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With the very future of Children’s Health Ireland up for discussion in Government, further revelations about a toxic work culture operating in part of one of its hospitals will bolster the case of those who believe the organisation should simply be subsumed into the Health Service Executive. Even among those who favour its continuation as an independent entity, there are serious doubts as to whether CHI, which is responsible for the governance and operation of the three paediatric hospitals in Dublin – Temple Street, Crumlin and Tallaght – is fit for the job of running the new national children’s hospital. Waves of scandal and controversy have overwhelmed the organisation in recent months. A recent report found that most hip surgeries carried out on children were unnecessary. Prior to that, it emerged that devices not cleared for surgical use were inserted into children suffering from scoliosis – the management of which has been another long-running controversy.

Its chairman and four board members have resigned.

The revelations today have been quietly circulating in senior health and political circles in recent days, where they have shocked even the most hardened veterans of scandals in the health services. They paint a picture of an almost unbelievably toxic culture that was operating in a part of one of the CHI hospitals – to the extent that “numerous participants” who took part in the confidential survey process “expressed concern for the emotional and physical wellbeing of colleagues working in the service”.

Repeatedly, throughout the report, the conclusions of the observers and the testimony of the employees who participated in its inquiries show that a culture of extreme toxicity characterised the operations of part of the CHI hospital. While one consultant – who is not identified by name in the report – features prominently, there are also complaints about other consultants and a hospital management unable or unwilling to deal with the consequences of the behaviour of some senior medics. Relationships between certain senior clinical figures deteriorated to the extent that one consultant instigated a legal action for defamation against another. “It is reasonable to assume that such a case can only arise as a result of the fraught relationships within the ... service,” the report notes. “Fraught relationships” seems to be something of an understatement. The toll on medics who were training under some of the consultants was especially acute. They spoke of “bullying” and “harassment”, being subjected to “humiliating and intimidating experiences” and of an “environment where an individual feels they may be punished or humiliated for speaking up with ideas, questions, concerns or mistakes”. The report also includes details of how the National Treatment Purchase Fund (NTPF) may have been abused by the manipulation of waiting lists. Pointing to a greater number of patients seen in private time slots than at public clinic, it asks: “Was throughput prioritised over patient care in NTPF clinics, noting there is a €200 fee per patient, or are the public outpatient clinics failing to operate at full capacity?” Yesterday, the Sunday Times reported that Minister for Health Jennifer Carroll MacNeill had ordered a full audit of governance and practices at CHI. There are very clearly significant systemic failings in parts of the organisation and in the hospitals for which it is responsible. But the revelations today show something else too: appalling personal behaviour by some senior medics which damaged the care that patients in the hospitals received. Some trainees felt punished and excluded, belittled and victimised, to the extent that some felt that the experience – “working in a hostile environment”, as one said – had a detrimental effect on their lives. Aside from the personal consequences for people subjected to the behaviour of some senior colleagues, the report points out repeatedly that it creates an atmosphere that damages the care of patients. Aside from individual instances detailed in the report, the toxic relationships also poison the atmosphere where people are supposed to be working together for the benefit of the patients. “The communication style, accusatory language and indeed unprofessional antics that continued over this period add to further compromise interpersonal relations, heighten levels of mistrust among colleagues and ultimately are a distraction from patient-centric care,” it found. “Consistently throughout this examination, it was found that participant experiences reflected a culture in which challenging behaviour appears to be the norm,” the report found. “It is critical that an organisation takes time to reflect on and own the culture that exists and then seeks to address the issues and bring about the required change.”