Oireachtas Joint and Select Committees
Thursday, 9 October 2025
Public Accounts Committee
Financial Statements 2024: National Treatment Purchase Fund
Financial Statements 2023: Beaumont Hospital Board
2:00 am
John Brady (Wicklow, Sinn Fein)
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This morning, we will engage with the National Treatment Purchase Fund to discuss its 2024 financial statements, and with Beaumont Hospital to discuss its 2023 financial statements. We are joined by the following representatives from the National Treatment Purchase Fund: Ms Fiona Brady, chief executive officer; Mr. Seán Flood, director of finance; Mr. Eoin Darcy, director of ICT; Ms Bernadette Weir, director of commissioning; and Ms Rebecca Maher, head of operations commissioning. We are also joined by the following representatives from Beaumont Hospital: Ms Anne Coyle, chief executive officer; Mr. David Sweeney, deputy chief executive; Mr. Francis Hanlon, director of finance; and Mr. Mark Graham, director of ICT.
We have received apologies from Deputies Boland, Geoghegan and Connolly.
We are joined by the Comptroller and Auditor General, Mr. Seamus McCarthy, who is a permanent witness to the committee, and Mr. Mark Scully, audit manager at the Office of the Comptroller and Auditor General. They are very welcome.
I wish to explain some limitations to parliamentary privilege and the practice of the Houses as regards reference witnesses may make to other persons in their evidence. The evidence of witnesses physically present or who give evidence from within the parliamentary precincts is protected, pursuant to both the Constitution and statute, by absolute privilege. This means they have an absolute defence against any defamation action for anything they say at the meeting. However, they are expected not to abuse this privilege and it is my duty as Cathaoirleach to ensure it is not abused. Therefore, if witnesses' statements are potentially defamatory in relation to an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction.
Witnesses are also reminded of the long-standing parliamentary practice that they should not criticise or make charges against any person or entity by name or in such a way as to make him, her or it identifiable or otherwise engage in speech that might be regarded as damaging to the good name of the person or entity. Therefore, if their statements are potentially defamatory in respect of an identifiable person or entity, they will be directed to discontinue their remarks. It is imperative that they comply with any such direction.
I now call the Comptroller and Auditor General, Mr. Seamus McCarthy, to make his opening statement.
Mr. Seamus McCarthy:
As members are aware, Beaumont Hospital is a major voluntary hospital funded substantially by the Health Service Executive under section 38 of the Health Act 2004. The hospital's financial statements, like those of some others in the health sector, are presented with separate income and expenditure accounts for recurrent and capital spending. This format is in line with the framework for hospital financial reporting directed by the Minister for Health.
The hospital's recurrent expenditure in 2023 was just under €660 million, of which €404 million related to staff salary and pension costs. At the end of 2023, the board employed just under 4,500 whole-time equivalent staff.
Beaumont Hospital's income is almost entirely from public funding sources. In 2023, the HSE allocated a grant of €529.4 million for the day-to-day running of the hospital. Recoupment of drugs costs and salaries in respect of staff seconded to the HSE totalled €33.6 million. A total of €11.4 million was received from the National Treatment Purchase Fund in 2023 and €4.5 million was received in fair deal funding. The hospital also retained €8.8 million in payroll deductions, which mainly comprised employee pension contributions. The main non-State source of funding comprised receipts totalling €29.2 million in 2023 in respect of charges for patient accommodation or emergency department attendances.
The hospital recognised capital funding of €30 million received from the HSE in 2023. Total capital expenditure was €29.2 million.
I issued a clear audit opinion in respect of the board's 2023 financial statements. However, I drew attention to a material level of non-compliant procurement by the hospital. The statement on internal control reported that the hospital had identified non-compliant procurement for 2023 totalling €18.5 million. Subsequently, the hospital identified further contracts that were procured in a manner that was non-compliant, which raised the estimated value to €20 million.
I issued my audit report on the hospital's 2023 financial statements on 8 October 2024. In recent days, I finalised my review of the draft 2024 financial statements, which I understand will be signed off by the hospital's board in the next few weeks when some outstanding issues have been addressed.
On 3 July this year, the committee examined the 2023 financial statements of the board of the National Treatment Purchase Fund. At that stage, I had just issued my report on the board's 2024 financial statements but they had not yet been presented for the committee's examination. The board's financial statements for 2024 show income of €239 million received directly from Vote 38 - Health. Expenditure of €247 million was reported, resulting in a deficit for the year of €8.5 million. This resulted in a reduction in the retained revenue reserves.
The board secures treatment and assessments for patients on public waiting lists from private hospitals and from public hospitals that can offer spare capacity. In 2024, payments made to private hospitals amounted to €155 million, while payments to public hospitals amounted to €80 million. Payments to individual hospitals are not shown in the fund's financial statements.
The board's payroll costs and other administrative expenditure amounted to €12.3 million in 2024. Included in this are administrative costs of just under €1 million in respect of the board's function to negotiate with private nursing homes on the charges they impose on residents availing of the HSE's fair deal scheme.
I issued a qualified audit opinion in respect of the board's financial statements for 2024. However, the qualification is only in respect of the accounting treatment of retirement benefit liabilities for the board's staff, which are recognised only as they fall to be paid. This is not in line with generally accepted accounting practice but does comply with the accounting directions of the Minister for Health, which are common to a number of health sector bodies I audit. In all other respects, I am satisfied that the financial statements present a true and fair view of the board's financial situation at the year end and of its transactions for the year.
John Brady (Wicklow, Sinn Fein)
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I thank Mr. McCarthy. I now invite Ms Brady to give an opening statement on behalf of the NTPF. As set out in the letter of invitation, she has five minutes to make her statement.
Ms Fiona Brady:
I thank the committee for the invitation to appear before it today to discuss the role of the National Treatment Purchase Fund within Ireland's public healthcare system. I acknowledge my NTPF colleagues in attendance today.
By way of background, I was appointed chief executive of the NTPF in July 2023, following five years as chief executive of Our Lady of Lourdes Hospital, Drogheda, and Louth County Hospital. Prior to that, I was chief operations officer and director of unscheduled care. I also worked with the national clinical programmes on a project for the emergency medicine programme. I began my career in clinical practice, having trained as a nurse and midwife.
The NTPF carries out three core responsibilities within the public health system. The first is commissioning treatment and care. This includes inpatient and day case procedures, outpatient procedures and endoscopies for patients experiencing the longest waiting times. Second, we facilitate the management of hospital waiting lists by collecting, collating, validating and publishing national waiting list data. Third, we negotiate nursing home rates by setting the maximum prices for long-term residential care in private or voluntary nursing homes under the nursing home support scheme, NHSS, a function that is critical both for protecting residents and safeguarding public finances. In 2024 alone, the NTPF concluded more than 300 negotiations with individual private and voluntary nursing homes.
Today, I will focus primarily on the NTPF's commissioning role, outlining our approach and our impact on patients. I will also provide an update on the actions we have taken in recent months in response to concerns regarding the misuse of NTPF funding for approved insourcing initiatives within public hospitals.
The NTPF enables public patients to access timely care through two commissioning pathways. Insourcing is where funding is provided directly to public hospitals to deliver additional treatment or outpatient consultations beyond their core HSE-funded activity. Second is outscourcing, where the NTPF procures treatment and care for public patients in private hospitals. Currently, outsourcing represents approximately 70% of all NTPF commissioning expenditure, while the remaining 30% is insourcing expenditure.
Robust governance and oversight arrangements are in place for all commissioning activity. Outsourcing agreements are governed by legally binding contracts between the NTPF and the treating private hospitals. Similarly, public hospitals undertaking insourcing initiatives are required to adhere to the principles of a formal memorandum of understanding, MoU, setting out their obligations in relation to NTPF-funded work.
Since 2019, the NTPF has arranged treatment and care for more than 1 million public patients, supporting the health system in progressing towards the waiting time targets set out under Sláintecare. In 2023 and 2024 alone, over 500,000 public patients accessed surgery, consultant appointments, endoscopies or diagnostic scans sooner as a direct result of NTPF commissioning.
As previously communicated to this committee, following allegations of non-compliance with NTPF insourcing processes, the NTPF conducted a comprehensive insourcing assurance review during May and June 2025. This review covered 38 public hospitals that had applied for and received approval to undertake NTPF-funded insourcing initiatives. Each hospital was formally requested to confirm that all NTPF-funded insourcing activity had been delivered in accordance with the signed MoU and the NTPF’s governance procedures. All 38 hospitals responded and the NTPF was satisfied with the responses of 35 out of 38 hospitals that they had delivered their insourcing initiatives in full compliance with their MoUs. There were three hospitals that breached the principles of the MoU but there are no ongoing concerns from an NTPF perspective in these cases.
Beaumont Hospital was excluded from the insourcing assurance review as all of its NTPF-funded insourcing initiatives had already been suspended on 11 April 2025 following reported concerns regarding compliance. The NTPF acknowledges that it continued to fund insourcing initiatives at Beaumont Hospital in the absence of the hospital returning a signed MoU. This action was taken as the previously signed MoU was still in place, the terms had not changed and in the interest of ensuring long-waiting patients received their much-needed care. The National Treatment Purchase Fund and Beaumont Hospital continue to work collaboratively to improve waiting times for patients. While insourcing has been temporarily paused, the NTPF remains actively engaged with Beaumont Hospital to provide outsourcing solutions for long-waiting patients. In addition, the NTPF undertakes administrative validation of waiting lists to ensure their accuracy and Beaumont Hospital remains fully engaged in the NTPF audit process. The NTPF is fully committed to maintaining this collaborative relationship and is pleased to continue working with the management team at Beaumont Hospital to support the effective management of patients and waiting lists.
The NTPF is continuing to strengthen its insourcing processes with the aim of improving access to care for patients. As part of this, the NTPF is introducing enhanced monthly tracking and monitoring of all insourcing activity in relation to waiting list volumes and wait times. This will support a more targeted approach, helping to ensure that patients are seen more quickly and that overall efficiency leads to shorter waiting times for treatment.
The NTPF welcomes the Minister and HSE’s commitment to driving greater productivity across our health service especially in light of the new public-only consultant contract. The executive and staff of the NTPF are ready and committed to working closely with the Department of Health and the new regional structures to deliver a more focused and collaborative approach to managing waiting lists, fully aligned with the ambitions and targets set out in Sláintecare.
John Brady (Wicklow, Sinn Fein)
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I thank Ms Brady. I now invite Ms Coyle to provide the opening statement on behalf of Beaumont Hospital.
Mr. Anne Coyle:
Good morning. I thank the committee for the opportunity to discuss Beaumont Hospital’s annual financial statements for 2023.
The last two years have seen significant change for Beaumont Hospital. A new board has been appointed with a strong focus on ensuring that appropriate governance processes are in place to support strategic and operational delivery. I was appointed as CEO just over a year ago and I have led the recruitment of almost the entire leadership team, filling positions that were either vacant or filled by staff in an interim capacity.
Beaumont is a complex model 4 hospital representing the largest catchment area in the entire country and it is growing. Our most recent data shows that our hospital is getting busier. Despite this growth, we have achieved measurable improvements in our patient flow and quality of patient care, which our key performance indicators illustrate. Patients and staff are front and centre in everything that we do and are at the core of our new 2025-30 hospital strategy, Building Excellence in Care, Together, which launched earlier this year.
The hospital has a very ambitious capital development plan, which is supported by the HSE. The eagerly anticipated cystic fibrosis building will open in quarter 4 of 2025 and represents a significant first step in our journey to improve our services for patients and staff. It is acknowledged that there is an ongoing need for infrastructural investment in Beaumont Hospital for us to continue to deliver access to safe, excellent care and improve service efficiency and productivity. We are working with colleagues in the HSE to advance refurbishment of our existing capital infrastructure and accelerate new capital developments.
In terms of other developments, I am pleased to announce the successful implementation of our Beaumont Hospital information system, BHIS, replacement project. Project Coral, our new clinical information system, went live in September 2025. The project represents one of the most transformational clinical system upgrades in the hospital’s history and was designed to modernise operations, enhance patient care and strengthen future readiness. It is a milestone achievement for our staff and our organisation. We are incredibly proud of what has been accomplished and are thankful to the HSE for supporting this critical infrastructural project.
