There is inadequate monitoring of the elimination of private practice in public hospitals by consultants who signed up to new contracts precluding them from treating fee-paying patients, Health Service Executive internal auditors have warned.
In a report released on Wednesday, auditors also maintained that rostering of consultants to work on Saturdays or evenings as permitted under the new contract remained low.
They said rostering arrangements broadly mirrored those in place for senior medical staff who operate under older non-public-only contracts.
Hospital chiefs were only securing a “limited realisation” of the work practice flexibilities allowed under the contract, said the HSE internal auditors.
RM Block
The audit comes days after the row between Minister for Health Jennifer Carroll MacNeill and the Rotunda Hospital in Dublin over senior medical staff covered under the new contract being allowed to continue treating private patients.
The board of the maternity hospital subsequently backed down earlier this week in the face of strong Government criticism.
The audit report also reveals that one consultant in the Dublin North East region was paid more than €6,400 in on-call allowance payments for a period of sick leave between May 2024 and January 2025.
Under the public-only contract – introduced in 2023 – consultants received higher salaries of between €231,000 and €277,000 before additional allowances or premium payments.
Under the deal, private practice for those working under its terms was to be phased out completely in public hospitals by the end of last year.
The HSE said on Wednesday that a national governance framework was being developed to oversee the removal of private practice from public hospitals with data collection under way in this regard.
“The HSE has not been notified of any alleged breach of the public-only contract where private care was carried out in the public hospital system [other than the Rotunda],” it said.
The audit report, dated March 30th, 2026, covers 2024 and 2025.
The audit’s sample covered 30 doctors, of which 15 were in the HSE’s Dublin and northeast region, 10 in the midwest and five in the Mater hospital – a voluntary institution which is run by its own board.
The auditors found there were “inadequate systems in place to monitor and report on the phased elimination of private work in public settings and the increased roster flexibilities in the contract. This increases the risks of failure to achieve the benefits of the contract and failure to achieve value for money.”
The HSE said that since completion of the initial internal audit report, more consultant [work] plans now include evening and Saturday work.
Under the public-only contract, consultants can be asked to work between 8am and 10pm Monday to Friday and between 8am and 6pm on Saturdays as part of their overall core 37-hour week.
The audit found that the flexibilities set out in the public-only contract were “not being fully realised” on Saturdays and weekday evenings.
“The analysis showed the roster patterns of public-only consultant contract [holders] and non-public-only consultant contract [holders] were notably similar,” it said.
“By not rostering consultants to work Saturdays and weekday evenings as envisioned in the contract, there is a value for money risk as these arrangements were used as a basis for pay negotiations under the contract,” the report states.
Auditors also maintained that there was insufficient monitoring and oversight of travel and subsistence claims in the health service.
A separate audit report found that a national travel and subsistence unit had been established in the HSE in 2021 to monitor claims by staff.
Auditors found the unit only operated in two payroll areas: the East and the Southeast.
The report indicated this limited the oversight of the unit to 22 per cent of HSE employees, as travel and subsistence claimants, and 25 per cent of overall claims.
Overall, the HSE spent €92 million on travel and subsistence payments in 2024.
