The Health Service Executive could be facing unforeseen losses due to “outdated” levels of insurance on its property portfolio, a report warns.
Meanwhile, it continues to insure individual “obsolete” items dating back to the 1990s, such as car-phone and camcorders, according to HSE internal auditors.
The auditors cite evidence that the HSE’s €10 billion property portfolio may be significantly under-insured.
The HSE owns over 4,100 buildings including hospitals, community health centres and housing. Its property register does not list values though a separate register held by its insurance broker does.
Total coverage was over €10 billion in 2020.
“Due to the lack of detail, and large amount of legacy data, assurance cannot be provided on the accuracy and completeness of the insurance register,” the internal audit report states.
They noted that three sales of properties in 2019 and 2020, worth a combined €75,000, were not marked as sold on the register.
The four largest hospitals are insured collectively for €1.735 billion but the auditor say this appears “somewhat low” in light of costs at the new national children’s hospital.
Properties are not revalued periodically and there is no evidence of a formal revaluation process being in place.
They also express concern that 623 buildings on the HSE’s register, representing €850 million in cover and 8 per cent of the overall value of the portfolio, are listed as “miscellaneous”. Due to the number of such listings, it was difficult to determine if all sold properties had been removed from the register.
Specified all-risk cover, relating to art and high-value electronics, is not up to date, the auditors note, as it contains items that are obsolete. On the other hand, there is a risk that items are not listed and therefore not covered.
Among the items the HSE has insured under specified all-risk cover are six car-phones insured for €7,618, although car-phones are obsolete; two JVC camcorders, insured for €30,000, dating from the 1990s; and a 2001 telephone system insured for €30,000.
The list also includes mobile phones and car kits insured for €414,000, also obsolete; and six digital cameras from the early 2000s, insured for €4,232.
The HSE said it has since implemented a “more beneficial” contents cover with its broker.
Both the HSE’s insurance broker and one of its providers expressed concern that the sums insured were “outdated and therefore undervalued”.
The insurer said that back in 2017 it determined Cork University Hospital should be insured for €750 million. Its present insured sum is just €495 million.
The auditors say there is no evidence construction inflation has been factored in to reinstatement costs.
Significant differences exists across different disability services in relation to the HSE’s national consent policy and there is a need for a national coordinated approach, according to a separate audit report.
Auditors visited four disability sites and found that in three of them, no evidence was provided of governance arrangements to provide oversight of the policy in relation to informed consent or assisted decision-making processes.
In only one of the sites had staff been trained in the consent policy and there was limited evidence in the sites that residents had been provided with information on it. The HSE first published the policy in 2013 and updated it last year.
Auditors said they could give only moderate assurance that 17 voluntary hospitals were in compliance with recommendation on improving IT security made in the wake of the cyberattack on the health service in May 2021. Some hospitals were unable to implement certain “end-point protection, containing and hardening” recommendations due to limitations associated with the technology they were using.
While a good level of compliance was noted, this needed to be subject to ongoing review, the auditors said.
Most of the report provided under freedom on information was redacted.
A separate audit report was critical of aspects of procurement at the National Ambulance Service, including a lack of training for staff.
University Hospital Limerick was found in another report to have paid €31,050 in rental costs to an ENT consultant after the person had ceased employment. There was no agreement or approval on file for this “non-standard arrangement”.
HSE auditors have criticised governance and financial management at a Cork-based charity for survivors of institutional abuse.
Right of Place Second Chance does not operate an adequate accounting system, and access to bank accounts is not appropriate, according to an audit report on the charity.
Cash handling procedures were not adequate and there was a potential shortfall in rental income received, the report states. Documentation on HR files was incomplete, and there was no evidence of procedures in place to manage staff attendance and hours of work.
The organisation, which provides financial and other supports for survivors of residential institutional abuse, receives €160,000 a year in funding from the HSE in Louth/Meath, even though it is based in Cork.
An audit of payroll allowances to consultants at University Hospital Kerry found anomalies noted by management indicating some call-out claimed were invalid, along with underpayment in oncall allowances to two out of 11 consultants who were audited.
An audit of Coolmine Therapeutic Community found there was no evidence of any formal procurement process for eight out of 10 suppliers tested. There was also non-compliance in credit card spending on office fit-out equipment.