While such achievements demonstrate progress in our management at the hospital, we are very much still in a transitionary phase of change and improvement. We acknowledge that there is still work to do to enhance our systems of governance as highlighted in our statement of internal controls for our annual financial statements 2023, AFS23, which we will detail today for the committee. Accordingly, I will draw the attention of the committee to AFS23 as I outline its key points. The board acknowledged in its statement of internal control that there was a risk that hospital performance on service delivery and budget control was challenged in 2023 against a backdrop of service pressures previously noted. Since 2023, the board and executive team have been working together to revise our governance processes. This has included external governance support and the establishment of reconstituted subcommittees, with new terms of reference and operational polices being implemented.
I will now address a few specific items, the first of which is non-compliant expenditure. In relation to non-compliant expenditure, the hospital provided a list of non-compliant expenditure to the secretariat of the Committee of Public Accounts in August. We are continually balancing the need for competitive tendering with the need to respond to immediate service continuity risks, which are under continuous oversight by the hospital. The reports on the level of expenditure where the related procurement complied with procurement rules showed that compliance levels increased from 91.8% by the end of 2023 to 93.3% by the end of 2024. We are very conscious of the need to make further improvements towards the achievement of full compliance and are focused on taking all necessary action to realise this.
In March 2025, the hospital made a self-disclosure to the NTPF regarding the possibility of non-compliance with the NTPF MoU within rheumatology outpatient clinics. The NTPF subsequently paused the funding of all NTPF initiatives provided by the hospital pending review. HSE internal audit undertook a fact-finding review that is now complete. Included in the findings was that Beaumont Hospital billed the NTPF for €25,000 in error for rheumatology waiting list services that had already been funded by the Health Service Executive. This amount has been reimbursed to the NTPF At all times, the hospital’s overriding focus was actively managing waiting lists for rheumatology during the review period to ensure waiting times were reduced and maintained. The report confirms that, throughout the period under review, NTPF funding enabled the delivery of around 1,700 rheumatology treatments, which contributed to these waiting list initiative results. Beaumont Hospital accepts the findings of the HSE internal audit report and is committed to implementing the recommendations made in relation to the hospital. Beaumont Hospital confirms no rheumatology consultant received any additional income or reimbursement related to treatment clinics billed by the NTPF. Beaumont Hospital and the NTPF continue to work collaboratively to improve waiting times for our patients.
The hospital, as a local, regional and national service provider, remains committed to strengthening clinical governance, patient safety and risk oversight, and ensuring that lessons from legal claims, Health Information and Quality Authority, HIQA inspections, and national patient surveys are embedded into governance processes.
I am available for any questions.
John Brady (Wicklow, Sinn Fein)
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I thank Ms Coyle. I advise everyone that we will suspend the meeting for about ten to 15 minutes at 12 o'clock. I will now open the floor to members. The lead speaker is Deputy Farrelly, who has 15 minutes. All other members will have ten minutes each. If time permits, there will be a second round of questioning.
Aidan Farrelly (Kildare North, Social Democrats)
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I thank everybody for being here this morning. It is lovely to see Ms Brady again and I thank her for her time. I also thank Ms Coyle and her team for being here. My first question is for Ms. Brady. Was the decision taken lightly to pause NTPF funding at Beaumont Hospital?
Ms Fiona Brady:
No, it was not. I met Ms Coyle and we had several conversations about this. We both decided that there would not be a knee-jerk reaction to how the disclosure was made. I agreed to go back to the NTPF and look at a year's invoices. We picked 2023 because that was post Covid and post cyberattack. It was the first full year back for commissioning and the health service was fully operational. We reviewed one year's invoices and I sent them to Ms Coyle. She reviewed them and then confirmed to us that, in fact, we had been invoiced for activity that went on in core hours. We did not take it lightly. We were concerned and we brought it to the board. We did continue outsourcing and we did continue the validation process as well. Insourcing is just a tiny part of what we do for Beaumont Hospital.
Aidan Farrelly (Kildare North, Social Democrats)
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Has the insourcing resumed? Is the NTPF satisfied now to go back and begin insourcing at Beaumont Hospital again?
Ms Fiona Brady:
As of today, it has not. The report is not long published. I have brought it to the board and the NTPF has received the assurances it needed to restart insourcing.
I have communicated with Ms Coyle earlier in the week that we will meet and begin the arrangements to restart insourcing. We will be doing it.
Aidan Farrelly (Kildare North, Social Democrats)
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What are the consequences for the other three hospitals that have been flagged as part of that 38-hospital review - Naas, Kerry and one in Dublin - arising from the fact they have not worked within the MOU? Have they been reinstated or will they be?
Ms Fiona Brady:
In relation to Kerry, we are not doing any commissioning with Kerry at all at the moment. That is their decision, their choice. They have not asked us for anything. They have completed the assurance review in St. Michael's. The initiative that had been ongoing had been completed by the time I did the assurance review. They have not looked for any funding at all, so there is nothing there. Naas have been fully engaged with us and I think the internal auditors from the HSE are in there doing a review at the moment, so we are awaiting the outcome of that.
Aidan Farrelly (Kildare North, Social Democrats)
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Does Ms Brady have a rough idea of the total amount that was misspent under the NTPF between the four hospitals, based on those reviews?
Aidan Farrelly (Kildare North, Social Democrats)
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How much has the NTPF recouped from misspent funds? I assume that if the officials do not have the first figure, they will not have the second figure, even for 2023.
Ms Fiona Brady:
The only money we have recouped so far has been from Beaumont Hospital. We have not looked for any of the funding from Naas hospital or from Kerry. It is public money. It is not our money, essentially. We are funded by the Department of Health. We have not looked for any money back from Kerry or from Naas.
Aidan Farrelly (Kildare North, Social Democrats)
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Does the NTPF intend to?
Aidan Farrelly (Kildare North, Social Democrats)
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That would strike me as interesting. If potentially funds have been spent and patients have had their services paid for twice, why would we not recoup that money?
Ms Fiona Brady:
They would not have been paid twice. We do not pay consultants. The issues that pertained to Naas and Kerry were that the package of money that we agreed for the initiatives was paid directly to the consultant. They were not paid twice, because it was all done outside of core hours so they had already done their HSE core activity. They were not paid twice. Essentially, our money did treat patients that were on a public waiting list.
Aidan Farrelly (Kildare North, Social Democrats)
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But they would have been treated otherwise. For Naas, for example, if I read the reporting right, the NTPF funding seems to have been spent during normal working hours, not outside them.
Aidan Farrelly (Kildare North, Social Democrats)
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They were potentially paid twice, if people are being paid to be there during normal working hours and then the service was being paid for under NTPF funding. My interpretation is that essentially they were being double-billed for something.
Aidan Farrelly (Kildare North, Social Democrats)
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Ms Brady just said it was not. That is my challenge. I am just trying to understand.
Aidan Farrelly (Kildare North, Social Democrats)
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I thank Ms Brady for her time. I also thank Ms Coyle for being here this morning. Could she outline how she and the board came to the realisation that something was wrong regarding the NTPF funding?
Ms Anne Coyle:
In March 2025, Beaumont Hospital brought a query to the attention of the NTPF. This arose through a clinical specialty meeting I had had with the rheumatologists in Beaumont Hospital. They raised the query regarding the reporting of activity that was funded by the NTPF. It was upon discussions of that situation that we raised the issue with the NTPF.
Aidan Farrelly (Kildare North, Social Democrats)
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The HSE then conducted an audit.
Aidan Farrelly (Kildare North, Social Democrats)
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Has that been published?
Ms Anne Coyle:
The fact-finding audit has been concluded. My understanding is that it will be released as part of the normal cycle by the HSE of its release of internal audit reports.
Aidan Farrelly (Kildare North, Social Democrats)
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Let us say for 2023, of the €11 million that the NTPF gave to Beaumont Hospital, are we saying that very strictly only €25,000 was misspent?
Ms Anne Coyle:
The figure of €25,000 relates to the period 2019. The fact-finding review the HSE internal audit undertook focused solely on rheumatology. One of the recommendations of the HSE fact-finding review is that Beaumont Hospital now continue that and look at a further range of specialties that were funded by the NTPF. That is a further eight specialties of which we will now undertake our own fact-finding review. The outcomes of that will be reported to the regional executive officer of HSE Dublin north east.
Aidan Farrelly (Kildare North, Social Democrats)
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Would Ms Coyle have any concerns that the issue could have been wider than just rheumatology?
Ms Anne Coyle:
It was the rheumatology issue that was raised. We have done a lot of work and participated and Mr. Hanlon, who is here today, did a lot of that work with HSE internal audit as part of the fact-finding review. We had another eight specialties. We will extend the review and replicate the exercise that was undertaken by the HSE internal audit ourselves.
Aidan Farrelly (Kildare North, Social Democrats)
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Was the HSE review just for 2019 or which years did it cover?
Aidan Farrelly (Kildare North, Social Democrats)
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The other eight departments will experience the same terms of reference timewise.
Aidan Farrelly (Kildare North, Social Democrats)
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So that is self-assessed. The hospital will do that, publish it and send it back.
Aidan Farrelly (Kildare North, Social Democrats)
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Were there recommendations from that HSE review other than broadening the scope of it?
Aidan Farrelly (Kildare North, Social Democrats)
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Was this review specific to Beaumont?
Aidan Farrelly (Kildare North, Social Democrats)
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What were the other recommendations?
Ms Anne Coyle:
I have shared today the recommendations that were specific to our hospital. On the funding we received, there was an overpayment to Beaumont Hospital and that funding has been returned. The audit to look at the wider specialties confirmed that there was not any double payment to any individual consultants. Those are by and large the main report and recommendations for us. Mr. Hanlon might have something further to add.
Aidan Farrelly (Kildare North, Social Democrats)
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Do we foresee a possibility that we will be back here in six months or a year when the full review has been done and that €25,000 has multiplied considerably? Is there a flaw in the MOU or in the way it is communicated to professionals? Where potentially is this process falling down such that funds can be misspent?
Ms Anne Coyle:
Before pre-empting the outcome of that, in relation to the rheumatology example, what happened there was an overlap in a consultant starting in post, so that was funded by the HSE and the money was covered for that period by the NTPF. That was an overlap of the two. We will look into all of the other specialties to ascertain. We will, as we have done to date, be upfront and honest with the findings and take the appropriate remedial action.
Aidan Farrelly (Kildare North, Social Democrats)
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I noted from the 2023 accounts that there were concerns with regard to members of the board changing quite quickly. There was board changeover.
Aidan Farrelly (Kildare North, Social Democrats)
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What impact did that have on the hospital in general?
Ms Anne Coyle:
The year 2023 predates me so I may defer to Mr. Sweeney to my left. Part of the board change covers the natural cycle of the public appointments process, so term of office. We will go through that cycle again when the current incumbents come to the end of that. It is a normal cycle of events. I will pass to Mr. Sweeney on any specific issues he may or may not have identified.
Mr. David Sweeney:
There was a level of churn in the hospital board over the last few years.
The board as a governance model continues to operate and function. I am told its meetings are within the code of the governance for public and State bodies. From a day-to-day perspective, the hospital continues to operate as normal. From an executive perspective, there was still very much a level of support provided by the board. I cannot identity any discern about change or impact. It was just a natural churn. We still maintained the structures within the board.
Aidan Farrelly (Kildare North, Social Democrats)
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Am I correct that three members joined and left the board within the same six- or eight-month period? That would not strike me as a natural churn.
Mr. David Sweeney:
The board composition is determined by nominations from various bodies, ministerial nominations and the local county council. The cycle of appointments gave rise to this simultaneously, but there was nothing within the turnover that I can point to that was out of the ordinary in terms of natural lapses of appointment times.
Aidan Farrelly (Kildare North, Social Democrats)
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There are significant IT works in various status of process and change, such as the BHIS system. Am I correct that that is finished and completeand award winning if my research is right?
Aidan Farrelly (Kildare North, Social Democrats)
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I congratulate Ms Coyle on that.
Significant IT projects are ongoing. There are potentially €128 million worth of claims outstanding and HIQA reports that identity concern about infrastructure, such as the status of the ED project or some of the other infrastructure. The nub of what I am trying to get at is that the finance, capital and IT committee seems to only have had a quorum to meet twice in 2023. Is there parallel between potentially an absence of governance and leadership in a year when we have seen so much spend? Do we have any cause for concern with regards to IT overspend or delays with projects? Have the issues of oversight, leadership and governance been addressed in those areas?
