Cork University Maternity Hospital (CUMH) is in breach of its obligations to monitor, report and control the public/private practice of its consultants, a new HSE internal audit report has suggested.
One doctor who operated under an older 1997 contract had a public practice of only 37 per cent of the total number of patients seen, the report says.
The control environment at the hospital on consultants’ public/private practice is “unsatisfactory”, according to the overall assessment of the HSE internal auditors in a report released on Tuesday.
Management at the hospital told auditors in March last year that standardised work practice plans for each consultant had not been introduced due to insufficient support staff to undertake this process, the report says. Management said it planned to commence this arrangement in the final quarter of 2019.
The report points to weaknesses in sample work practice plans given to auditors last year, including documents that were hand written in multiple formats; the total number of weekly scheduled working hours being excluded; forms not signed by consultants or the clinical director; and the lack of indication whether private practice carried out was in the public hospital or in another facility.
“The absence of signed, agreed work practice plans precludes the monitoring of compliance with contractual terms including on- site/off-site practice”, the report suggests.
The report says that CUMH management had told auditors that they had commenced a process to review consultants’ public/private ratio on an individual basis in 2018.
“However no evidence of detailed public data monitoring or performance reporting as required by the comprehensive framework for consultant contract compliance and by Section 20 of the 2008 consultant contract was available to internal audit.”
The report says that the absence of a process for monitoring public/private practice against that permitted under doctors’ individual contracts on a monthly basis “means that consultants could exceed their contractual public/private practice ratios without any remedial action being taken”.
The report says that one consultant operating under the 1997 category II contract with the State had a public practice of only 37 per cent.
It says the 1997 consultants’ contract states that category II consultants can engage in on-site private practice subject to the requirement that a consultant’s overall proportion of private patients should reflect the ratio of designated private beds.
However the specific designation of hospital beds as being for public or private patients was removed under legislation in 2013.
The report says management at the hospital group in the south was awaiting a reply from the HSE regarding the private practice ratio applicable to consultants working under the category II contracts dating from 1997.
