St Vincent’s University Hospital in Dublin has been identified as a facility where increases in activity trailed considerably behind the level of recent State investment.
Minister for Health Jennifer Carroll MacNeill told an Oireachtas Select Committee on Health on Wednesday that 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”.
Questioned by Marie Sherlock of the Labour Party, the Minister said the hospital was St Vincent’s.
The Minister said the issues involved were complex and the hospital may be better placed to explain these factors themselves.
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The Minister said activity in hospitals overall was not keeping pace with record levels of State investment over recent years.
She said she had “a higher expectation of performance in return for public investment” and that efficiency in the health sector had been questioned in recent international reviews.
The Minister also told the committee she wanted to reduce reliance on the practice of “insourcing” – where hospital staff are paid more to see additional patients at weekends, evenings, and in the private sector to cut waiting lists.
This follows controversy surrounding the use of money provided by the National Treatment Purchase Fund at Children’s Health Ireland and at Beaumont Hospital in Dublin.
The Minister said she was awaiting a report on insourcing carried out by the HSE and an investigation by internal auditors.
[ Jennifer Carroll MacNeill in the spotlight as health controversies intensifyOpens in new window ]
In an opening statement to the committee, the Minister said investment in health in Ireland had “moved ahead of activity levels” and that efficiency had been questioned in recent international comparisons.
“Our investment in health is very high. In 2022 Ireland ranked third highest health spend as a percentage of GDP/GNI (Gross Domestic Product/Gross National Income) out of 27 EU member states.”
The Minister maintained that a recent International Monetary Fund (IMF) benchmarking review found Ireland’s health system was “inefficient compared to other countries: good outcomes but high costs”.
She said the IMF “estimate that up to 15 per cent of expenditure could be saved while maintaining life expectancy”.
“This is borne out by our own analysis. I sent the committee an invite yesterday to see a demo of a new interactive hospital productivity dashboard. The dashboard will be made public shortly.
“It was developed under the productivity and savings taskforce as part of our commitment to have objective performance data that is open and transparent.”
The Minister said this “shines a light on the difference in performance across sites, between specialisms and even within sites”.
“For example, it shows us:
•Over the last five years we have increased real expenditure in our hospitals by approximately 36 per cent above inflation. This includes an average increase of 18 per cent more staff on the ground.
• At the same time, we can see that activity in our hospitals – inpatients, day cases, outpatients and emergency department presentations – has increased on average 12 per cent over the same time period.
• This shows activity on average has fallen behind investment. This average also masks considerable variation in performance."
Ms Carroll MacNeill said in contrast to St Vincent’s “another model four hospital saw a 22 per cent increase in overall activity from a 40 per cent increase in workforce and 46 per cent increase in real expenditure.
“I have a higher expectation of performance in return for public investment because every cent invested must produce a result that responds to the demands we face.”
The Minister said “this isn’t about efficiency for the sake of metrics, though those are vital, this is about making everyone’s life easier when they have to engage with the healthcare system. This is about ensuring that when you need an appointment, you get it within the Sláintecare model.”
