Fresh scrutiny of paediatric care has put waiting list governance at the centre of Ireland’s health debate. In a significant update from the Health Service Executive (HSE), an internal audit into Children’s Health Ireland (CHI) says stronger controls, better data and clearer oversight are needed to improve how children access care and how waiting lists are managed.
The review, published on gov.ie through the HSE, examined governance and equity in patient access across Orthopaedics, Urology and Respiratory Medicine between January 2023 and May 2025. While the audit found no clear evidence that public and private patients were treated inequitably, it did identify systemic weaknesses that affected transparency, assurance and waiting list governance.
What the HSE audit found about waiting list governance
The Health Service Executive (HSE) said the audit was launched following concerns raised in earlier reviews and at the request of the Minister for Health. The findings point less to a single failure and more to structural issues that limited confidence in oversight.
- Delays beyond clinically recommended timeframes were common
- Capacity and workforce pressures were a major cause
- Documentation and data quality were often incomplete or inconsistent
- Oversight of HSE and National Treatment Purchase Fund initiatives needed strengthening
- Policy controls and assurance systems were not sufficiently developed
For families, these weaknesses matter because poor data and weak administration can make it harder to track referrals, prioritise cases correctly and demonstrate value for public spending. The report also noted that elements of future consultant private practice arrangements at the new children’s hospital remain unresolved.
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Progress already made at CHI
Despite the concerns, the Health Service Executive (HSE) report also highlights areas of progress. CHI recorded increased activity, some reductions in long-waiting groups, improvements in average waiting times and a broader use of nurse-led care models. It also expanded additional capacity through funded initiatives.
According to the published response, CHI has prepared a 32-action plan linked to the audit recommendations. Of those actions, 20 are already fully or partially completed, 11 remain in progress and one will begin after earlier measures are implemented.
A separate narrative review commissioned by the HSE added the voices of patients, families and staff. That feedback painted a more emotional picture, describing frustration over long waits, poor communication and a lack of transparency. CHI has also created a 26-action Quality Improvement Plan in response, with around 65% complete and the remainder partially complete.
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Why this matters for the wider public sector
Although this review focuses on paediatric services, its implications stretch beyond one hospital group. Better waiting list controls are also relevant to broader public administration across Finance, Social Protection and Public Expenditure, where accurate reporting and governance are essential. Agencies such as HIQA, the Department of the Taoiseach and the Revenue Commissioners all operate in systems where public trust depends on transparent processes and measurable outcomes.
The HSE said lessons from the CHI review will be considered nationally for system-wide learning. That aligns with wider expectations across Irish public bodies, from the Workplace Relations Commission (WRC) to the Central Bank and the Data Protection Commission (DPC), that governance frameworks must be robust, documented and accountable.
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What happens next
The Health Service Executive (HSE) and the Department of Health say a national oversight improvement steering group is already in place to connect recommendations across CHI, HIQA and internal reviews. Leadership changes, including a new CHI CEO and the formal integration of CHI into the HSE, are also expected to support tighter accountability.
Key next steps include:
- Full implementation of audit and narrative review recommendations
- Evidence-based assurance on waiting list improvements
- Better patient communication and family engagement
- Stronger documentation, data governance and referral tracking
- Continued audit and oversight as CHI transitions toward the new children’s hospital model
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The central message from the Health Service Executive (HSE) is clear: no evidence of inequity was found, but governance reform cannot wait. If these actions are fully delivered, the Health Service Executive (HSE) says children and families should see not only shorter waits, but also a more transparent and trustworthy system.
