Martin Daly criticises CHI governance over children's hip surgeries
Martin Daly criticised CHI's handling of developmental dysplasia of the hips and the use of non-medical grade springs in spinal surgery, calling the situation scandalous and a system-wide failure. He said there is "zero confidence" in the CHI board and warned that whole departments operated on spurious evidence without proper audit or governance.
Martin Daly said this is not about a single surgeon but a whole system failure. He argued that a generation of children were operated on who should not have been, and that governance and audit were inadequate across hospitals.
He referenced the Thomas Audit into Management of Developmental Dysplasia of the Hips and the HICWA report into the use of non-medical grade springs. He quoted HICWA finding "no overarching CHI-wide standardised governance structures" and said site-level policies were over-complex and difficult to use.
Daly described the springs controversy as inexplicable given procurement and quality checks, and stressed that a GAIM report into one surgeon’s practice is still awaited. He warned against throwing individual surgeons "under the bus" without answering questions about management, workload and decision-making pressures.
He said there is zero confidence in the CHI board and management despite recent changes, warning that building a new hospital is pointless if governance remains poor - "top of the range hardware for your computer and the software is rotten," he said.
After his remarks a representative apologised for not conveying the gravity sooner and said governance structures have been reviewed and some site responsibilities changed. The reply acknowledged past deficiencies and outlined steps taken to correct clinical director reporting and supports.
Allegation of systemic failure
Martin Daly said this is not about a single surgeon but a whole system failure. He argued that a generation of children were operated on who should not have been, and that governance and audit were inadequate across hospitals.
Findings cited from the Thomas and HICWA reports
He referenced the Thomas Audit into Management of Developmental Dysplasia of the Hips and the HICWA report into the use of non-medical grade springs. He quoted HICWA finding "no overarching CHI-wide standardised governance structures" and said site-level policies were over-complex and difficult to use.
Non-medical grade springs and pending GAIM inquiry
Daly described the springs controversy as inexplicable given procurement and quality checks, and stressed that a GAIM report into one surgeon’s practice is still awaited. He warned against throwing individual surgeons "under the bus" without answering questions about management, workload and decision-making pressures.
Confidence in CHI board and new hospital concerns
He said there is zero confidence in the CHI board and management despite recent changes, warning that building a new hospital is pointless if governance remains poor - "top of the range hardware for your computer and the software is rotten," he said.
Response from leadership in the chamber
After his remarks a representative apologised for not conveying the gravity sooner and said governance structures have been reviewed and some site responsibilities changed. The reply acknowledged past deficiencies and outlined steps taken to correct clinical director reporting and supports.
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Transcript
And notwithstanding your comprehensive statement, there is no sense in that statement of the gravity of what has happened to the children in terms of the developmental dysplasia of the hips. There is no sense in your statement of the absolute gravity of what has happened. It is absolutely scandalous. I'm a member of the medical profession. I'm not an orthopaedic surgeon, so I don't pretend to be, but I am a doctor of 40 years standing. Before I came into this job, I would have been minded to defend our profession, where it could be defended. But the Thomas Audit of the Management of Developmental Dysplasia of Hips and Children, CHI Temple Street in Crumlin, and the National Orthopaedic Hospital in Capa, is deeply disappointing and unsettling, most especially as it follows on from the use of non-medical grade springs in spinal surgery and CHI. The HICWA report into the use of non-medical grade springs, we don't have all the answers. The HICWA report, and I quote, there were no overarching CHI. By the way, no one person should be thrown under the bus for this, notwithstanding if they have a question to answer about their judgment, about their caseload, about their decision-making. This is not about one surgeon, this is about a whole system failure and when you talk about moving into CHI, the new hospital, 2.5 billion, it's like having top of the range hardware for your computer and the software is rotten. There is no other way to put it. I don't think you imparted the sense of realisation of the anger, not just to the community of children who were involved. I do accept the spinal issue might be different, but the HICWA issue is just inexplicable that in a small city, relatively speaking, in a small country, between three orthopaedic hospitals, three orthopaedic departments, that you could have such stark divergence of decision-making. The Thomas report has vindicated one department, but the other two departments, international experience will show there will be some divergence, in the order of five to seven percent maybe, I stand to be corrected by an orthopaedic specialist in this, but in the order of 60, 70, 80, 90 percent, there's something absolutely rotten in that department, notwithstanding the work that's done and the good cases that come through, but there is a whole generation of children who have been operated on, who shouldn't have been operated on, on spurious evidence, without proper audit and without proper governance. Now I know you're new in the job, Ms. Nugent. Ms. Hardiman, you were