The Health Service Executive (HSE) and the National Treatment Purchase Fund (NTPF) are appearing before the Oireachtas health committee on Wednesday morning discussing waiting lists and the State funding aimed at tackling them.
The funding has been under scrutiny in recent months following a number of controversies around potential mismanagement of public fund.
The NTPF was set up 20 years ago as a vehicle to tackle waiting lists through the use of private facilities (outsourcing) and the use of public facilities or staff outside of typical working hours (insourcing).
- Here’s our report on the review carried out by Bernard Gloster, HSE chief, on the use of NTPF funding in both private facilities and in public facilities - a system called insourcing.
- In his opening statement, Mr Gloster will tell politicians there is now an “over reliance” on insourcing to supplement core activity. Over a 27-month period, from 2023 until the first quarter of this year, a “rounded figure” of €100 million has been used on insourcing in acute settings, Mr Gloster will tell politicians.
- We also had this piece looking at CHI Crumlin, which has seen a rapid increase in NTPF-funded Saturday work. A leaked unpublished internal report into the hospital, from 2022, found “serious concerns about the prudent and beneficial management” of this funding.
The meeting has now concluded. The National Treatment Purchase Fund will be back before politicians tomorrow when it appears before the Public Accounts Committee, accompanied by Children’s Health Ireland.
Bernard Gloster said “one of the greatest dysfunctions” of the health system is patients using a bed to ensure they can access treatment, despite not needing a bed at that time.
Mr Gloster was speaking following a comment from Fine Gael’s Maria Byrne who said she was aware of an individual who was advised to stay in a hospital bed to ensure they would get timely access to an MRI.
The health chief said there was a need for a system in which people let go of the bed and “we guarantee the other [test] will happen”.
“‘Go home and return for your MRI the following day’ - we’re trying to push that practice very hard. Not just for MRI but for a whole range of diagnostic tests,” he said.
“It’s a bit of a hill to climb because people are used to the particular way.”
Sheila McGuinness, director of access at the HSE, said the current waiting times is an average of 6.8 months, but this is expected to improve.
Ms McGuinness said the HSE has a target waiting time for the year of an average of 5.5 months.
“We are targeting people who are waiting the longest,” she said, with the hope that by the end of the year over 90 per cent of people will be waiting less than a year.
“We’re very hopeful for a lot of progress this year,” she added.
The meeting has resumed.
Marie Sherlock has asked the NTPF about what has happened in Beaumont hospital in relation to the use of its funding.
Fiona Brady, chief executive of the NTPF, said in early March she was reviewing finances when she noticed Beaumont hospital in Dublin had not applied for funding this year.
The hospital received €8 million the year before, she said.
Ms Brady said she spoke with the new chief executive who told her doctors in the rheumatology had expressed concerns about the use of this funding.
A doctor confirmed that patients for which the hospital received NTPF funding were seen in “core clinics”.
Ms Brady said she is not aware of such issues being present in any other hospitals.
In the context of Naas hospital, Bernard Gloster said internal audit has just begun to examine NTPF funding at the facility, after concerns were raised there too.
The length of time of this audit will depend on the “scale of documentation to review”, but “conservatively” he believes it will take three months.
The NTPF are satisfied with the steps being taken by the hospital.
Ms Brady said the hospital has stopped the use of insourcing of their own volition in response to these concerns.
The meeting has been suspended for a short break, after which questioning will resume.
Bernard Gloster said he has confidence in the new chief executive of Children’s Health Ireland Lucy Nugent.
The recent interventions by Minister for Health Jennifer Carroll MacNeill in relation to CHI’s board also give him confidence, he said.
“I want to be very clear. I believe the entity is seriously challenged. We have a way to go to see whether the entity is sustainable in the future,” he added.
Pádraig Rice, chair of the committee and Social Democrats TD, said he welcomes that insourcing will be phased out by the end of June 2026.
He reads from the report, published on Tuesday, highlighting “key concerns in respect of insourcing”.
The report states that a growth in insourcing without adequate oversight and controls it can create conflicts of interest, lead to non-compliance with procurement rules, lead to inequitable use of public funds, disincentivise normal job plan delivery, undermine long-term workforce sustainability, limit productivity improvement and reform of public healthcare services, lead to risk of abuse, misuse, fraud and lead to low public confidence.
