Naas, Kerry and St Michael’s hospitals used money solely for clinicians, despite funds allocated for all costs associated with additional work
Three hospitals used funds provided for insourcing solely to pay consultants, despite the money being provided to cover all costs associated with the work, a nationwide review has found.
Naas General Hospital, University Hospital Kerry (UHK), and St Michael’s in Dun Laoghaire made disclosures to the National Treatment Purchase Fund (NTPF) that they were operating outside of the Memorandum of Understanding (MOU) for how funds provided for insourcing work should be used.
Insourcing is an initiative which utilises spare capacity in public hospitals over and above core hospital activity, in order to get public patients treated faster. This typically involves evening or weekend work and the use of additional theatre capacity.
“In each case the hospital disclosed that the full package of agreed funding provided by the NTPF to the hospital to pay for the insourcing initiatives (outpatient appointments) was paid to the treating consultants involved,” the NTPF report said.
“Under the NTPF’s MOU, the package of agreed funding is the marginal cost required to deliver the additional capacity, covering all costs associated with the insourcing initiative including nursing staff, and administrative staff.”
The review said that Naas General Hospital was also unable to assure the NTPF that all insourcing work was taking place ‘outside of core activity and are not displacing or overlapping with services already funded under the HSE National Service Plan’.
According to the report, dated July 21 but published on the NTPF website this week, insourcing has been suspended at Naas and the HSE’s internal audit team has been engaged.
No NTPF-funded insourcing is currently taking place at UHK, the report said, while the St Michael’s insourcing initiative that involved a misuse of funds ceased last May.
The national review of insourcing work included 38 hospitals who had applied for and received approval to proceed with NTPF funded insourcing initiatives in 2025.
Its findings do not include Beaumont Hospital, which suspended its insourcing activities in April after the NTPF found ‘potential financial irregularities’. The HSE’s internal audit is currently investigating the matter.
While the NTPF does not engage with third-party providers for insourcing, 11 hospitals said that they have used such providers to deliver additional clinics. In each case the hospital confirmed that their used complied with the HSE Procurement Framework.
Issues with insourcing first came to the fore after reports that a consultant in a Children’s Health Ireland (CHI) hospital potentially abused the NTPF insourcing system for personal benefit.
Regarding allegations that a consultant transferred patients to their own NTPF-funded clinic rather than move them on to another colleague’s shorter waiting list, a CHI review found that ‘certain NTPF-funded clinics did not adhere to NTPF standards of chronological scheduling (i.e. seeing the longest waiting patients first)’.
A summary of the CHI report added: “Data suggested that some of these patients could have been seen by other departmental colleagues within the existing day to day service and potentially managed in a more proactive way.
“Patients seen in the outpatient clinic who required ongoing treatment were placed on an already long inpatient waiting list without consideration of redistribution of patients to colleagues with a shorter waiting list. The examination raised the issue as to the possibility that this could have led to any negative outcomes for patients.”
A spokesperson for HSE South West said that University Hospital Kerry notes the publication of the review. “UHK will, via the HSE South West be engaging with the NTPF to provide further clarity on its position to evidence compliance with the objectives of the review.”
A HSE Dublin and Midlands spokespeson said that they are ‘not in a position to comment’ on issues regarding Naas General Hospital ‘while an internal audit is in progress’.
