Naas General Hospital voluntarily paused the use of an initiative to tackle waiting lists, after concerns were raised about the way in which public funding was used.
The National Treatment Purchase Fund (NTPF), a vehicle set up to reduce waiting lists, provides funding through outsourcing – the use of private facilities – and insourcing – the use of public facilities and staff outside of core working hours.
In recent months concerns have been raised about the way in which the use of insourcing has been governed, after a leaked 2022 report from Children’s Health Ireland (CHI) highlighted allegations about potential misuse of these funds.
Funding for the hospital was temporarily suspended in light of these allegations but has since resumed, while funding for Beaumont Hospital has also been suspended in light of “potential financial irregularities”.
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Speaking at a meeting of the Oireachtas health committee on Wednesday, Bernard Gloster, chief executive of the Health Service Executive (HSE), confirmed concerns have also been raised about Naas General Hospital.
According to Mr Gloster, the regional executive officer received correspondence outlining potential issues at the hospital.
“It’s not unusual when the CHI report.. came the way it did that you would start to see sequentially people starting to express concerns. There is a concern about how NTPF funding was used or governed by Naas hospital. [An] internal audit will look at that,” Mr Gloster said.
“Conservatively” the audit will take about three months, he added.
Fiona Brady, chief executive of the NTPF, said: “Naas of their own volition stopped their own insourcing temporarily while they liaised with myself and my executive team and we are happy they will be rectifying this issue immediately.”
Mr Gloster said the issue around insourcing is widespread, and not about individual doctors or hospitals.
“Fundamentally it appears to be a systemic issue, albeit very different in every hospital,” Mr Gloster said.
He said there are “mechanisms of governance” but the “effectiveness of the governance is probably questionable” in relation to insourcing.
In Mr Gloster’s report to Minister for Health Jennifer Carroll MacNeill on the topic, published late on Tuesday, he outlines a desire to wind down the use of insourcing by June of next year.
The report states that a growth in insourcing without adequate oversight and controls can create conflicts of interest and lead to noncompliance with procurement rules; inequitable use of public funds, risk of abuse, misuse, fraud and low public confidence.
Mr Gloster said the risks of insourcing are “too high for the public”, which is why he believes it should be phased out. An “over-reliance” on the system has developed over time, he said.
In the interim, he said there will be new “protections” in relation to potential conflicts of interests.
In recent years, the health service has taken steps to move towards a longer working week, with health unions last week agreeing to work five over seven days – increasing the hours of work outside of a typical Monday to Friday, 9am to 5pm.
Mr Gloster agreed the existence of insourcing creates an impediment to the extended working week.
“For as long as we have this type of third party insourcing, we will not get to five over seven in the management of waiting lists,” he said. “Productivity will not be encouraged and risk of conflicts of interest remain.”
The health chief was also critical of CHI’s decision to to publish an anonymised version of the 2022 report. He expressed confidence in Lucy Nugent, the new chief executive, and the new board members, but said there is a “way to go to see whether the entity [CHI] is sustainable in the future”.
