The National Maternity Hospital (NMH) in Holles Street has said it was “coerced” by the HSE into signing a service agreement despite having reservations due to “critical funding” being withheld until it agreed to do so.
The hospital in official correspondence also appeared to be concerned that the HSE service agreement provisions could extend into services funded privately by fee-paying patients. It said the agreement “fails to cater for what should be fundamentally different arrangements as between the publicly-funded and privately-funded operations within NMH”.
It said in 2016 the HSE had specifically recognised in writing that it had a right “to engage in private funded services and these being outside the remit of the service agreement”.
The hospital subsequently told The Irish Times this week that for several years it has had “concerns about the requirements in the service level agreement which could potentially interfere with the NMH executives’ fiduciary responsibilities to the hospital”. It said this included the HSE “introducing the reservation of the right to take over the hospital and put in a new management team”.
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The hospital said the service level agreement only covered publicly-funded activity. “It is a contract for publicly-funded services,” it said.
The HSE enters into such agreements with all voluntary hospitals and agencies to which it provides funding. These essentially set out the services to be provided in return for money allocated by the State. However, in correspondence to senior management in the HSE hospital group in which it is located, the NMH said it believed that certain provisions in the service agreement were “totally unsuited” to its long-existing structure.
The NMH in Holles Street is funded largely by the State. In 2023 it received €92.7 million from the HSE. However over 10 per cent of its income – about €12 million – was generated from private sources.
The hospital this week released details of correspondence to the then Ireland East Hospital Group (since replaced by the HSE Dublin and South East region) last July about the current service agreement.
Senior hospital management in the letter sent last July said it continued to have reservations about the circumstances under which it had signed up to such service agreements.
The hospital said it was “coerced into signing the service agreement after the HSE unilaterally withheld critical funding until we agreed to sign”.
The hospital said in a statement that in its letter last July it had reiterated concerns raised in correspondence each year going back to 2016 “when the NMH signed the agreement following the withholding of 20 per cent of the hospital’s funding”.
The NMH also said in the July letter that it was concerned about the introduction of a new “integrated financial management system”.
It said it would engage with a HSE team implementing a national integrated staff records and pay programme across the health system. But it reserved the right to maintain its own HR management systems.
The hospital said that the provision of services under the service agreement was “totally dependent upon the HSE and the hospital group allocating sufficient funds to it to provide for the appropriate resourcing of these services”.
It said it required that any deficits in the pension schemes were “a liability of the HSE and should be funded and similarly any income shortfalls against HSE-set targets require funding”.
The HSE Dublin and southeast health region said in a statement that it “values the inpatient and day support services provided in the NMH, which the HSE supports through funding under the Section 38 of the Health Acts”.