Ms Anne Coyle:
I thank the Deputy very much for his feedback on the BHIS programme and the replacement with Project Coral. On the oversight with the finance subcommittee, this has been a reconstituted committee. It has recently taken that responsibility around IT. It is just part of our governance infrastructure. We have recently strengthened our governance infrastructure, for example around capital. The infrastructure covers the capital developments that are planned, and we hope will be realised over the next few years. The board also receives those reports from the finance committee. The Deputy is right that it is a busy subcommittee but there are meetings, subcommittees and workstreams that feed into that.
On the budget for Project Coral, I will ask Mr. Hanlon whether that information is to hand on our performance on that.
Mr. Francis Hanlon:
There were two elements. There was a capital element and a revenue cost element. There was a capital allocation of €5.1 million and we spent €4.1 million to date, but there are additional works to happen in 2026. On the revenue side, there is a projected cost of €5.24 million. We received €660,000 in 2024. We have outstanding funding of €4.58 million, which is agreed with the HSE to fund in 2025. There were delays. It was nine months. The cost of that delay was €197,000 because we hired staff and the project had not begun yet.
Albert Dolan (Galway East, Fianna Fail)
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It is phenomenal to hear that the NTPF provided almost 500,000 treatments in the year alone. That is an incredible number. It is an incredible benefit to the people who are waiting on these waiting lists. When I think about consultants and the money they are earning, consultants deserve to be paid great amounts because they provide immense value. They should be compensated for incredible performance. Where consultants can clear a waiting list, they absolutely should be paid for that but my fear is that the NTPF could be incentivising consultants to delay. Does Ms Brady believe that consultants are incentivised to leave people on their waiting lists so that they get transferred to a NTPF list where they could subsequently benefit from same?
Ms Fiona Brady:
No, I do not believe that is true because the management of the waiting list lies with the acute hospitals. The management in the acute hospitals need to manage the wait times and volumes on their waiting lists. The NTPF only steps in at a certain stage. There is an expectation there for every manager within the hospital to have their own waiting list action plan. There is a national one, but each hospital have its own. I had one myself in Drogheda as well. If someone felt that a waiting list was falling behind a little, it is up to the manager to call in the consultants or the speciality team and have a word with them in relation to that. The NTPF steps in to assist, but the hospitals have to do their bit first.
Albert Dolan (Galway East, Fianna Fail)
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I have a concern because out of the purchase orders that the board has published for quarter 1 of 2025 and quarter 2 of 2025, the figure was €2.82 million for quarter 1 and €2.821 million again for quarter 2. It just seems like it is almost like a direct debt to the hospitals. It does not seem like it is related to the volume of work that is being done. Are any related party checks performed on whether a consultant is benefiting from an insourcing list?
Albert Dolan (Galway East, Fianna Fail)
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Does Beaumont Hospital perform any related party checks on its insourcing? For example, there is a consultant who is also a shareholder of a company, and that company is benefiting from NTPF. Have any consultants signed a document confirming they have no conflicts of interest?
Mr. David Sweeney:
On insourcing initiatives, the model that Beaumont has historically operated has been on the basis of self-sufficiency. We would hire a consultant on our payroll. They would work through waiting lists and our waiting list targets would be pursued. We would not have had in any point in time a double payment to consultants. The relationship between the hospital and those consultants is employer-employee. On the conflicts of interest with that insourcing model, there would not have been any conflicts of interest.
Albert Dolan (Galway East, Fianna Fail)
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Are there consultants working in Beaumont that do these clinics on a Saturday where they could take a huge number of patients off their own waiting list and clear it down? Does that happen?
Albert Dolan (Galway East, Fianna Fail)
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That is what is about to start. We are looking at the accounts and financial statements from the past. We have to learn from the past. My understanding is that if someone is on a waiting list for more than three months or six months, they can be referred to the NTPF. There is a portal to do that. Are there consultants profiting from NTPF because they have people on a waiting list?
Albert Dolan (Galway East, Fianna Fail)
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Mr. Sweeney can tell me.
Mr. David Sweeney:
The outsourcing model is not managed independently by the hospital. We have a list of patients. They go through the central system and they are accommodated in external hospitals. A lot of the external private hospitals will be staffed by public consultants because there is a mix of public and private-----
Albert Dolan (Galway East, Fianna Fail)
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A Beaumont Hospital consultant on their public contract has his or her waiting list. Somebody who is on his or her waiting list in the public hospital can end up on his or her private waiting list in another private hospital, and that can be funded by the NTPF.
Albert Dolan (Galway East, Fianna Fail)
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That is perfect and I appreciate that clarity. What about from an insourcing perspective?
Albert Dolan (Galway East, Fianna Fail)
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On the related party checks, does the hospital check that a consultant on its books does not end up treating people under a different company's heading? Are there are related party checks? That is what I want to know.
Albert Dolan (Galway East, Fianna Fail)
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What compliance rate is there with those? Is there confirmation that every consultant has completed their obligations?
Albert Dolan (Galway East, Fianna Fail)
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So 25% of the consultants are ignoring their SIPO obligations?
Albert Dolan (Galway East, Fianna Fail)
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If 25% of TDs did not return their declarations of interest, we would be dragged over hot coals. If 25% of the consultants are not answering it, that points to the people who are probably benefiting from insourcing or other things like that. There is a body of work to do there. If consultants are not complying with their SIPO obligations, that is really serious - 25% is a big proportion for any hospital. I have no doubt that is not just Beaumont. I would say other hospitals are similar as well. Does the NTPF check whether consultants are compliant with their SIPO obligations?
Albert Dolan (Galway East, Fianna Fail)
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Okay. When Ms Brady was in Drogheda, what was her experience?
Albert Dolan (Galway East, Fianna Fail)
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On the review, the review was carried out. Was a separate review done for Beaumont? It was said that the review that was carried out on the insourcing captured every hospital except Beaumont. Why would Beaumont be left out if it was known it was the one that had the problem?
Albert Dolan (Galway East, Fianna Fail)
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Who made the decision to leave Beaumont out of a review of the entire insourcing system, given that it was the one the public knew had the problem with insourcing?
Albert Dolan (Galway East, Fianna Fail)
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That is awfully convenient, is it not?
Albert Dolan (Galway East, Fianna Fail)
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It will get a separate review now?
Albert Dolan (Galway East, Fianna Fail)
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Okay. I am conscious of time. I apologise to the representatives from Beaumont Hospital. I left them out of my email list and I did not write to them to check whether the hospital was compliant with its purchase order obligations. Does it publish its purchase orders on its website?
Mr. Francis Hanlon:
I am aware of the work the Deputy is undertaking. I have started the work to try to summarise the purchase orders so that we can publish them. However, just to reassure the Deputy, we publish our tenders on eTenders and they are readily available. In 2023, we published 37 tenders, and in 2024 31 tenders, on eTenders, which is far above our peers in model 4 hospitals.
Albert Dolan (Galway East, Fianna Fail)
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I appreciate that. Whenever the hospital publishes its purchase orders online, I ask its representatives to please write to me because we will look to include it in the tracker. I appreciate that.
Albert Dolan (Galway East, Fianna Fail)
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On data quality from the NTPF, I have multiple prompt payments reports from the hospital's finance department. One has a labelling error, the files in another do not agree with the Department of Health's version of the file and there is another where the total sum does not agree with that of the Department of Health. An example I found quite concerning was that quarter 4 of 2019 and quarter 1 of 2021 had the exact same number of payments. There were 8,283 payments in both of those quarters and I find it incredible that two quarters have the exact same number of payments. There is no other quarter that is anywhere close. It might be a coincidence but it looked like it must have been an error. I find it hard to believe it was the exact same number. The chances of that are slim to none.
Albert Dolan (Galway East, Fianna Fail)
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Could I get a comment on the data quality and the reports? There are a lot of errors and it is not an isolated incident.
Catherine Ardagh (Dublin South Central, Fianna Fail)
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I thank everyone for coming in today. I will look at the 2023 NTPF funding. A lot of people watching the meeting from home will be trying to figure out what insourcing and outsourcing is. I ask the witnesses to break down how much of the 2023 funding was for insourcing and how much was for outsourcing.
Catherine Ardagh (Dublin South Central, Fianna Fail)
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No, I was asking about Beaumont. It was stated that in 2023 Beaumont received €11.4 million from the NTPF. What percentage of that was insourcing and what percentage was outsourcing?
Catherine Ardagh (Dublin South Central, Fianna Fail)
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This is all insourcing.
Catherine Ardagh (Dublin South Central, Fianna Fail)
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That €11.4 million is all insourcing.
Catherine Ardagh (Dublin South Central, Fianna Fail)
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I know my colleague Deputy Dolan spoke about how it is actually patients who are benefiting from this. It is working really well in the majority of hospitals. Mr. Flood outlined that in 35 out of 38 hospitals around the country, it works perfectly. Obviously, there are issues and with every scheme in the country, someone is able to figure out a way to contravene it or go against what it is meant to be used for. Can Mr. Flood give me a clinical breakdown of what it was used for in 2023 and in what departments? How many endoscopies or other procedures were there? Can he provide even a generalisation of on what it was spent?
Catherine Ardagh (Dublin South Central, Fianna Fail)
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It says here that in 2022 the amount spent on the NTPF was €6.6 million. Which department had the biggest increase? Where did the extra €5 million go?
Catherine Ardagh (Dublin South Central, Fianna Fail)
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I am trying to figure out where the bump was. It was a significant bump, with the amount spent on insourcing increasing from €6.6 million to €11.4 million. I am trying to figure out if there was one sector that just decided, "This is great, we will capitalise on it", and was that the sector where we saw issues with governance?
Catherine Ardagh (Dublin South Central, Fianna Fail)
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I thank Mr. Hanlon. My next question might be for Ms Coyle as it is about the total expenditure in the hospital. Obviously, it is a fantastic hospital. It is huge. It does amazing work, especially for the elderly and those with brain injuries. It has a great reputation across the world. At the moment, it seems to be running a deficit. Can Ms Coyle tell me what the situation is? How will she bring that under control? What steps are being taken to ensure the deficit does not increase?
Catherine Ardagh (Dublin South Central, Fianna Fail)
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There was a deficit in 2023.
Obviously, it looked like it was continuing until 2024. Is a further deficit anticipated this year?
Mr. Francis Hanlon:
I can speak to 2025. I joined Beaumont Hospital in April 2025. We have put together a non-patient-facing cost containment plan of €6 million and we are working through that. We have a projected deficit of €20 million and we are working with the HSE to try to resolve that issue. An expenditure limit for 2025 has been set and we are projected to deliver on that.
Catherine Ardagh (Dublin South Central, Fianna Fail)
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I am going back to insourcing. Sorry, I do not mean to go back to it, but it was mentioned that insourcing will be started again. Why did it take so long to do that?
Catherine Ardagh (Dublin South Central, Fianna Fail)
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Yes. Why is it taking so long to reinstate the insourcing?
Ms Fiona Brady:
We had to wait for the report from the internal auditors in the HSE, which is only just complete.
Catherine Ardagh (Dublin South Central, Fianna Fail)
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Okay. That is the only reason. How long was it stalled for?
Catherine Ardagh (Dublin South Central, Fianna Fail)
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Deputy Farrelly mentioned issues regarding the board. In 2023, there were only two board meetings, which seems quite peculiar. Does Ms Coyle have any comment on that?
Catherine Ardagh (Dublin South Central, Fianna Fail)
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I understand there were two formal board meetings. Maybe there were meetings without sufficient quorum that were not able to be recorded as formal meetings.
Catherine Ardagh (Dublin South Central, Fianna Fail)
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What is the current make-up of the board? Is there a quorum? Is the board able to have sufficient meetings to ensure proper governance?
Catherine Ardagh (Dublin South Central, Fianna Fail)
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The board meets twice a month.
Catherine Ardagh (Dublin South Central, Fianna Fail)
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So six board meetings per year.
Catherine Ardagh (Dublin South Central, Fianna Fail)
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Okay. Two meetings in 2023 seem quite sparse, from a governance point of view.
Catherine Ardagh (Dublin South Central, Fianna Fail)
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I apologise; Mr. Sweeney is correct. Generally, I have a small question on a clinical matter, namely, the lung cancer screening pilot project. It is something I am interested in. How is that going? Are there plans to make it more permanent and resource it properly? This question is probably for Ms Coyle.