Bernard Gloster said the risks of insourcing are “too high for the public”. There are also new “protections” going in for conflicts of interest, until the use of this scheme is phased out.
Mr Gloster added that healthcare demand is “only going in one direction”.
“We’ve to reduce the dependency on third-party insourcing. We will need outsourcing for a time to come. If you want to reduce that dependency... it’s not as simple as building hospitals and beds,” he said, adding that it’s also about the way of working.
David Cullinane, Sinn Féin’s health spokesman, asks about HSE staff benefitting from this funding.
Bernard Gloster said an audit is being carried out on some 148 companies, which have “300-odd directors”. Of these, Mr Gloster said there were 93 directorships held by 83 people who were either serving or former HSE employees.
Mr Gloster acknowledged that the existence of insourcing creates an “impediment” to the extended working week.
The Health Service Executive is seeking to have a system in which healthcare staff work five over seven days. This will extend the working hours outside of the typical Monday to Friday, 9-5 - increasing the time during which health care can be carried out.
“For as long as we have this type of third party insourcing, we will not get to five over seven [working days for staff] in the management of waiting lists,” he said.
“Productivity will not be encouraged and risk of conflicts of interest remain.”
Mr Gloster said he disagrees with the view of Children’s Health Ireland (CHI) to not publish the internal 2022 review, which has been largely leaked by the media, and which highlighted issues around NTPF funding.
Mr Gloster said it is his view that the report could have been published in an anonymised way.
He said “nothing he has seen” suggests the HSE was aware of this report in 2022.
Bernard Gloster has concluded his opening statement. Members will now question guests.
Martin Daly, Fianna Fáil TD, said there is a “moral hazard” connected to NTPF insourcing.
“It seems a system-wide issue. I don’t think people understand that also hospital gain from NTPF service,” he said.
Mr Daly said the NTPF was set up to deal with long waiting lists and was “not a revenue-generator for public hospitals”.
He asked if there is an “over-arching audit system” to regulate NTPF funding.
“We are relying on hospitals who are looking for revenue to police themselves,” he said.
Mr Gloster said the issue was “not about doctors” but about the whole system.
He said there are “mechanisms of governance” but the “effectiveness of the governance is probably questionable” in relation to insourcing.
“Our focus was probably on rushing to do the right thing to get waiting lists down,” he said.
“I think we have too many governance systems and it’s very hard to stay on top of all of those in a country this size.”
Mr Gloster said “fundamentally” it is easier and more transparent to manage outsourcing than it is to manage insourcing.
Mr Gloster said the experience of the public with regard to waiting times would be “totally unacceptable if we did not take additional steps”.
These “additional steps” include something called insourcing - which is the use of external companies or third-party providers to deliver services often outside of normal working hours, using HSE-owned facilities and equipment.
However, Mr Gloster said an “unintended consequence” of this is “an unsustainable reliance on short term measures”.
“Insourcing by its nature carries risks and having assessed these I have agreed with the Minister and the Department the need to take a series of steps which firstly reduce those risks and increase safeguards and secondly which removes our dependency on insourcing,” he said.
“I hope to finalise those steps when the Minister has had an opportunity to consider in full the report and any next steps at her direction will be communicated clearly.”
The hearing has begun.
Bernard Gloster, chief executive of the HSE, has told politicians that the pace of reform in the health service to tackle waiting lists has “presented challenges in the context of increasing demand”.
“Such was the demand post the pandemic that our own projection methods were greatly challenged and thankfully we believe we have got to grips with this in 2025,” he said.
Achieving reform “timely and consistently is now our greatest priority”, he said.
According to Mr Gloster, 85 per cent of all patients on the key hospital waiting lists at the start of 2024 were seen, treated and removed by the end of the year.
“This is again despite further unprecedented growth in new referrals,” he said.
Public policy correspondent Martin Wall reports:
Naas Hospital was included in list of centres under investigation regarding the use of NTPF funds after a complaint was sent to the HSE, informed sources have told The Irish Times.
It is unclear as yet whether the NTPF has suspended funding to Naas.
The HSE report on insourcing, published on Tuesday night by Minister for Health Jennifer Carroll MacNeill makes reference for the first time to any investigation involving Naas.
NTPF funding to Beaumont for insourcing has been suspended since April on foot of concerns regarding potential irregularities. Funding was also paused for children’s hospitals run by the CHI group for a time in May.
