Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome our delegates. I assume they have all seen the "RTÉ Investigates" programme. The first question that must be asked is this whether the delegates surprised when they saw the programme or whether they were shocked, or both? Did they have any inkling that this type of activity and practice was being carried out? The witnesses have referred to the fact that it was limited. However, what "RTÉ Investigates" would suggest that it is not as limited as we are trying to suggest here. There may be reasons our delegates suggest differently.

In the context of the perverse incentives that are now in the public health system, and the funding of same, we have been talking about the issue of stretched targets for a very long time. Mr. Woods stated that the decision by way of legislation to effectively de-designate private beds - 2013 legislation - was aimed at optimising private income and supporting the delivery of accelerated income targets. That change came about primarily because of the Comptroller and Auditor General's recommendations. In doing that, do the delegates agree there is now a perversion at the heart of the funding of public hospital systems? In other words, there is an incentive for public hospitals to put private patients in beds ahead of public patients. That filters down to the involvement of consultants. Due to this perversion at the heart of the system, it is very difficult for hospital managers, and those managing budgets, to confront consultants who are pushing private patients through the public hospital system.

Everybody working in the system tells me that there are no stretched targets in it. Everybody around this committee table looks at the accounts and knows that at the heart of it there is an incentive to facilitate private patients ahead of public patients. If somebody here can tell me I am wrong, I call on them to do so and to explain why I am wrong. I believe this is at the heart of the difficulty. It puts clinical directors and hospital managers in a very invidious position because consultants are involved in this as well and are facilitating the increased stretched budgets available to public hospitals. I would like to hear the delegates' comments on that issue.

From what I can gather, the HSE pays an extra €46,000 extra to a clinical director. They are obviously the ones charged with the responsibility of making sure these contracts are upheld. Has a case ever been brought to the attention of a hospital manager, a clinical director, the HSE or the Department of Health in which there was a breach of contract? Has anybody ever picked up a phone and reported that a consultant was only working 13 hours a week, as was reported in one case? A young person in a carpark with a clipboard and a stopwatch was able to identify it, but our amazing systems could not. Why is that the case, in view of Ms Cody's claim that this issue on the agenda? Ms Cody stated that the director general of the HSE issued clear instructions to relevant health sector management in October 2012. I have also been advised that it has been on the agenda of almost every meeting. Has it ever been raised to the point where a consultant, clinical director or hospital manager was called to account? Is there now a situation where the HSE and the Department of Health are utterly compromised when it comes to dealing with consultant contracts? There are a number of reasons, which I have outlined, including stretched budgets, which are now endemic in the heath system, for funding of public hospitals and the fact there was a court case which could potentially place a liability of €300 million on the State over changes in contracts and working conditions for consultants over the years, the court cases flowing from that and the fact they were vindicated. Is there a cosiness developing between the HSE, the Department of Health and consultants to delay the payment of that €300 million and turn a blind eye to other issues that at the very least are unethical, immoral and potentially illegal? I would like to hear the delegates' comments on that issue.