Ms Anne Coyle:
This is a really exciting development. It was launched earlier this year, in February. The funding was received through the cancer charity. It is a lung screening initiative that is in place in other countries. It is now about testing this as a principle. It is a research programme delivered in partnership with the GAA. It has exceeded the expectations in terms of the uptake and meeting the anticipated numbers that were going through it. As it is a research project and programme, it is really about that proof of concept with the intent to demonstrate the efficacy to mainstream that work.
Catherine Ardagh (Dublin South Central, Fianna Fail)
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Is there an intention to roll it out on a wider basis?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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I welcome everyone here today. I have a few questions which I would like to get down to the nitty-gritty on. My first question relates to consultants. When consultants receive a contract from the HSE, are they given a specific number of hours they have to work every week?
Ms Anne Coyle:
Mr. Sweeney is better placed to answer that question in his role from a HR point of view. There are different types of consultant contracts. The most recent consultant contract is the public-only consultant contract in 2023. All new consultants who join the HSE and Beaumont Hospital will join us on the public-only contract. Currently in Beaumont Hospital, there is an 81% uptake among our consultants of the public-only contract. Some people have other contract types, and they can choose to either opt in or to retain their existing contract. A number of our consultants have chosen to do so.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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In the public-only contract, what are we contracting consultants for? Are they contracted for a specific number of hours per week? If I could just get a yes-no answer.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Okay. Consultants come into our hospitals run by the HSE. Under that contract, are they monitored to see whether those hours have actually been worked and the number of patients seen during those hours?
Mr. David Sweeney:
As part of the application process to either replace or generate a new consultant post, there is a work practice plan established. That is worked through by the relevant department or sub-speciality and hospital management to advance. That will set out a level of commitment within the weekly workload and weekly working hours, which is a balance between clinical activity, such as outpatients, theatres, endoscopy procedures or whatever the speciality is, and the administrative element in terms of consults, rounding, taking chart reports and reporting on-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Has a review ever been carried out of the hours they are paid to do compared with the hours they actually do? Has there ever been a review of that?
Mr. David Sweeney:
The activity levels within the hospital are self-explanatory from their own perspective in demonstrating that activity is increasing. We do not swipe all staff in and out on a daily basis, no more than my role or other executives’ roles. We are satisfied in terms of day-to-day operations that consultants are delivering-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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There are long waiting lists for people to see consultants but Mr. Sweeney is satisfied that consultants are doing their work.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Okay. Mr. Sweeney mentioned the swiping in and out. There was a documentary a couple of years ago relating to consultants who just swiped into work and then went away off to their private clinics. Has that been reviewed or has any work been done to ensure that is not still happening?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Has that ever been checked in Beaumont Hospital?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Okay. With regard to the private sector and the NTPF, I just want to get down to the nitty-gritty on that. Can Ms Brady explain how someone is referred to the NTPF process? How does someone actually get onto that process? If there is a long waiting list in the hospital, how is the validity of someone getting from the long waiting list in the hospital to the NTPF programme assessed? How does someone get up the ladder to get to that stage?
Ms Bernadette Weir:
To take a patient who is waiting in Beaumont Hospital for a cataract operation as an example, we go out to tender and procure cataract services. We know there are long waiting lists for such services. We look at the all the long-waiting patients across all of the hospitals and the capacity available to us in the private sector. We identify the long-waiting hospitals – Beaumont Hospital in this example - and we take, say, the 50 longest-waiting cataract patients. We prepare a file. It is on our system. We tell the hospital that we have identified these 50 long-waiting patients and there is local capacity available for them in the private system. We ask the hospital to check whether these people are clinically suitable to go across, because some are and others are not. For those who are suitable, we ask the hospital to contact them and offer, for example, treatment in the local private hospital. As soon as they accept, our system is updated and we notify the private hospital to expect a file from Beaumont Hospital.
It will transfer that file and the private hospital phones the patient, arranges a suitable time for him or her to come in from a pre-op operation and, if he or she passes that treatment, for the surgery.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Going back to the consultant, is he pushing his waiting list? With the people who have been taken off that list by the NTPF, is his or her list going down?
Ms Bernadette Weir:
What would happen then, and Beaumont Hospital can talk to this, is that the patient is discharged. That paperwork comes through to us and obviously we pay for it. We can also see in our system whether or not that patient has removed from the waiting list, because that patient is no longer waiting for that particular surgery in the hospital.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Regarding the consultants, there has been no review of their work or how much they have to do. Have their waiting lists gone down due to the NTPF or due to the work they are doing?
Mr. David Sweeney:
I refer to the fact that on a monthly basis, we have performance reports relating to all subspecialties and activity demonstrates a continuous increase. It is important to note that when I say the hospital is satisfied that consultants have delivered on their commitment, they are actually delivering over their commitment in many cases.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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How come the waiting lists are so long, then? It is extraordinary. They are very lengthy and some people wait for years to get an appointment. It hits me as quite extraordinary. I would like to deal with another area, that of the fair deal scheme. Could the witnesses bring me through the process of how fair deal works?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Is that more expensive for a public patient than a private patient?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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The NTPF does not deal with-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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The NTPF used to deal with public.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Are additional charges placed on families? How does the NTPF decide on the price of a nursing home? Are they all the same price?
Mr. Seán Flood:
No, they are not. We do everything on an evidence-based basis. We have all this detail on our website for anybody who is interested. We operate through four criteria. When we engage with a nursing home, in the first instance we send out a renewal pack and the home completes its operational, financial, staffing levels and all that kind of data. There will then be questions seeking more information. Then we apply our four criteria. These are the price previously charged, costs recently and prudently incurred, the county average and the budgetary constraints of the State. We deal with nursing homes on an individual basis and we apply the same criteria consistently and fairly to each individual nursing home.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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That is okay. That finishes my questions on the fair deal scheme. I want to go back to consultants. I have heard that some consultants charge cash prices when people go into their clinics. Why would that happen? With Revenue and everything else, how can a consultant be allowed to ask for cash for appointments?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Okay. It does not happen in Beaumont Hospital. Can the witnesses verify that? Have they ever put out a questionnaire to their consultants about whether that happens? Do they know if it happens in consultants' private clinics?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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I have one more question for Beaumont Hospital. I hear that the scanners in Beaumont Hospital quite often break down and it has to outsource all its scans to Allianz Medical in Smithfield. Why would that happen? Why are scanners not working in our hospitals under the HSE such that it has to outsource to a private body? How long has that been ongoing?
Ms Anne Coyle:
There are no long-standing issues with our scanners or diagnostic equipment. We will have a new emergency department CT scanner which will open later this year. The demand for diagnostics and scans such as MRI, CT and ultrasound has increased year on year. This year, we are predicting an 11% increase on last year's demand for diagnostics.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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If Beaumont Hospital knows that it will be 11% up, would it not purchase another scanner instead of outsourcing to a private body?
Ms Anne Coyle:
That is a fair point and, as part of the work around 5 over 7 and the implementation of the public-only contract, we are looking at ways in which we can extend service. We offer and have clinics into the evening and clinics available on the weekend, but the demand continues to exceed the capacity.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Could the witnesses furnish me with information on how many scans Beaumont Hospital is outsourcing to private clinics?
Mr. Francis Hanlon:
To address the machine itself, we received funding from the HSE under the national equipment replacement programme. In 2025, we received €5 million for various hospital equipment that needs to be replaced. We have a good relationship with the HSE to help us replace equipment that breaks down.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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The hospital still does not have the equipment. It has the money but it never-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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So the hospital is replacing the equipment but is still outsourcing-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Why is Beaumont Hospital still outsourcing?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Could I get, in tabular form, how much Beaumont Hospital is outsourcing and how much that is costing the taxpayer? I thank the witnesses.
Séamus McGrath (Cork South-Central, Fianna Fail)
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I thank everybody for being here. I will start with the NTPF if I may. I am trying to fully understand the operation of the insourcing and how that works in reality. In her opening statement, Ms Brady referred to it as funding provided directly to public hospitals to deliver additional treatment or outpatient consultations beyond their core HSE-funded activity. What is the definition of a core funded activity in essence?
Ms Fiona Brady:
I will put my other hat on in Drogheda. Ms Coyle and Mr. Sweeney mentioned consultant contracts and work schedules earlier. All staff, particularly consultants who we are talking about here, have to sign a work schedule of what they are planning to do within core activity on a weekly basis in the acute hospital service. They will typically have two outpatient clinics, an on-call, a post-call and their specialty rounds. When those 37 hours are complete and they have completed all of their clinics, that typically means they have fulfilled their core activity hours.
Séamus McGrath (Cork South-Central, Fianna Fail)
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Is there a facility for them to do more hours under the public system? In other words, have they overtime options under the public system? That is not in the insourcing system, but working within the core funding system.
Séamus McGrath (Cork South-Central, Fianna Fail)
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The premium for that overtime would not be as much as what they would get from insourcing additional hours. Is that fair to say?
Séamus McGrath (Cork South-Central, Fianna Fail)
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Yesterday, the HSE chief said there is a disincentive to do additional hours under the core funding model. If they do additional hours beyond their 37, they get additional payment and it is at a premium, but it is quite clear to me that they are better using their time, from a financial point of view, on the insourcing options.
Séamus McGrath (Cork South-Central, Fianna Fail)
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I thought Mr. Sweeney said they did.
Mr. David Sweeney:
To clarify, because there may be a level of confusion, the consultant contract allows for a 37-hour week. Over and above that, there is an on-call provision, but consultants will routinely work in excess of their 37 hours without any recompense. Regarding the NTPF funding, it is cheaper to be self-sufficient on an insourcing model as opposed to outsourcing.
Séamus McGrath (Cork South-Central, Fianna Fail)
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I understand that but what I am getting at is whether the core funding system allows consultants working in the core funding model of 37 hours-plus to do extra hours to try to clear patient backlogs. My point is that they are not going to do that if they can get funded through the insourcing model, which is more lucrative for them. That is the key point. There is a disincentive for them to do additional work on the public waiting lists under the core funding system. This is exactly what the HSE report seems to suggest, that it is a disincentive, which is why the HSE chief is suggesting that insourcing should be phased out by the summer of next year.
Ms Fiona Brady:
To provide clarity on that, the insourcing that Mr. Gloster referred to was the insourcing with the use of third-party providers. Normal payroll insourcing, which is what Mr. Sweeney is talking about, which is overtime and agency, is still going to be permitted in relation to insourcing. It is the insourcing with third-party providers that Mr. Gloster is looking to end.
Séamus McGrath (Cork South-Central, Fianna Fail)
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To clarify, is that for third-party providers within the public hospital setting?
Séamus McGrath (Cork South-Central, Fianna Fail)
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It can happen.
Mr. David Sweeney:
It may make sense to do that or operate on that basis, particularly from a continuity of care perspective. It is a model that is established. It is not specific to Beaumont Hospital. It is national and has been acknowledged by the CEO of the HSE in recent weeks here. It is acknowledged that a strengthened and more robust framework needs to be managed through the regions going forward and will be in place as soon as next year.
Séamus McGrath (Cork South-Central, Fianna Fail)
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I am caught for time. It is hard to get away from the fact that this whole structure is, effectively, robbing Peter to pay Paul. It has been said that 30% of NTPF funding is used for insourcing.
Séamus McGrath (Cork South-Central, Fianna Fail)
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On the recommendation to phase out insourcing, what are the implications for the delivery of services? It seems a large portion of funding is for insourcing. I know that only a certain element of insourcing is to be phased out but I presume it will still have a significant impact on patient care and treatments and procedures.
Ms Fiona Brady:
We are still unclear as to how it is going to impact the waiting list but we will still be offering insourcing in the normal overtime and agency, in the way that we have always done, to the hospitals. I cannot give the Deputy an answer to what the uptake will be like. There has been a lot in the media about insourcing. If I can just say, it does so much good as well. The patients are being seen in their own hospital, following all the principles of Sláintecare. There has been huge amount of-----
Séamus McGrath (Cork South-Central, Fianna Fail)
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I understand that but there is, for the want of a better word, a whiff around it in terms of conflicts of interest and the disincentive to do additional work over and above the normal within the core funding system. A lot of conflicts arise that need to be thrashed out further, to be perfectly honest. Does Ms Brady accept the HSE report and the HSE chief executive's views on phasing it out? Does she accept that is the right move?
