The suspension of some initiatives to tackle waiting lists at Naas General Hospital followed concerns that funds provided by the National Treatment Purchase Fund (NTPF) were paid directly to consultants and not shared with other staff.
On Wednesday HSE chief executive Bernard Gloster said an issue had arisen in relation to the operation of a waiting list scheme at Naas and that auditors were carrying out a report. Management at the hospital had voluntarily stopped the initiative known as insourcing – where staff receive additional payments to treat patients after hours or at weekends – when the issue was highlighted.
On Thursday, NTPF chief executive Fiona Brady told the Dáil Public Accounts Committee that to the best of her knowledge the issue involved Naas directly paying consultants involved in the waiting list initiative rather than using the money provided by the NTPF to pay all the staff involved.
Ms Brady said the NTPF agreed a €200 fee per patient to cover all personnel involved including the consultant, clerical staff and potentially nurses.
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“You need a team if you are going to run an initiative at the weekend. The €200 goes to the hospital to cover all of them. It is my understanding that the hospital was paying the €200 directly to the consultant.”
NTPF funding for insourcing is also suspended at Beaumont Hospital in Dublin where HSE internal auditors are also looking at what has been described as “potential financial irregularities”.
Funding was also paused for a period in May and early June at Children’s Health Ireland (CHI), after a highly controversial leaked report, originally drawn up in 2022, raised questions over whether some clinics funded by the NTPF had been necessary.
Ms Brady said two other hospitals had a deadline of Friday to provide clarification as part of a process the NTPF had put in place to seek assurances that hospitals were complying with their funding agreements.
Separately, the Public Accounts Committee was also told the State had paid €123,000 in legal fees as part of the settlement of a legal dispute initiated by the former CHI chief executive Eilish Hardiman.
Ms Hardiman said there had been an employment law issue after former Minister for Health Stephen Donnelly rejected an application by the CHI board to reappoint her for a third successive five-year term in early 2024.
The Minister had maintained Government policy had stipulated that a chief executive in a non-commercial State body should serve no more than two terms.
Ms Hardiman said that after having completed two terms, she was eligible for a contract of indefinite duration. She said she initiated legal action and the issue went into mediation.
CHI told the committee legal fees in dealing with this issue had amounted to €123,000 but that the agreement had been reached by the Chief State Solicitors Office.
CHI said it would provide the committee at a later date with its own legal costs as well as details of any other bills.
Fianna Fáil deputy Seamus McGrath said the total costs were potentially a lot more in legal fees.
Ms Hardiman was subsequently appointed to a new role as strategic director at CHI on the same terms as she had as chief executive.
The current CHI chief executive Lucy Nugent said on taking up the role she had never been briefed about the 2022 internal report, which identified potential issues regarding NTPF funding as well as a toxic culture in one department in the hospital group.
She said she only learned of the existence of the unpublished internal report, when a media query was sent to the group by The Sunday Times in May.
Ms Hardiman said she had gone on sick leave in October 2023 before Ms Nugent had been appointed. Ms Hardiman said a lot of issues in the report had already been addressed.
The internal report raised questions about whether special waiting list clinics funded by the NTPF – and for which a consultant was paid over €35,000 in fees – had been necessary.
Ms Nugent said she did not believe that there had been any misuse of public funds involved and that the matter did not warrant being referred to gardaí.
However, she said in hindsight the issues in the report should have been raised with the HSE and the NTPF.
The NTPF, meanwhile, said it was ready to restore funding for insourcing initiatives to tackle waiting lists at Beaumont Hospital when it received sufficient assurances regarding its appropriate use.
The provision of such NTPF funding for Beaumont has been paused since April on foot of what were described as “potential financial irregularities”.
The HSE this week defined insourcing as the practice of engaging external companies or third-party providers to deliver services often outside of normal working hours using public-owned facilities and equipment and often employing existing healthcare personnel on premium rates.
In an opening statement to the Dáil Public Accounts Committee on Thursday NTPF chairman Don Gallagher said that upon learning of “potential issues in relation to NTPF-funded insourcing work at Beaumont Hospital, it immediately suspended all insourcing work and payments at Beaumont and informed the Department of Health and HSE of its concerns”.
He said that HSE internal auditors were currently carrying out a detailed review in Beaumont.
The Irish Times reported last month that the catalyst for the suspension of funding for insourcing initiatives was a letter sent by consultants in one speciality to the chairwoman of Beaumont which maintained that the hospital had billed the NTPF for about 1,400 patients over a number of years who had actually been seen at regular public clinics.
