Members of the board of the group that runs paediatric hospitals in Dublin had concerns three years ago that allowing staff to work for private companies on the premises after regular working hours – a practice known as insourcing – posed significant risks.
Internal documents released by Children’s Health Ireland (CHI) show members of its board had serious reservations about the initiative and wanted formal correspondence from the Health Service Executive setting out that it supported insourcing arrangements in the hospital system “given the challenges of long waiting lists”.
Senior board members maintained that insourcing in practice allowed CHI staff to be hired by a third-party entity and then hired back to CHI to carry out additional work.
In June, following some controversy over insourcing in some hospitals, HSE chief Bernard Gloster proposed that the practice be ended by next summer in a report to Minister for Health Jennifer Carroll MacNeill.
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Mr Gloster will provide an update on insourcing arrangements to the Oireachtas committee on health on Wednesday.
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Mr Gloster said in July hospitals had developed “an over-reliance on insourcing to supplement core activity”.
Insourcing arrangements were financed either from special funding allocated to hospitals either by the HSE or by the National Treatment Purchase Fund (NTPF).
A HSE report in July revealed that one company – known as EHF 29 Limited – received more than €54 million in a 27-month period to the end of March for providing insourcing services to tackle waiting lists in public hospitals.
Earlier this year the NTPF suspended insourcing funding to Beaumont Hospital in Dublin amid concerns that it was not following the rules of the scheme.
However, newly-released official documents show there were worries about insourcing over a number of years in parts of the health system.
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A memorandum drawn up in relation to a meeting between CHI board members, management and senior HSE officials which took place on June 21st, 2023, sets out the concerns in the children’s hospital group.
“The CHI board had become aware of the use of ‘insourcing’ in October 2022 and had raised concerns about it, through its committee structure.
“Whilst the impact of insourcing had been beneficial in terms of reduced waiting lists and improved access to patient care, the board felt the initiative posed potential governance, reputational and ethical risks.
“A significant number of board members felt they could not endorse the insourcing initiative as it stood, while being fully cognizant of the positive impact on waiting lists”, the memorandum says.
The document maintains that at a meeting the HSE had told CHI the insourcing initiative was a short-term arrangement.
“At the suggestion of the chair of CHI, the HSE national director of acute operations agreed to revert to the board of CHI with formal correspondence confirming that the HSE is aware of the nature of ‘insourcing’ as practised in the acute hospital system and is supportive of its use, given the challenge of long waiting lists in the sector.
“However, she did reiterate this is not a sustainable model, but aware of the waiting lists numbers and extended time periods children spend waiting for care, the process is being used to manage these backlogs, but it is important that CHI have a cessation plan and monitoring of this plan will be delivered through the access performance meetings.”
The CHI board’s audit and risk committee had been told by management in December 2022 that without insourcing arrangements the group would be “challenged to make significant headway” in addressing waiting times in some specialities “given the gap between supply and demand and the lack of appropriate core workforce to manage the activity”.
