Close to €100 million has been spent in just over two-and-a-half years on engaging external companies that use HSE-owned facilities and equipment after normal working hours – in many cases employing existing health service staff – to reduce public waiting lists.
A report for Minister for Health Jennifer Carroll MacNeill, published on Tuesday night, reveals 83 serving or former health staff are acting as directors in 148 companies providing what are known as insourcing and outsourcing arrangements to reduce waiting lists.
It says 23 of these company directors are serving HSE personnel.
About 500,000 instances of care were provided from the beginning of 2023 to the first quarter of this year. .
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At the same time more than 13 million instances of care were provided by the HSE during core working days.
HSE chief executive Bernard Gloster, who drew up the report, is to tell an Oireachtas committee on Wednesday that the figures suggest that “in waiting-list management we have developed an over-reliance on insourcing to supplement core activity”.
“Insourcing by its nature carries risks and having assessed these I have agreed with the Minister and the Department [of Health] 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 is expected to say.
He is to say that the HSE has carried out a review covering a 27-month period, taking in 2023/2024 and the first quarter of this year, to identify the scale of the dependency the health service has on insourcing and on outsourcing.
Mr Gloster will define insourcing as the practice of engaging external companies or third-party providers to deliver services often outside of normal working hours using HSE-owned facilities and equipment.
“In many cases, these providers may employ or subcontract staff who are already directly employed by the HSE, effectively re-engaging internal staff through a separate commercial arrangement, typically at premium rates,” he is expected to say.
“It is not the use of standard overtime within employment contract arrangements of existing staff, which is a different form of insourcing.”
Following a number of controversies over insourcing arrangements, in April the Minister asked the HSE to examine on a national basis the scale and dependency of the health service on the practice.
Last September an HSE internal audit revealed that two companies which received more than €1.5 million between them in contracts awarded by University Hospital Limerick without a competitive procurement process were owned or part-owned by employees at the facility.
In May an internal report drawn up within a hospital run by Children’s Health Ireland said there were “serious concerns about the prudent and beneficial management” of National Treatment Purchase Fund (NTPF) funding in relation to a series of clinics run by one consultant.
Mr Gloster is expected to tell the Oireachtas Committee on Health that overall €1.1 billion was spent over the period between insourcing and outsourcing – which involves buying care from the private sector. Much work in this area is carried out by the NTPF.
He will say about €830 million was spent between insourcing and outsourcing over the period in acute settings, with the bulk being spent on outsourcing arrangements.
“Within acute settings €739 million of the spend is outsourcing and this ranges from private hospital care to private ambulances to laboratory products. That is to say not all of the outsourcing is for waiting-list management,” he is to say
“Within acute settings between €71 million and €91 million appears to be insourcing.”
The NTPF, which will receive about €230 million in exchequer funding this year, is expected to say about 30 per cent of its focus is on insourcing.
It is to say it only makes payments in relation to specific named patients who have been on a public waiting list and then only on receipt of detailed invoices from public hospitals confirming that care is completed and the patient discharged.
The NTPF is also expected to say payments are only made to hospitals and never to individual consultants or hospital staff members.
