New restrictions on hospitals engaging external companies that use public-service staff and facilities after normal hours to reduce waiting lists will have “some impact” on patients’ access to treatment, the HSE has warned.
The HSE estimates that up to 4 per cent of those who currently receive such treatment could be affected. This suggests that between 300 and 400 patients per month, who are treated as part of what are known as “insourcing” initiatives, could be affected.
New controls on insourcing arrangements were introduced by the HSE at the beginning of September, following a series of controversies that saw initiatives suspended in some hospitals.
HSE chief executive Bernard Gloster told senior staff insourcing can only be used as a “last resort”, and then only after other steps including the use of regular overtime, agency staff and outside private facilities have been taken.
RM Block
New controls also include limiting the duration of contracts with insourcing companies to three months, as well as checks that third-party providers are complying with tax and employment law and not paying public health service staff more than official HSE rates.
The Department of Health and the HSE are to monitor if, and to what extent, the new rules will impact on waiting lists and times for patients.
Mr Gloster has proposed to Minister for Health Jennifer Carroll MacNeill that insourcing be ended completely by next summer. A decision on this is awaited.
The HSE chief told senior staff “there is a risk that the extent of these controls will reduce the availability and attractiveness of third-party insourcing from the perspective of providers of those services currently and this in turn will have some impact on access to care”.
The HSE told The Irish Times the 4 per cent “outer risk” figure for those affected was “an approximate estimation of patients in receipt of third-party insourced care at a point in time”.
A report provided to the Minister in June said about 500,000 “instances of care” were provided to patients in the 27 months from the beginning of 2023 using insourcing arrangements either funded by the HSE or the National Treatment Purchase Fund (NTPF).
This would suggest that more than 9,000 patients per month, on average, are receiving treatment on foot of insourcing arrangements funded either by the HSE or the NTPF.
The report to the Minister defined insourcing as the practice of engaging companies or third parties to deliver services, often outside normal working hours, using HSE-owned facilities and equipment. It said that in many cases these providers “may employ or subcontract staff who are already directly employed by the HSE”.
The report found that 83 serving or former health staff were acting as directors in 148 companies providing insourcing and outsourcing – another system that involves buying care in outside private facilities – arrangements to reduce waiting lists.
Mr Gloster said insourcing carried risks, presented potential conflicts of interest and governance had become questionable.
Insourcing arrangements were suspended at Beaumont and Naas hospitals while HSE internal auditors carry out reviews.
Meanwhile, the children’s hospital group CHI – which runs paediatric hospitals in Dublin – has told Sinn Féin health spokesman David Cullinane it cannot provide “without disproportionate effort” details on the amount of work carried out by consultants during contracted hours as opposed to under insourcing or other extra-contractual hours.
Mr Cullinane described the CHI stance as “breathtaking and arrogant”.
“It is important that the health service and the political system can measure value for money. Public-only consultant contracts are important, but if hospitals are not collecting the data on output, we cannot measure what work is being carried out and how effective it is,” he said.
