• Ciara McGlade, site clinical director; 
• Colin Hawkes, clinical director for paediatrics; 
• Brian O’Donnell, clinical director for perioperative, anaesthesia, critical care, and operating theatres; 
• Conor Deasy, clinical director for emergency medicine; 
• Barry Plant, clinical director for medicine; 
• Brian Manning, clinical director for surgery; 
• Dearbhaile Collins, clinical director for oncology; and
• Vitaliy Mykytiv, clinical director for diagnostics.

The letter was also sent to senior officials in HSE South West, the new structure over Cork and Kerry health services.

The hospital’s paediatric department is awaiting a new building despite planning permission being granted in 2022. Work is expected to start early next year.

The letter says CUH made multiple applications to build two units in the meantime, starting from January 2025.

'Preventable paediatric deaths' 

It says that, in July, regional management was warned that “immediate action was required to mitigate the risk of preventable paediatric deaths”.

Despite this, the interim units were only approved in March. This raised questions for the consultants over how long the request took to reach regional executive officer Andy Phillips.

It is understood that work is now progressing.

Much of the letter focuses on “a sustained pattern of decisions” at regional level taking too long or not being made.

It says that this “prevented the hospital from implementing solutions its management has already identified, costed, and formally submitted”. 

HSE South West is now under strict budgetary constraints, having been told to cut spending by HSE chief executive Anne O’Connor.

The approved staffing level at CUH is equivalent to 4,745.02 full-time staff. It is understood, however, that the numbers in place are equal to 4,983.14.

'Equipment can't be used' due to understaffing

The letter criticises staffing plans for a new outpatient unit, saying with regard to a plain film X-ray machine and a DEXA scanner, “without the staff to operate it, neither machine can be used”.

It says a fracture clinic, seeing 100 patients daily, “cannot safely relocate without radiology, physiotherapy, and occupational therapy”.

It is understood that the HSE received a revised business case in June after this letter was sent in late April.

Clashing attitudes on insourcing were also clear.

This was the use by HSE hospitals of external firms to treat patients outside of regular hours, often using HSE staff.

Concerns over costs

Public and political outrage at spiralling costs last summer led to this being phased out.

CUH ceased working with EHF29 Ltd in April, having cut €650,000 in spending last year, the letter indicates.

However, it criticises a decision to use “voluntary overtime and agency nursing” instead of hiring staff in its place now.

Ken Walsh, co-founder of EHF29 Ltd, confirmed it no longer works for CUH and all its HSE work will stop on July 1.

It saw “over 45,000 public patients in CUH from July 2020 to April 17, 2026”.

HSE South West response

A HSE South West spokeswoman said it has “clear, robust management and governance structures” in place.

“All HSE South West staff and management prioritise patient safety, at all times,” she said, adding: “Individual staff and teams at various sites will hold views, and this is acknowledged.”

She said: “Decision-making by HSE South West management, which includes CUH management in its integrated structures, is informed by established risk-management processes and by national and regional strategic priorities in line with Sláintecare.”

A spokeswoman for Ms O’Connor confirmed she received the letter.

• Niamh Griffin, Health Correspondent