there. It looks like under your regime, you were rewarded for substandard management of the hospital. I'm saying that strongly because all of this happened under your watch. In relation to the HICWA report, and I quote, there were no overarching CHI-wide standardised governance structures, I'm going to keep it to five minutes because I'd like you to have your five minutes to respond, and supporting policies and procedures in place for the introduction and use of medical devices. This is an astounding finding. In addition, HICWA found what corporate clinical governance procedures were in place in the CHI group, they were over complex and difficult to understand for management and staff both at site-specific hospitals and the overall CHI group. I've spoken to medical professionals in those hospitals and they would vindicate that view by HICWA. With the changes from 2019 onwards, there was a loss of experienced management staff at Tempestry resulting in a breakdown of communication and governance pathways. While there were a number of controls in place, these did not provide adequate safeguards at each stage of the end-to-end process for the introduction and use of springs. I'm going to leave that because I'm going to run out of time. We have the HICWA report, we're waiting in a GAIM report into the practice of one surgeon in relation to the use of non-medical grade springs. It is just incredible that, you know, they came through a whole procurement process, a quality code, and they arrived to a surgeon in the operating theatre. And yet everyone is throwing that surgeon under the bus. Management have thrown that surgeon under the bus. He might have exhibited poor drugs, he might have been overworked, he might have had pressure put on him to fulfil waiting lists and to operate more, and that was for him to resist. But management has serious answers to this, and I don't believe those answers were gotten for us, saying I'm running here, so I'm going to give you a chance. We're waiting in a GAIM report, and we will have to wait for that. Just very quickly, in relation to the HIPs, I've covered that, a lot of the same governance issues, and it would appear that there was a department that was dominated by one or two surgeons who decided what would be best for a child in 15, 16, 20, 30 years and operated on children who shouldn't have been operated on, on spurious evidence and spurious data. Finally, much has been made about retaining the CHI board intact going in to open a new hospital. I have to say, there is absolutely zero confidence in the CHI board, zero confidence in the management, notwithstanding the changes you have outlined, Ms Newton, but there is zero confidence. I'm speaking as a medical professional who would be inclined to try and tease out the nuances of this. There are no nuances. I'm going to yield to our visitors. Thank you Deputy. First, if I did not convey the gravity of the situation, I apologise. It keeps me awake at that. I accept that. In relation to the governance structures, like any new CEO, I have come in and I have reviewed them, notwithstanding the HIPAA report recommendations. Those structures were put in place at a time when the new children's hospital was imminent. However, we have corrected the issue, for example, of the site responsibility for the clinical directors. They no longer have that. I have changed that. We have enhanced the supports they have. In addition, we have clinical specialty leads. We have revised their job descriptions so that they take on more of a management as well as a leadership role. This is also identified. Again, I think that would be a great help to the clinical directors. In relation to the executive management team, since my appointment, I have appointed a permanent director of people and culture. Obviously, that's a huge focus for us. He took up his permanent role on the 7th of April. The director of operations started on the 9th of June and the deputy CEO will be starting on the 7th of July. I have two other posts on the executive management team that were temporary that I'm progressing to permit. This is important to stabilise the executive management structures to ensure that we are for the purpose. A lot of work has been done in regard to that. I fully accept it as a systems process response. It's never one individual. In relation to the medical device management process, we now have a clinical ethics committee in place. That's important because, you know, in paediatrics, unfortunately, manufacturers don't always manufacture paediatrics specific devices, etc. So, we have a clinical ethics process in place by any off-label use of a particular device, in other words, using it for a different purpose for which it was originally designed. Any non-CE marked devices are also brought through that committee. Could I interject, please? No, no, no. I accept everything you're doing now. But I'm going to ask Ms. Hardingman. You were the CEO of the hospital at that time. The surgeon was suspended because of the spinal spring, non-medical grade spinal spring being used in surgery. What sanction did management get? What sanction did you get? By the way, the HIP has happened on your watch as well. We just have 30 seconds left. Deputy Daly, first I want to echo Ms. Lugent in relation to her felt sympathy for what actually happened. This shouldn't have happened in CHI. We have been on record with saying that. We fully accept the HIC report and did identify that there were weaknesses in relation to the management and I welcome the changes that have been brought in. In relation to the surgeon and appreciate that there is a process there. To be clear and honest about it, he went on voluntary leave, which is a separate process than just for the record to be clear, as opposed to suspension. We went through that process then and further HR processes. We yield our time now, because we've had a time. We may come back to it if we come around here. Sir, no problem. Sir, our next slide.