Séamus McGrath (Cork South-Central, Fianna Fail)
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On the NTPF review of 38 entities, which raised issues with three of those entities, from reading the report, it seems as if it was almost a self-declaration process. The NTPF asked the hospitals whether they were compliant and so on. Did the NTPF just accept their responses on that?
Ms Fiona Brady:
It was a self-declaration. That is what happened in relation to the breaches as well. They did self-declare. We are asking the hospitals if they can tell us that they are applying the three main principles of the MOU in relation to insourcing. The NTPF is a small organisation with fewer than 100 staff. We simply cannot be on every site. There is an element of trust here when we agree an insourcing initiative.
Séamus McGrath (Cork South-Central, Fianna Fail)
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It seems there was a large element of trust. It was effectively based on self-declaration.
Séamus McGrath (Cork South-Central, Fianna Fail)
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Does the NTPF accept that it continued to fund insourcing at Beaumont Hospital in the absence of a signed MOU? What level of funding was given out during that period in the absence of a signed MOU?
Séamus McGrath (Cork South-Central, Fianna Fail)
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Was the MOU in place throughout that period?
Séamus McGrath (Cork South-Central, Fianna Fail)
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I understand that but the MOU sounds like a fairly essential control measure. I get the trust element - we all have to have trust in life - but it is a lot of money and-----
Mr. Seán Flood:
I am sorry to cut across the Deputy but the hospitals did provide evidence. For example, they would submit an invoice on hospital headed paper. If it was for an inpatient day case or a GI procedure, there would be a discharge summary signed by a consultant. If it was for outpatient appointments, there would be an attendance sheet. They would provide the evidence. As Ms Brady said earlier, there is an element of trust. For example, we do not have the ability to go in and check consultant contracts or check their scheduling. We are a publicly funded body giving public funds to another publicly funded body. There has to be that element of trust. We have stopped invoices and we have queried invoices.
Séamus McGrath (Cork South-Central, Fianna Fail)
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I understand that but we are here because the trust broke down somewhere and issues arose.
Séamus McGrath (Cork South-Central, Fianna Fail)
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It seems an important factor. I am caught for time but I will turn to the Beaumont Hospital board briefly. Do they accept everything the HSE report said? There no dispute between the board and those reports in terms of the findings. Does the board accept everything?
Séamus McGrath (Cork South-Central, Fianna Fail)
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Is it implementing the measures and the recommendations?
Séamus McGrath (Cork South-Central, Fianna Fail)
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Are they all in place at this stage?
Séamus McGrath (Cork South-Central, Fianna Fail)
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The insourcing was paused from earlier this year. What impact has this had on the patient lists and waiting lists and so on in Beaumont Hospital?
Ms Anne Coyle:
On the reduction in Beaumont Hospital's NTPF funding, we went into 2025 with an intention to make a deliberate shift in our waiting list strategy. Our priority in 2025 was to reduce our reliance on externally funded initiatives and to focus on building sustainable capacity within our own services and across our regional networks. With our dermatology waiting lists, for example, we are doing a lot of work with Connolly Hospital, and we are doing gynaecology work with the Rotunda Hospital. We have seen productivity gains through a reduction in our did not attend, DNA, rates. Although we have seen quite a significant increase in referrals and demand for our services, for a similar period this year, we are seeing quite a significant increase in our referral volume through our own internal clinics.
Séamus McGrath (Cork South-Central, Fianna Fail)
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I thank the witnesses.
Joe Neville (Kildare North, Fine Gael)
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I apologise for stepping out as I had to speak in the Dáil Chamber. I apologise too if I cover again any area.
I thank the witnesses for coming here today. I am aware that the NTPF was before the committee recently, as were the Beaumont Hospital witnesses. I totally get it that it is not always easy to come in before the Committee of Public Accounts. We ask questions because we want to know the answers. I have a list of questions and I will do my best to ask them in a straightforward manner. Members of my family have been in Beaumont Hospital and were treated exceptionally. They have been dealt with really well and I want to say "Thank you" for that. My questions are from a compliance perspective, notwithstanding all the amazing work that is done every day for the people the hospital treats.
I will focus my questions on some of the non-core funding. The HSE would allocate the amounts per year. Is it €530 million?
Joe Neville (Kildare North, Fine Gael)
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Fine, it was increased. I was looking at the 2023 accounts.
What would the typical level of NTPF funding be annually?
Joe Neville (Kildare North, Fine Gael)
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Was there a large increase in 2022?
Joe Neville (Kildare North, Fine Gael)
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That is fine.
Separately, where do we anticipate the deficit being in 2025?
Joe Neville (Kildare North, Fine Gael)
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That will be an extra €20 million the hospital will be looking for at the end of the year. Is that correct?
Joe Neville (Kildare North, Fine Gael)
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What would that be like?
Mr. Francis Hanlon:
An example of that would be where we met with our dialysis taxi company. It brings patients to our dialysis centres in Dublin north east. We met with the taxi companies and asked them to try to adjust their route-planning and their prices to try to help us with our cost containment. That has been very effective. In six months we have saved €120,000 just by negotiating with those companies that help us deliver patients to our dialysis centres.
Joe Neville (Kildare North, Fine Gael)
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That is the dialysis centre in the hospital itself.
Joe Neville (Kildare North, Fine Gael)
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That is what I was wondering from the way Mr. Hanlon said that. Where are the other centres?
Joe Neville (Kildare North, Fine Gael)
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Would people get taxis from-----
Joe Neville (Kildare North, Fine Gael)
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Okay, so they would get taxis-----
Joe Neville (Kildare North, Fine Gael)
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How much would the hospital spend, roughly, on taxis a year if its saving is €120,000, just out of curiosity?
Joe Neville (Kildare North, Fine Gael)
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Is the €120,000 10% or so? Is the total about €1 million, does Mr. Hanlon think, or-----
Joe Neville (Kildare North, Fine Gael)
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I do not want to put him on the spot. We do not want to risk getting it wrong and there being a headline out of it.
As regards the insourcing, I know Deputy Ardagh touched on it as well, but there were obviously concerns about the insourcing in the hospital. We are happy with all those that have been dealt with. I know we touched on this earlier. We are all happy that they have been all dealt with. What way will it be now? What type of arrangements will be in place now with insourcing, and how will that work?
Joe Neville (Kildare North, Fine Gael)
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What are they, just out of curiosity?
Joe Neville (Kildare North, Fine Gael)
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How many people would have been involved in those? How many consultants?
Joe Neville (Kildare North, Fine Gael)
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How many people are we talking about here?
Joe Neville (Kildare North, Fine Gael)
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So two or three individuals.
Joe Neville (Kildare North, Fine Gael)
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We are all trying to learn, and there is no way we are going to be fully proficient in this, so some of the questions might seem quite basic, but how are the contracts awarded for insourcing, or how do the witnesses plan that they would be when they restart?
Joe Neville (Kildare North, Fine Gael)
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That is a more general question to the NTPF.
Joe Neville (Kildare North, Fine Gael)
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That funding would go to the hospitals, would it?
Ms Rebecca Maher:
Yes. We agree to fund successful initiatives once we have conducted a fairly substantial review of what is submitted to us. The initiatives we have we keep on a database, so we have a very in-depth knowledge of the marginal costs associated with running an insourcing initiative, dependent on specialty, geographic area and the type of hospital, be it a model 3 or a model 4. We make a qualified decision based on all that information as to whether or not to agree funding.
Joe Neville (Kildare North, Fine Gael)
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Does the NTPF set out a rough amount for the budget then? It is almost like a budget for the year ahead, is it?
Ms Bernadette Weir:
Yes. They agree a cost per patient so that they will see additional outpatients at a cost of, for example, €200 per patient, which will be the cost of running the clinic. There might be a diagnostic involved, the patient will be brought in, there might be a porter or a nurse on site, there might be a consultant, and the cost of an X-ray might need to be covered. We would agree then with the public hospital that we will fund it for an additional €300 - for example, orthopaedic outpatient appointments at a cost of €200 per patient for the year ahead. It is then for the public hospital to administer those clinics and they will invoice us for those. We will compare then when the invoices come in and we will check that those patients were long-waiting patients on a public waiting list in that hospital.
Joe Neville (Kildare North, Fine Gael)
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With that, is there risk of conflict where there is someone who could be doing this anyway as part of their job but then does it insourced separately and they delay things?
Joe Neville (Kildare North, Fine Gael)
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But where is the risk of conflict?
Ms Bernadette Weir:
It is the hospital manager, or going forward it will be the REO, who has identified a gap in their hospital such that they cannot treat all their patients in the time in which they would wish to do so and they have identified resources at a particular cost where they could see extra patients there.
Joe Neville (Kildare North, Fine Gael)
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In fairness, Ms Weir has answered that question, so I go back to Beaumont in this case specifically. It could be the same for everyone else, every other hospital. What governance and oversight arrangements can Beaumont put in place to ensure that that does not happen, or are the consultants almost acting autonomously in a situation like that?
Ms Anne Coyle:
No, the consultants are not acting autonomously. It is with a focus on outcomes and a focus on managing our waiting lists. There are policies and oversight arrangements in place. They are agreed and scheduled, and we do it as outlined by the NTPF. In terms of the commencement, we agree the terms with which the initiative will be undertaken, the method of delivery, the price and the volume and then, when that activity has been completed, the public hospital invoices the NTPF to secure the funds. However, we are moving into a different era. We are moving to the removal of the insourcing model. Our public hospitals are removing that. That has necessitated us to look differently, to look at ways in which we can improve our productivity, ways in which we can-----
Joe Neville (Kildare North, Fine Gael)
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Monitor performance, I presume, too, because it is performance assessment-based as well, is it-----
Ms Anne Coyle:
It is a matter of monitoring those. We are seeing more patients through our inpatient activity, our day-case activity and our outpatient activity in 2025 compared with 2023. We have three centralised waiting lists, the productivity initiatives we are doing in our theatre, our theatre utilisation, maximising the use of outpatients, as I have said, and we are working in collaboration with other hospitals as part of the network within the Dublin north-east region. We work with the Rotunda on some of those waits and we work, for example, in the management of our dermatology clinics, with other hospitals within the Dublin north-east region. Really, it is in all our best interest to deliver improved access for our patients and maximise the resources we have to hand, our theatres, our outpatients and so on. That is the work we have been really turning our attention to.
Joe Neville (Kildare North, Fine Gael)
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The issue was that that did not happen in the past.
Joe Neville (Kildare North, Fine Gael)
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I know I am over time but I just make the point that the reason we are here is that it did not happen in the past.
Paul McAuliffe (Dublin North-West, Fianna Fail)
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I thank our witnesses for being here today. We thank them for the good work they do. Unfortunately, in these hearings we often concentrate on areas where mistakes or errors are made or where improvements are needed. That sometimes overshadows the good work done.
I wish to discuss with the NTPF representatives the suggestion that there is a perverse incentive for public work or work that should otherwise be done under public contract to be manipulated or in some way there is a failure to deliver in order for additional income to be received by the hospital or individual consultant through the NTPF. That suggestion has been put out there and in blunt terms, I ask the witnesses to address that issue and what controls might be in place.
Ms Fiona Brady:
I thank the Deputy. On the perverse incentives that have been mentioned on numerous occasions regarding insourcing with third party providers - and it is not the normal payroll insourcing - from an NTPF perspective we have no oversight of consultant contracts or work schedules. That lies with hospital management. It lay with me when I was in Our Lady of Lourdes Hospital. If any consultant came to me with an initiative they wanted to apply to the NTPF for, I would review all the consultant contracts to ensure they had carried out all core activity, and everything else that could be done within the capacity of the organisation had been maxed out.
Paul McAuliffe (Dublin North-West, Fianna Fail)
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Does Ms Brady accept that for a hospital that wanted to secure additional funding and reduce its waiting lists, there could be an incentive not to carry out that check?
Paul McAuliffe (Dublin North-West, Fianna Fail)
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Ultimately, this is an opportunity for hospitals to secure additional funding and reduce waiting lists.
Ms Fiona Brady:
I accept what the Deputy is saying. Incentives lie with the third-party providers where HSE staff set up their own companies so as they could-----
Paul McAuliffe (Dublin North-West, Fianna Fail)
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Whether it was through their own companies or internally, I am asking, as the body responsible for reducing waiting lists and providing funding to do that by providing additional capacity, what steps the NTP has taken to ensure this is not used to provide additional funding and resources without the core and basic services being provided?
