The HSE has proposed phasing out over the next year, the use of external companies which use public facilities and employees outside normal business hours to tackle hospital waiting lists.
However, HSE chief executive Bernard Gloster warned in a report to Minister for Health Jennifer Carroll MacNeill, that without increases in productivity, ending what is known as insourcing arrangements in public hospitals could result in a significant increase in the use of the private sector.
The HSE chief had been asked by the Minister to review on a national basis how dependent the public system had become on insourcing to tackle waiting lists.
The report, published on Tuesday night, reveals that close to €100 million had 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.
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The report 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 such company directors are currently employed by the HSE.
Mr Gloster, who drew up the report, is to tell an Oireachtas committee on Wednesday that the report’s findings 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.
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.”
The report proposes ending the use of insourcing by June 30th next year. However, it warns political decisions would need to be taken to allow contracts to be ended.
The report warns if productivity did not increase – either through using provisions in the new public patient-only contract for hospital consultants or work practice reforms for other health service personnel, treatment for more patients on waiting lists would have to be outsourced to the private sector.
It suggested this could see 18,000 instances of care each month transferred to private hospitals.
The HSE was asked by the Minister to examine on a national basis the scale and dependency of the health service on the practice of insourcing after a number of controversies.
Last September a 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, a leaked unpublished internal report, originally drawn up in 2022 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.
Ms Carroll MacNeill said on Tuesday night that she would like to discuss a plan to reduce dependence on insourcing with the Oireachtas Committee on Health “so that we can achieve our shared goal of maximising productivity in the public health service, ensuring patients have timely access to the treatments they need”.
“I will be reflecting on some of these steps in the coming weeks and look forward to working together with the committee in the spirit of Sláintecare on this.”
