Serious weaknesses in system used by HSE to monitor private practice in hospitals

Significant weaknesses in the system used by the HSE to monitor the levels of private practice in the country's public hospitals have been uncovered by the Comptroller and Auditor General (C&AG).

The report says the system, known as HIPE, was developed to collect information about in-patient and day cases in hospitals and that the information it captures refers to whether the patient is seen by a consultant on a public or private basis.

The C&AG says there are no systems for capturing time spent by a medical consultant on out-patient activities.

Each hospital was to make its own arrangements for measuring this activity, but there is no central information about systems being used to measure consultant activity. “ It is also not clear how the information available locally on diagnostic activity would be linked with HIPE data to enable conclusions be drawn on the level of a consultant’s public and private activity in an acute public hospital.”

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The report says that “for the measure of public and private activity to be a good measure of performance, the activity within an acute public hospital must be capable of being influenced by actions which can be attributed to the HSE”.

“However, the HSE’s ability to effect a change in the level of private activity within a public hospital is limited. “

Information in HIPE for in-patients between 2012 and 2017 shows that the majority were admitted after attending the emergency department or maternity unit. “In these cases, the HSE has no control over the pattern of public and private patients presenting for treatment, and in all cases, patients are treated in order of clinical priority. “

The report says that in 2017 the HSE generated income of about €305million from private patients treated in public hospitals.

The report says that an external reviewer commissioned by the HSE as part of the defence of a legal action taken by a group of doctors examined a sample of public private ratios. The reviewer concluded that across the cases where data was available around one third of consultants were not compliant with their required private practice limits.

The C&AG says it was uncertain how representative these findings were.

The report says that in July 2017, the secretary general of the Department of Health wrote to the director general of the HSE "citing concerns that consultants may be exceeding their permitted level of private practice within the public hospital system and may be exceeding their offsite private practice rights or engaging in off-site private practice while being employed under a contract that does not permit any off-site private practice".

In April 2018, revised monitoring arrangements were agreed between the Department and the HSE. “The arrangements are characterised by assurance/compliance statements from individual consultants to the hospital, an annual report from the hospital to the hospital group and written assurance from the hospital group to the HSE’s national director of acute hospitals attesting to compliance with private practice limits .”