Ms Rebecca Maher:
When we receive submissions for funding, the referring hospital has to explain to us how it proposes to deliver the additional activity. Part of that is it has to clearly identify to us how it is additional to the core activity. As Ms Brady previously mentioned, the majority of our insourcing funding is for what we call payroll insourcing, whereby consultants and other staff work overtime hours either in twilight clinics or at the weekends to provide additional capacity. How we know that happens in these outside times is through the dates that are returned to us on the invoices, which are checked as part of our invoicing process.
Paul McAuliffe (Dublin North-West, Fianna Fail)
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Is Ms Maher saying that because of the dates on the invoicing which ensures-----
Paul McAuliffe (Dublin North-West, Fianna Fail)
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What security does it give that it is not for work that should otherwise be carried out in the context of core activity?
Mr. Seán Flood:
The hospital has to provide evidence. It has to comply with our MOU. My colleague Ms Maher talked about the approval stage for the initiative in question and the checks that are carried out. When it comes to us, again, the hospital has to provide an invoice on headed paper. It would not be invoicing for core activity. The very fact that it invoices us is evidence-----
Paul McAuliffe (Dublin North-West, Fianna Fail)
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What level of detail is on the invoice to ensure it is not core activity?
Paul McAuliffe (Dublin North-West, Fianna Fail)
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That is useful. The NTPF checks that the person is on the waiting list. Does it check how long the person has been on the waiting list?
Paul McAuliffe (Dublin North-West, Fianna Fail)
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Does the NTPF check whether there are disproportionate waiting times for particular cohorts of patients or for particular procedures in one hospital over another?
Paul McAuliffe (Dublin North-West, Fianna Fail)
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What I am trying to get at is in a situation involving three hospitals, for example, does the NTPF looking for trends where core work may be being done outside of it? I am trying to get to the bottom of that. There is clearly an issue here in that there is a concern that core work may be done under NTPF-funded activity. The witnesses would accept that it would be an inefficient use of its resources, but I do not see any robust processes within the NTPF to try to spot that trend across different hospitals or procedures.
Ms Fiona Brady:
Unfortunately, as I mentioned earlier, NTPF staff do not work in the acute hospitals, so there is an element of trust. I accept that. The other element is that hospital management has a huge role to play in this in ensuring that core activity is carried out before anybody applies for an NTPF initiative.
Paul McAuliffe (Dublin North-West, Fianna Fail)
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Hospital management also has a responsibility to treat patients and to use all available resources to ensure that it carries out its activity.
Paul McAuliffe (Dublin North-West, Fianna Fail)
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I would argue that the NTPF is the body that is accountable to us to ensure that the money for which it is responsible is used efficiently.
Ms Rebecca Maher:
Part of the approval process when the hospitals submit an initiative is that they would have to demonstrate that it is additional activity. As part of that process, when we have a negotiation with a public hospital, one of the inquiries I frequently make relates to that hospital's core activity. I would ask how many patients are seen on average under core activity for a particular specialty each week. As Ms Brady said, there can be reasons why there are challenges by specialty, geographic region and tertiary referral centre. It can be problematic for certain sites.
Paul McAuliffe (Dublin North-West, Fianna Fail)
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That is examined as part of the application process.
Paul McAuliffe (Dublin North-West, Fianna Fail)
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The follow-on from that is that it is done on an individual application basis. Is there any retrospective audit that seeks to identify a trend? Initiatives might be justified, for example, in one case or another, but is there any attempt to identify whether there is a trend for a particular procedure or specialty or geographic location?
Paul McAuliffe (Dublin North-West, Fianna Fail)
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Yes. Where is all that data contained, managed, published and collated?
Paul McAuliffe (Dublin North-West, Fianna Fail)
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In the context of all of the data that has been spoken about, namely the application, the audit of the relevant data and the management information that the NTPF collates, the difficulty for us is that we are trusting that what we are discussing is taking place. Is there any data source that I can look at to ensure that what the witnesses say about the applications phase is visible?
Paul McAuliffe (Dublin North-West, Fianna Fail)
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I would argue that whether it is the applications, an audit or a summary of the process, the best way to support the argument that core work is not being double-funded, as such, is to demonstrate that by means an audit of the NTPF-funded hours and how the applications are assessed on a generalised basis. As a member of the Committee of Public Accounts, that is my biggest question, and I do not necessarily have the data in front of me to answer it. Do the witnesses accept that?
Mr. Eoin Darcy:
As Ms Brady says, we are currently working on a dashboard that will allow us to draw a number of different data sources together in order to collate that information for monitoring purposes. As part of the insourcing review, we carried out internal reviews as well. We ascertained that we need to gather our data sources together in one place in order to be able to monitor everything. That is something we will do.
Paul McAuliffe (Dublin North-West, Fianna Fail)
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That is useful. The NTPF might come back to the committee on it.
I want to ask a question about nursing homes. We had a number of hearings regarding very significant concerns. I see a gap in the system here, where, essentially, the NTPF establishes the price, the HSE procures the service and HIQA establishes the minimum standards. A clear failure to deliver was evident in some of the coverage in the RTÉ programme. Payments were made for services and the services were not delivered to a satisfactory standard. As the procurer, is there a role for the NTPF in ensuring that the State gets the delivery docket, as it were, to the effect that it has received a service? While HIQA has a responsibility for establishing minimum standards, it clearly tells us that it is not responsible for the procurement element. Is there a gap between the NTPF establishing the price and HIQA establishing minimum standards?
Paul McAuliffe (Dublin North-West, Fianna Fail)
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For the purposes of the report we will be producing on that issue, is Mr. Flood saying that other than establishing the price, the NTPF has no other role in ensuring value for the procurement because it is not responsible for it?
John Brady (Wicklow, Sinn Fein)
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I thank Deputy McAuliffe. I have a few questions. The witnesses are all very welcome. For the record, could Ms Brady repeat the list of hospitals that currently have funding suspended?
John Brady (Wicklow, Sinn Fein)
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There were three hospitals in total where-----
John Brady (Wicklow, Sinn Fein)
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Mr. Gloster spoke about insourcing. He made reference to it being a more localised thing to do perhaps ten years ago, but that now the entire health system has become overly dependent on it. Is that something Ms Coyle would like to comment on? Does she think the entire health system is dependent on the NTPF and insourcing? Could Ms Brady please respond?
John Brady (Wicklow, Sinn Fein)
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Could I ask the question of Ms Coyle? Does she think the operation of Beaumont is overly dependent on insourcing?
John Brady (Wicklow, Sinn Fein)
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Prior to the work that has been embarked, was Beaumont overly dependent on insourcing?
Ms Anne Coyle:
Beaumont had the real focus. Covid would have changed things in those five years as much as a pent-up amount of demand that needed to be addressed to improve access quite quickly would have done. There was a period post-pandemic around the recovery and recovering of acceptable wait times.
John Brady (Wicklow, Sinn Fein)
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What does the direct impact of the funding being suspended look like for patients who may potentially have been on waiting lists for many years having their cases referred to the NTPF? Do we have numbers in respect of the patients who had were referred in this way? What impact is the suspension of funding having on patients?
Ms Anne Coyle:
As we entered 2025, the two areas that we were in discussions with the NTPF on were dermatology and endoscopy. Shortly after, we received a memo from the CEO of the HSE which challenged that.
John Brady (Wicklow, Sinn Fein)
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I get all of that. I am just looking for the specific numbers relating to the suspension of funding. How many patients have been referred over to the NTPF? With funding suspended, what is the real impact on patients in the context of their being in a vacuum? Do we have numbers in this regard?
Ms Anne Coyle:
Yes. Dermatology, for example, was an area that we were looking to focus on. Initially, we continued the initiatives that were scheduled. We did not disrupt people's appointments, and we continued that at a cost to the hospital. We then looked, particularly around our dermatology waiting list, at different approaches to our use of, for example, our minor procedure rooms in St. Joseph's for dermatology. Those combined actions that we took allowed us to deliver more activity within our existing resources and to drive efficiencies for dermatology. Dermatology will achieve the waiting list action of nobody waiting longer than 12 months by the end of this year. We are on track for that.
We did a lot of work as part of our management of internal patient flows which meant that we minimised disruption of endoscopy procedures. We continue to ensure that patients who require an urgent endoscopy are treated within the 28 days. Again, there is a gap. The number of referrals that are coming in for endoscopy exceeds our capacity to deliver that, regardless of whether the funding was suspended by the NTPF or not.
John Brady (Wicklow, Sinn Fein)
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Are their any cases of patients who had been referred to the NTPF and had a date for a procedure or whatever who are now back on an NTPF waiting list?
John Brady (Wicklow, Sinn Fein)
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Were there no cases of direct negative impact on patients?
John Brady (Wicklow, Sinn Fein)
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That is fair enough. In relation to the cost of insourcing, Ms Brady referred to a split of 70-30. What was the exact figure for insourcing for 2024?
John Brady (Wicklow, Sinn Fein)
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For the record, what were the figures for insourcing and outsourcing at Beaumont in 2023?
John Brady (Wicklow, Sinn Fein)
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With regard to SIPO, which one of the members referred to earlier, there is a responsibility on consultants to fill in the relevant statutory declarations. A figure of 25% non-compliance was provided in that regard. There may be reasons for that. Ms Brady gave the example whereby when she was in Drogheda hospital, all consultants filled that in. Is that the case-----
John Brady (Wicklow, Sinn Fein)
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-----irrespective of whether they had something to declare or-----
John Brady (Wicklow, Sinn Fein)
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They filled it in. There was a process for all consultants to fill it in.
John Brady (Wicklow, Sinn Fein)
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In the context of Beaumont, a figure of 81% was provided in respect of the public-only contract. How many consultants in total are engaged by Beaumont?
Mr. David Sweeney:
I can come back with the full detail but, broadly speaking, it is 350 or 360. A number of our consultants have shared appointments, so there is a distinct possibility that they may have declared at another site. A lot of the hospital consultant contracts are split between Beaumont and other hospitals. It is entirely possible that a consultant who did not complete a declaration in Beaumont and who has a commitment to Drogheda could possibly have signed a declaration there.
John Brady (Wicklow, Sinn Fein)
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But there is no process, similar to that in Drogheda, to ensure that the responsibility of the employer, which, in this case, is Beaumont, is complied with. There is no cross-referencing or anything like that to ensure that this is the case.
Mr. David Sweeney:
On the piece that we have, we have declarations provided to the hospital through an automated system similar to the one that is being developed. Those responses are compiled and reported in through EMG and our hospital board. Where we do not have a declaration, it is not to suggest that people have a declaration and are not returning it. It is more an absence of a receipt of a response, and that aspect of lack of response could very conceivably be captured at other hospital sites. From a management perspective, we need to develop matters internally by making that a little more robust and tracking and tracing those non-declarations, but it is not to suggest that they have valid declarations.
John Brady (Wicklow, Sinn Fein)
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I think the management certainly does. There is work that needs to be done in that regard.
I will deal with the issue of insourcing. Mr. Hanlon gave two figures for Beaumont for 2024, namely €11 million and €8.7 million. Will he explain why the figures are different?
John Brady (Wicklow, Sinn Fein)
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In 2024, it was €8.7 million.
John Brady (Wicklow, Sinn Fein)
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Can Mr. Hanlon break that down further with regard to insourcing for third parties, particularly as there is a difference?
John Brady (Wicklow, Sinn Fein)
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The €3.1 million was for insourcing. Would I be correct in saying that was to cover, I suppose, consultants who were on public contracts but it also involves engaging with third parties and utilising their work outside of and bringing them into Beaumont?
John Brady (Wicklow, Sinn Fein)
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Will Ms Brady give us a breakdown of the figures relating to the insourcing and the engagement with third parties for 2024?
John Brady (Wicklow, Sinn Fein)
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I will park my questions for now and will return to them if we get a second round.
Eoghan Kenny (Cork North-Central, Labour)
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I have a couple of supplementary questions. I thank the witnesses for coming in. I have a question on payslips. I understand that Beaumont Hospital used to use paper payslips and it has since transferred to electronic payslips. Is that correct?
Eoghan Kenny (Cork North-Central, Labour)
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Who has the contract for the provision of the electronic payslips?
