HSE chief to warn of overreliance on insourcing work in public hospitals

RTÉ News​

02-07-2025

HSE Chief Executive Bernard Gloster is to warn of an overreliance on insourcing work in public hospitals, to support core care and cut waiting lists and has said the dependency on this funding needs to be removed.
It comes after recent controversies involving funds provided to three public hospitals by the National Treatment Purchase Fund to cut waiting lists.
A new report from the Health Service Executive CEO has revealed that Naas Hospital is also the subject of an internal audit. Previously a Children's Health Ireland hospital and Beaumont Hospital had been identified where internal audits were under way for different reasons.
Mr Gloster will tell the Oireachtas Committee on Health that this insourcing work involves public hospitals engaging external companies, or third party suppliers to deliver services, often outside of normal working hours, using HSE-owned equipment facilities and equipment.
In many cases, the outside providers may employ or subcontract staff who are already directly employed by the Health Service Executive, effectively reengaging internal staff through a separate commercial arrangement, typically at premium rates.
Mr Gloster will say that a 27 month review by the executive of insourcing and outsourcing work has found that around €100 million was used for this insourcing work.
It amounted to over 253,400 instances of care, much of it funded by the National Treatment Purchase Fund (NTPF).
Mr Gloster will say that what he is referring to as insourcing, is not the use of standard overtime within employment contract arrangements of existing HSE staff.
The 27 month review covered 2023/2023 and the first quarter of this year.
It identified an outsourcing and insourcing spend of €1.1 billion for the period in review.
Most of this was for outsourcing, which ranged from securing private hospital care, to private ambulances and laboratory products.
Not all outsourcing was for waiting list management.
Mr Gloster will tell the committee that earlier this year, Minister for Health Jennifer Carroll MacNeill asked him to conduct a national review, with a particular focus on insourcing, and the level of activity and dependency on it.
He submitted that report to the minister this week.
Mr Gloster will tell the committee that insourcing by its nature carries risks, and that he has agreed with the minister the need to reduce these risks, and increase the safeguards and remove dependency on insourcing.
The committee will also hear from the NTPF, which helps pay hospitals to cut waiting lists, through insourcing arrangements with public hospitals and outsourcing arrangements with private hospitals.
It will tell the committee that 30% of its commissioning involves insourcing.
This has been at the centre of recent media coverage, involving Children's Health Ireland and Beaumont Hospital and the use of NTPF funds.
The NTPF suspended insource funding to Children's Health Ireland in May, after a leaked report found that a consultant at one hospital had breached the fund guidelines by referring patients to the doctor's own weekend clinics.
Funding was later restored after the NTPF secured assurances from CHI.
The NTPF also suspended funding to Beaumont Hospital in April, due to a separate issue to what was found in the internal CHI review.
The Beaumont issue did not relate to a consultant-led issue.
In March, Beaumont Hospital had approached the NTPF of its own volition about activity conducted as part of insourcing work under the waiting list initiative. An independent review of the matters is under way by the HSE's Internal Audit Team and the committee heard previously that it involves potential financial irregularities.
The NTPF will tell the committee hearing that it takes its responsibility to manage public funds with the utmost seriousness.
It says that internal governance of insourcing remains with the referring public hospital, under a Memorandum of Agreement with the NTPF, for the money to be used as specified and agreed.
Payments are only made to the hospital by the NTPF, not to any individual consultant, or staff member.
Since 2019, the NTPF said it has arranged surgery or care for around one million public patients.
83 current, former health service staff acting as directors in 148 companies
A HSE report for the Minister for Health has found that 83 current, or former health service staff, have been acting as directors in 148 companies, providing insourcing or outsourcing services for public hospitals to cut waiting lists.
The report by Mr Gloster says that of the 83 individuals, 58 were HSE and 25 were with Section 38 health agencies funded by the HSE.
Of the HSE individuals, 35 are former HSE employees and 23 are serving employees.
Mr Gloster notes that there is nothing unlawful in being a company director, and there are equally obligations in respect of Standards in Public Office and or employment contract terms.
However, these issue were not assessed for this preliminary analysis.
"More testing and refinement is needed however this notwithstanding, I am advised than in an audit context this is a higher end level of return on such a search," Mr Gloster states in the report, published by the Minister for Health and also being provided to the Oireachtas Committee on Health members.
The analysis looked at 148 companies covering 365 listed directors and compared names, date of birth and address, against current and former HSE employees.
There were 93 matches.
The report says there is a need to put in place more robust safeguards following recent reports and events which have affected public confidence.