily Collison did, and I think it was a really important piece of work, and it really speaks to the experience that children had. It is improving, not perfect. I think there's often an attempt to suggest that discrimination between private and public patients doesn't have an impact on safety or patient care, and that happened in the debate around the rotunda, for example, and you were involved on the correct side of the debate in that, but the report, I quote from it, for spinal patients, only 41%, 9 out of 22 were treated within the clinical recommended timeframes, meaning 59% faced delays, sometimes for several months. In terms of urology, of the 73 patients reviewed, 30%, 41% were treated outside the clinical recommended timeframes. The median delay was 152 days. There was one case where a child waited seven years for routine surgery. The report points out that children may wait longer than clinically recommended for assessment, investigation, or treatment, with potential consequences for clinical outcomes, disease progression, and quality of life. Do you agree that just as private healthcare has no place in our public maternity hospitals, it similarly has no place in CHI? We shouldn't be building private suites in the National Children's Hospital. We shouldn't be building in inequality into our health system. Yes, Deputy, I mean, I'm a firm supporter of the public system. There is simply no question about that. 71% of our consultants in CHI are on the public-only consultant contract, but there is also a contractual requirement to continue to provide private space for those old type B contract holders, and it is anticipated that fewer than half of the eight planned consultancy rooms will have any private clinics, and the rest of the rooms are dedicated for public clinics, but much more importantly, there'll be private clinics winding down over time, and that will all move to public because it will only be public consultants hired in, but we're still committed to the rule of law and to upholding contracts. If I say contracts have to be upheld, I have to uphold it on the other side, and we have to make that space, as you're aware, so we have a very, very strong commitment to public service. I don't believe that there is space for private work in the same way. I need to make sure that, so I'm in agreement with you, but at the same time, there's still contract holders who have a contractual entitlement to a certain amount of private rooms, and I see in the new hospital, that will be wound down and down and down as we get from 71% to 80% to 85%, and that will happen over time.
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