Eoghan Kenny (Cork North-Central, Labour)
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Does Mr. Hanlon know if it was a tendered process?
Eoghan Kenny (Cork North-Central, Labour)
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How much is that contract per year?
Eoghan Kenny (Cork North-Central, Labour)
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It is very important. I understand that no tendering process took place for the transfer of payslips to electronic form, the contract was awarded to those who provide the electronic format of the HSE and the contract is approximately €4 million. If the tendering process was disregarded, it would be a significant issue. I would appreciate it if the committee could be given that information as quickly as possible.
Eoghan Kenny (Cork North-Central, Labour)
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The payslips themselves.
Eoghan Kenny (Cork North-Central, Labour)
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When did Mr. Sweeney take up the role of deputy CEO?
Eoghan Kenny (Cork North-Central, Labour)
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Was that a brand-new role to Beaumont Hospital? Was there a deputy CEO previous to that?
Eoghan Kenny (Cork North-Central, Labour)
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Was the deputy CEO role that was vacated in 2019 taken away completely?
Eoghan Kenny (Cork North-Central, Labour)
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Who made the decision to recontinue the role again in 2024?
Eoghan Kenny (Cork North-Central, Labour)
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Why did the board of the hospital make that decision?
Mr. David Sweeney:
I am better placed to answer that as I received a letter at the time from the board. I was asked to step in to CEO role in an interim capacity and thereafter for continuity purposes in the context of the churn of the executive management team, I was asked would I maintain additional responsibilities over and above the director of HR role. That is on an unpaid pro bono basis.
Eoghan Kenny (Cork North-Central, Labour)
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Is that an unpaid role?
Eoghan Kenny (Cork North-Central, Labour)
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Are some of the responsibilities that Mr. Sweeney undertakes as deputy CEO just for the sake of the hospital?
Eoghan Kenny (Cork North-Central, Labour)
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Those are all my questions. I have to say fair dues. Mr. Sweeney's grá for Beaumont Hospital is clear. I probably would not undertake a role if I was not being paid to do it. I thank the witnesses. I would appreciate it if the committee could get an understanding of the tendering process and the amount that is spent on the contract for the payslip and payroll section of Beaumont Hospital.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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I thank the witnesses for answering all the questions so far. I want to go back to the start. After I listened to all of the questions and answers, I am kind of at a standstill to understand when the NTPF was formed and what the purpose was in forming it. Why were not enough consultants put into the hospitals in the first place to ensure that patients got adequate care? The NTPF is an additionality. Who made the decision and when was it made?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Yes, when was the inception of the NTPF?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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What was the reason for that?
Ms Bernadette Weir:
There were obviously pressures on the hospitals at the time and it was a Government decision to give people access to treatment faster and to do something to reduce the waiting lists. The figures are publicly available. I think it was about €30 million for the first year and then it grew.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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I am sorry; how much?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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The Government spent €30 million to ensure that-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Instead of putting additional consultants in the hospital to create additional access, it created an entity. I do not really get it.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Does Ms Bennett recall which Government it was?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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The NTPF does not provide beds.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Where can the NTPF source beds from?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Is it nearly an entity that helps fund the private hospitals? When we come down to it, is that what it really is?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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We have created this extra slush fund for the private hospitals. That is the way I am looking at it. If we had looked after the HSE and paid it to ensure we had proper hospitals and consultants for a start, we would not need to fund the private hospitals.
Ms Bernadette Weir:
That is probably a question for the HSE. There are patients out there who are waiting and they can avail of treatment under the NTPF. They are no longer waiting and in pain. They have a better quality of life through availing of it.
The other point I was trying to make is that we can work with the hospitals to identify the gaps in delivering treatment. In some instances, the gap is that they do not have beds. They do not have a hospital bed for recovering patients so we can arrange funding for consultants to work on a public contract in a private hospital. They are on the payroll in -----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Do they get two salaries - a private one and a public one?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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They have already been paid by the public hospital and now they are going to get paid by the private hospital as well through the NTPF.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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They take home their public salary. Do they get anything additional?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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I know from experience and from hearing from others that people do go to see private consultants in public hospitals. They pay the private consultant and then they are seen in the public hospital. We have to get down to the nitty-gritty of it and I do not know how we are going to do that. Everybody in this room needs to work on that. There have to be reports done on this to see where the consultants are because a lot of additional money is being spent.
How much is in the NTPF?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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This would have gone a long way towards improving public services. This money has been spent since - what year was mentioned by Ms Brady?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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It was 2004, so there has been €230 million every year since that-----
Ms Fiona Brady:
In 2017, the NTPF was only funded €17 million. Based on my experience of working in the public system, the reason for the efficiencies private hospitals provide the public health service with is because they do not manage unscheduled care. Every day, Ms Coyle has to come in to face a very busy emergency department with patients on trolleys - 60,000 or 70,000 presenting to an emergency department. The private hospitals do not have that. Public patients get cancelled in public hospitals because the theatres and day wards are full and there is no space in outpatients. That is where the NTPF can step in and use private capacity to look after public patients but we do not pay the consultants for that. It is already paid by let us just say, Beaumont Hospital. That is only one way we use our money. For extensive waiting lists-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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It does not add up for me that the consultant has already been paid by Beaumont Hospital-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Are they not on a contract? They are on a contract.
Ms Fiona Brady:
I made the very strong point earlier that if we are using private capacity for public waiting lists, for example, Beaumont Hospital, the referring consultant cannot be the treating consultant so consultants cannot refer a person from their public list to a private hospital and then head over there and see them themselves. You absolutely cannot do that. This year, 300,000 patients will be removed from the waiting lists because of the NTPF and 180,000 patients will have a better quality of life because of what we have done this year.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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I beg to differ. I believe that you can see a consultant in a private clinic and they will refer you to Beaumont Hospital to see-----
Ms Fiona Brady:
That is totally different from what we do. Let us say a public patient saw a consultant in a private hospital and needed other sub-specialisation that was only available in a particular hospital. For example, Beaumont Hospital specialises in neurology. Drogheda certainly did not have that. That is what could have happened. Level four hospitals are all tertiary referral centres for specialties that are just not available in level three hospitals.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Our system is not working. People are on huge, long waiting lists for everything as far as I can see. They cannot see a consultant when they need to but they can do so if they go through the NTPF or go private. The system is broken. It is not working. Something needs to change.
John Brady (Wicklow, Sinn Fein)
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To return to the issue of in-sourcing, I refer to the report by the Minister that revealed that in the 27 months to the end of March 2025, close to €100 million was paid out engaging external companies that use HSE facilities and equipment after normal hours. The report revealed that 83 serving or former health staff are acting as directors in 148 companies providing what are known as in-sourcing and outsourcing. To me, this raises a number of questions. When Bernard Gloster appeared before the Oireachtas Committee on Health, he defined in-sourcing as the practice of engaging external companies or third party providers to deliver services often outside normal working hours using HSE-own facilities and equipment. Would Ms Coyle agree with that?
John Brady (Wicklow, Sinn Fein)
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Is that how Ms Coyle would see it in operation in Beaumont Hospital?
Ms Anne Coyle:
No. In Beaumont, exposure to third-party in-sourcing has been quite small. I do not know if Mr. Hanlon has the detail on that. Some has been through endoscopy, for example, where we have capacity constraints. It is looking at different ways through extended hours and weekend working so we can maximise our use of the equipment and rostering people differently. That is work in progress to reduce our exposure and liability to third party in-sourcing. We have had it in particular specialties but it has not been-----
John Brady (Wicklow, Sinn Fein)
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We might get those figures. As has been stated here, there are some consultants - we are not sure about the figure or percentage - who have not filled out the statutory SIPO declarations. Does Ms Coyle think there is potential for conflict of interest? Do we know of any consultants in Beaumont who has been a director of any of those companies that are providing in-sourcing through third parties? Are there any cases of consultants providing those in-sourcing arrangements who are directors or otherwise involved in companies?
John Brady (Wicklow, Sinn Fein)
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Potential? Would Mr. Sweeney be concerned that the potential has not been explored if he thinks there is potential for a conflict of interest?
John Brady (Wicklow, Sinn Fein)
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I am talking about Beaumont rather than national level. Mr. Sweeney said there is the potential for a conflict of interest. Is he concerned that there may be a conflict of interest involving a consultant? He does not know whether there is or there is not. I find it extraordinary that piece of due diligence has not been explored or investigated, the fact we do not know whether consultants are directors in these third party providers providing in-sourcing arrangements within Beaumont.
Mr. David Sweeney:
I will address the point as best I can. There is a potential conflict of interest. I would concur with the view of the CEO of the HSE. The extent to which individual hospitals in the system are exposed to that conflict of interest or the extent to which it applies is an entirely different matter. From the perspective of Beaumont Hospital, we are comfortable that we have the structures within the system to oversee any movement of waiting list activity through in-sourcing or outsourcing during the course of our operations.
John Brady (Wicklow, Sinn Fein)
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Can I ask a direct question? Are any consultants who currently work or have worked within Beaumont over the past number of years involved in third party providers of in-sourcing?
John Brady (Wicklow, Sinn Fein)
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I am talking about Beaumont. Mr. Sweeney said there is potential for concern. What due diligence-----
John Brady (Wicklow, Sinn Fein)
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Potential for a conflict of interest - I think that needs to be looked at if there is potential for a conflict of interest. Mr. Sweeney said consultants. Is it consultants who are or have worked there, or both?
John Brady (Wicklow, Sinn Fein)
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Certainly prior to that there were consultants there. I agree there is the potential for a huge conflict of interest, particularly where some consultants are not filling out their statutory declarations to SIPO. Essentially, I am not sure in all of the processes Mr. Sweeney has talked about that the proper safeguards are being adhered to and being implemented and I am really concerned around that oversight and due diligence piece for the potential for abusing a system without those safeguards in place.
I want to move on to a couple of other issues relating the IT system and the integrated human resource and payroll system. I think Deputy Farrelly mentioned it earlier on. Mr. Sweeney said there was a delay of nine months in the implementation of that. Is that correct?
John Brady (Wicklow, Sinn Fein)
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That was an overrun of €197,000. Is that figure correct?
John Brady (Wicklow, Sinn Fein)
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The integrated human resource and payroll system was-----
John Brady (Wicklow, Sinn Fein)
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How did that fare? Was there an overspend there?
John Brady (Wicklow, Sinn Fein)
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Did Mr. Hanlon say there was no tender done on this?
John Brady (Wicklow, Sinn Fein)
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This is extraordinary. There was an overspend of €2.8 million. How much was the total spend on it?
John Brady (Wicklow, Sinn Fein)
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Mr. Hanlon did not think it was applicable.
Mr. Francis Hanlon:
Management at the time felt there was a derogation in place for that particular system. As newly appointed director of finance, I reviewed the derogation and I did not think it was applicable so we corrected the record regarding non-compliant procurement, which was submitted to this committee in August 2025, and this is the cost of that project.
John Brady (Wicklow, Sinn Fein)
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That is extraordinary. Does Mr. Hanlon agree?
John Brady (Wicklow, Sinn Fein)
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I am sorry, Deputy Kenny, I will let you back in shortly.
We need a lot more detail on this because the committee has embarked on a piece of work looking essentially at what amounts to mismanagement, poor oversight, poor due diligence and lack of processes, specifically on IT projects. This just follows on from a litany of other wastage of public money. That is what it is. What role did the audit and risk committee play in this project? Were any concerns raised by the audit and risk committee in relation to this IT project?
John Brady (Wicklow, Sinn Fein)
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Is there someone else who might speak to that?
Ms Anne Coyle:
The issue, when Mr. Hanlon raised it, was reviewed by the board, including the recommendation and review undertaken of the understanding as it was at the time. Our statement of internal control and our annual financial statement have been updated to reflect the refreshed and revised opinion on the procurement of the integrated HR and payroll system.
John Brady (Wicklow, Sinn Fein)
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Who thought there was a derogation in place? How did that train of thought come about? I am not sure who might be able to answer that.
Mr. David Sweeney:
In 2019, the hospital identified the need for an integrated HR and payroll system and approached the HSE with a view to rolling out the national system as soon as possible. Unfortunately, at that time the HSE project team were otherwise occupied with the roll-out of the system to the statutory hospitals and while they were positively disposed to rolling it out in Beaumont hospital, they did not have the capacity to do so at that time. During the height of the Covid-19 pandemic, we came to the increased realisation that the system we had was at end of life. The system provider was a UK-based company that had indicated it would no longer support and develop the system we had. We felt at that time as the senior management team, and taking into consideration the impact of recruitment and payroll-related activities for a hospital that undertakes hundreds of thousands of transactions through its payroll system each year, that the circumstances at that time warranted a derogation.
