Children’s Health Ireland (CHI) is “falling short” of its ambition to provide the “best-in-class care to children and young people in Ireland”, a report has found.The Health Service Executive (HSE) on Monday published an internal audit and narrative review of governance and equity in patient access and waiting list management at the paediatric healthcare provider.The reviews were commissioned following allegations about potential waiting list mismanagement and misuse of public funds to increase delivery of care.The narrative review found CHI is “failing to meet waiting time targets, including for critical and time-sensitive urgent referrals”.The report cites CHI policies and national protocols which specify the time sensitive “clinical characteristics/outcomes of conditions” of urgent referrals, which includes risk of permanent damage, suspected malignancy, and rapid deterioration,As of October 2025, across all specialities at the group, 73 per cent of children on outpatient waiting lists and 67 per cent on inpatient waiting lists with urgent referrals did not receive appointments within the clinically recommended waiting time of less than 28 days.Similarly, for semi-urgent referrals, 64 per cent and 60 per cent of children respectively did not receive on time outpatient and inpatient appointments (less than 13 weeks). Across all clinical prioritisation categories, the audit found the number of children receiving late appointments (57 per cent) outnumbered those receiving on time appointments (43 per cent). “This shows that waiting time breaches are systemic rather than exceptional,” the audit said. “The purpose of maximum waiting time targets, as explained in national protocols, is ‘to minimise risk and/or achieve best clinical outcomes’, therefore, it is reasonable to conclude that CHI is not meeting this objective.”Monday’s reports were commissioned by Bernard Gloster, then chief executive of the HSE, following concerns raised in previous reviews.The aim of the audit was to review governance, access to care, payment practices, waiting list and NTPF oversight and assess the balance between public and private patient management in the period January 2023 to May 2025.The internal audit reviewed three specialities – orthopaedics (including spinal), urology and respiratory medicine – and looked at processes for patient referral pathways, waiting list administration and whether initiatives met the required conditions for funding.The report found no clear evidence of inequity in access to care, but did identify consistent systemic issues affecting waiting list governance, transparency and assurance.The auditor also noted progress made by the services in recent years, including increased activity, reductions in some long-waiting cohorts, improvements in average waiting times, expansion of nurse-led models of care, and use of State-funded initiatives to provide additional capacity beyond routine service delivery.In response to the internal audit report CHI has developed an action plan with 32 actions to address the recommendations from the report, 20 are either fully or partially complete with 11 still in process, 1 further action will commence once actions are implemented. Lucy Nugent, chief executive officer of CHI, accepted the organisation needs to “continue to improve access times”.“These reports identify areas requiring improvement in terms of waiting list governance, data, documentation and communication processes for families. The recommendations arising from both reports have been prioritised and are either fully or partially complete,” she said.Anne O’Connor, head of the HSE, acknowledged the report’s finding of breaches in clinically-recommended time frames.“Progress is expected to reduce waiting times, improved patient flow and timely access to care for children and these recommendations are being considered by the HSE nationally for system wide learning for all regions,” she said.“The narrative review highlights systemic issues affecting paediatric patients and families and their experience on waiting lists and engaging with clinical and operational services.”