The Government wants to move away from paying public hospital personnel to work additional hours at weekends and night-time – known as insourcing -- as well as using the private sector to tackle hospital waiting lists.
Minister for Health Jennifer Carroll MacNeill told an Oireachtas committee on Wednesday an “overreliance” had developed on insourcing and on private work to deal with public waiting lists.
“We need to move away from our dependency on this model to fully use the internal underutilised capacity we have within the core health system,” she said.
She suggested that the Government wanted to “wean ourselves off” the use of insourcing and the National Treatment Purchase Fund (NTPF) which buys care in both the public and private sectors.
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However, she told the Oireachtas Select Committee on Health that a “fine balance” would have to be achieved between moving away from the current model for reducing waiting lists while not negatively affecting waiting times and outcomes for patients.
The Government will this year provide €420 million in funding between the HSE and the National Treatment Purchase Fund (NTPF) to tackle waiting lists.
Both insourcing arrangements and the operation of the NTPF schemes in some hospitals have generated controversy in recent times.
A HSE report last September found that two companies which received more than €1.5 million between them in contracts awarded by University Hospital Limerick without a competitive procurement process were owned or part-owned by employees at the facility.
Separately the NTPF suspended funding from Children’s Health Ireland after it emerged concerns had been raised in an unpublished 2022 internal review about the necessity for some waiting lists clinics for which it had paid a consultant over €35,000 in fees.
On June 11th the NTPF said it had paused funding for insourcing initiatives at Beaumont Hospital on foot of “potential financial irregularities”.
The Irish Times reported subsequently that this followed a letter sent by doctors at Beaumont to the hospital’s chairwoman in which they alleged it had billed the NTPF for about 1,400 patients seen in routine public clinics.
Ms Carroll MacNeill told the committee that examinations currently under way in relation to insourcing and the NTPF schemes were very important because of the “ (a) proper processes involved in it,(b) to ensure there is no corruption of those process and (c) to ensure that it is not operating as a barrier to us getting to a universal public system”.
“I became aware and concerned about this at a very early stage, about six or eight weeks into being Minister. It arose from constantly asking about the use CT machine and diagnostics, what time does it run until or what happens on Saturdays.”
She said it turned out that in some hospitals equipment was working at weekends but not necessarily in the public system.
The Minister said until the findings of a forthcoming HSE analysis – which is due shortly –”we do not have a real understanding on a site-by-site basis on what is happening, what the national implications for that are, how that is being used in different ways, how this has the capacity to be used wrongly, even if legitimately, in delivering the overall public good of a public system working at maximum productivity”.
The Minister said she was notified about the NTPF issue in Beaumont on April 11th after she had already begun the review into insourcing.
Separately the Minister said activity in hospitals overall was not keeping pace with record levels of State investment over recent years.
She said one large hospital – known technically as a model four facility – “ only saw a three per cent increase in overall activity from a 36 per cent in workforce and a real expenditure increase of 42 per cent”.
The Minister later identified this centre as St Vincent’s University Hospital in Dublin.