John Brady (Wicklow, Sinn Fein)
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So there were no processes and no tendering processes. Was a view sought from the Department or from the HSE?
Mr. David Sweeney:
There was a discussion with the HSE. The system we ultimately acquired was SAP, so it was aligned to the national system of choice and system support provider. We felt we were aligned to the national strategy.
John Brady (Wicklow, Sinn Fein)
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That was the HSE, and it said it was-----
John Brady (Wicklow, Sinn Fein)
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I find it extraordinary and it is an issue this committee will certainly return to.
I have a number of other questions.
Eoghan Kenny (Cork North-Central, Labour)
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I want to pick up on the Chairman's point. It was my first question in relation to payslips. I know there was some confusion perhaps regarding payslips and payroll. How much, right now, is the contract for the payroll system in Beaumont Hospital?
Eoghan Kenny (Cork North-Central, Labour)
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Mr. Hanlon mentioned an overspend to the Cathaoirleach.
Eoghan Kenny (Cork North-Central, Labour)
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How was there such a significant overspend?
Eoghan Kenny (Cork North-Central, Labour)
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That is a bit of an understatement.
Eoghan Kenny (Cork North-Central, Labour)
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That is in or around €3 million in excess of the predicted cost. That cost is on the Exchequer now. It is on the taxpayer.
Eoghan Kenny (Cork North-Central, Labour)
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When was the decision made to move to a new system?
Eoghan Kenny (Cork North-Central, Labour)
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Was it just because people felt it was time to move on from the system they had?
Eoghan Kenny (Cork North-Central, Labour)
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Which company currently has the contract?
Eoghan Kenny (Cork North-Central, Labour)
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Who signed off on that contract with SAP?
Eoghan Kenny (Cork North-Central, Labour)
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Surely the senior management team would have thought it should put it out to tender.
Mr. David Sweeney:
For the reasons I was identifying earlier - it was during the height of the Covid-19 pandemic and for the operational resilience of the payroll - it was deemed that the derogation was in order, particularly because the system was aligned to the national mandated system of SAP.
Did the hospital pass that by the HSE or the Department?
Eoghan Kenny (Cork North-Central, Labour)
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The HSE decided it was okay not to go to tender.
Eoghan Kenny (Cork North-Central, Labour)
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It is a mistake on the hospital's part, therefore, of €3 million to the taxpayer. It is a very significant issue and I am sure that when the Comptroller and Auditor General comes back with his report, our committee will have to investigate that further.
Joe Neville (Kildare North, Fine Gael)
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To clarify, on the budgets declared, that is 2024. That will be coming up in the----
Joe Neville (Kildare North, Fine Gael)
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That is the thing. It is something that is coming to light. We are here for the 2023 accounts for Beaumont. This is in 2024. In fairness, we know that the system was to be put in place but this is the first we have heard of the numbers involved.
Joe Neville (Kildare North, Fine Gael)
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Just to clarify, it almost like a bombshell coming at the end.
Joe Neville (Kildare North, Fine Gael)
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Exactly, and that is why there might be more confusion. Maybe that is why we are asking those extra questions now. Just to clarify, €1.9 million was the projected cost. When was that decision made to go ahead with the new SAP system?
Joe Neville (Kildare North, Fine Gael)
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In what month roughly, just out of curiosity? Early or late?
Joe Neville (Kildare North, Fine Gael)
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That is what I am looking for, the context. I know Mr. Hanlon is only new in the position. To simplify it, I am talking about cases where somebody decides that a project is outside the scope that requires a tender. Coming back to the word "derogation", who decides when it applies and who gives the context?
Mr. Francis Hanlon:
I believe there are eight reasons you would seek a derogation under procurement rules. My understanding is that the hospital procurement department did not make that decision on the derogation, as they would normally make a decision on a derogation under those eight particular criteria. The decision to seek a derogation was made outside of the procurement department.
Joe Neville (Kildare North, Fine Gael)
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Who made that decision?
Joe Neville (Kildare North, Fine Gael)
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Mr. Hanlon's predecessor.
Joe Neville (Kildare North, Fine Gael)
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Mr. Hanlon is permanent now, yes?
Joe Neville (Kildare North, Fine Gael)
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It was the previous permanent person.
Joe Neville (Kildare North, Fine Gael)
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Was it a permanent person or an interim person?
Joe Neville (Kildare North, Fine Gael)
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The previous permanent person in that role decided to seek a derogation. Did that person ultimately decide a derogation should be in place or did they recommend it? Was it that person's sole decision or did they recommend it as a joint decision?
Joe Neville (Kildare North, Fine Gael)
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I am just wondering who actually decided the derogation should apply.
Joe Neville (Kildare North, Fine Gael)
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Who is the body, the collective body? Is it the board? Probably not. Is it the CEO and senior management team? Did the director let the CEO know? Did the CEO know that the derogation was being sought?
Ms Anne Coyle:
We are coming to this a number of years after the event. A number of us were not in post, myself included. We are reliant on correspondence and memory at that point in time. We are taking the work under way in terms of that reflection. As Mr. Hanlon has outlined, the eight points to identify whether a derogation applied or not----
Joe Neville (Kildare North, Fine Gael)
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It was decided it was outside the scope of the eight points, from what I believe.
Joe Neville (Kildare North, Fine Gael)
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Somebody just went straight past all the usual rules, the procurement team, and decided outside the procurement team, which normally would use the eight rules, and just said there was a derogation in place. It might have been just done for urgency or whatever the reason was.
Joe Neville (Kildare North, Fine Gael)
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I am just trying to find out who knew at the top and who ultimately made a decision. Are the CEO of the time and the chief financial officer of the time still involved in the board at all or are they retired and gone? Is the predecessor Mr. Hanlon was talking about still there?
Joe Neville (Kildare North, Fine Gael)
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They are not on the board. They are not involved at all, are they?
Ms Anne Coyle:
If I may, we are dealing with a very live issue. We are working through understanding the decisions and the decision points, what might have contributed to that view and the feeling at that time, as opposed to now, five years on, when we are looking at it in the cold light of day. I take the question and I take the intent. It is difficult for us to answer in terms of who was responsible at the moment. We are looking at this as a hospital issue.
Joe Neville (Kildare North, Fine Gael)
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We do not want it to be that it is one of those "lessons will be learned" cases. We are sick of that term. I do not mean that in regard to those present but in general in this country. It is a case of why, who and what. We will probably be here on the 2024 account sooner rather than later.
Mr. Seamus McCarthy:
I am just looking back at the 2020 financial statements and the certificate I issued. There were significant difficulties in the hospital at the time. I drew attention to governance issues, a change of chairpersonship, and to the audit committee not functioning as intended or as would normally be expected. I also drew attention to the failure, or at least I did not see any evidence of it, of the board to carry out the required review of internal controls in respect of 2020. In fact, on payroll I drew attention to payroll overpayments where people had continued on the payroll after they had left the employment of the hospital. I drew attention to four cases with total expense of €294,500. There were a lot of difficulties at that point in the hospital. I also drew attention to non-compliant procurement, so that has been an annual reference in the audit certificate for the hospital. These things are connected and the committee can see the further connection in the payroll. In trying to remedy some of these difficulties there is a cost overrun on that project.
John Brady (Wicklow, Sinn Fein)
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If I may ask a question, the officials have come before the public accounts committee today. I am sure meetings took place among them as to what might be discussed here. Did they not think they should be forthcoming with information such as this, given that they were coming before the committee that is tasked with scrutinising public expenditure? Do they not think that should have been forthcoming? There is no mention of it anywhere, only for this having come up at the latter end of the meeting when a lot of the members are not here. Should the witnesses have been forthcoming with this bombshell information?
Ms Anne Coyle:
The information has come to light in terms of this very specific and live issue.
We have updated the statement of internal control and added it to the list of lack of compliance with procurement. That was the information we had laid maybe in hindsight, but the issue, I suppose, will come through in the 2024 discussions.
John Brady (Wicklow, Sinn Fein)
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It certainly will, and I think there will be a lot more information required from the hospital. I ask that we would get a briefing note from the hospital because we will have the HSE in before us next week and I think it is going to be critical to have all that information. I am trying to tie all the pieces together. As the C and AG said, there are governance issues in Beaumon going back before a lot of the witnesses' time, but there is a very costly pattern here and the taxpayer is the one picking up the tab. There are issues there. I asked about the audit and risk committee. I think we will need minutes of the board meetings to see whether this issue has been discussed previously at board level. There are concerns there. Other members touched on board members resigning, and an explanation was given for some of those resignations. I will ask the question as to whether any of those resignations or step-downs or whatever had come about as a result of some of these concerns. May I ask that direct question?
John Brady (Wicklow, Sinn Fein)
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Personal issues. Okay, so no board member who stepped down raised any concerns about this specific issue and cited this as potentially one of the reasons why they had decided to step down from the board.
John Brady (Wicklow, Sinn Fein)
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Okay. Maybe seek that information and provide us a note on that.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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I have just one more question. The money spent in the NTPF went up to €234 million in 2024 from €62 million or €63 million in 2019. Why was there such a severe increase there? It seems like an awful increase in the income and expenditure in those years. Why would that be?
Mr. Seán Flood:
If the Deputy looks at our budget, our budget this year is €230 million, of which €215 million is care expenditure, so the increase has been down to the funding of patient treatments under both outsourcing and insourcing arrangements. I would point out, however, that commissioning was restarted, re-established, in mid-2017, and it takes time to build up the commissioning function. Basically, from our perspective, we think we have been very successful in treating large numbers of patients over that period. We have set out in the opening statement the figure of 1 million patients over the past six years, I think, who have received-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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But if the NTPF is treating the patients, what are our hospitals doing? That is what I do not get. Why is there such an increase? Why are the hospitals not doing the work? That is what I do not get. The amount of income that has been spent under that fund is threefold what it was. I am just wondering why. How was it happening in our hospitals back in 2019, and in 2024 it is the NTPF that is receiving such a significant amount of income towards patient care?
Ms Fiona Brady:
It is a phenomenal amount of money, and we are very grateful to get it. We do make a huge difference to the public system. I would like to make a strong point to the Deputy now. She may not be aware that our budget has been cut next year by €30 million, so while we have €230 million this year, we will have €200 million next year. We fully anticipated that in light of what the Minister, the Department of Health and the HSE are looking to achieve in relation to the new regions and the new public money consultant contract. They are looking for more productivity and we are getting less money, so it is going in the right direction.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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I am just trying to understand it. It just does not make sense that we have so many hospitals and we are building a huge new hospital that is costing a lot of money and then we are still spending this money on outsourcing. It just does not make sense, so I am just trying to get my ahead around that.
Administration expenses within the NTPF were €12 million a year - is that correct? - last year or in 2024.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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What would that entail, or what would that be for?
Mr. Seán Flood:
Over half of the administration budget would be for salaries, for payroll. At the end of 2024, we had 95 WTEs, an increase from 80 the year before. The majority of our administration budget would be for salaries. Another significant cost for us would be waiting list validation. That would be budgeted for €3.2 million, for example, for this year.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Do the NTPF's board members get paid?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Okay, and that is paid out of that amount, out of that money?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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What kind of stipend would that be?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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Is it common across the public sector that board members would get paid? In Beaumont do the board members get paid?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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They do not get paid there.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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I am just wondering right across. Maybe the C and AG can-----
Mr. Seamus McCarthy:
As regards the figures that were quoted there, €11,970 is a very standard rate for a relatively small public sector body, and I think €7,695 is again standard for an ordinary member of a board of a relatively small organisation. In larger organisations there might be higher payments to board members, but in any case they should always be in line with Department of public expenditure limits.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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What is the difference then between a hospital board member and an NTPF board member if one gets paid and the other does not?
Mr. Seamus McCarthy:
There are a number of public bodies where either conventionally there has never been a fee paid, or maybe during the recession board members ceased to be paid. There is a little bit of sporadic difference, but I think the figures that are quoted for the NTPF board members would be the more general thing. I think maybe in the health and the education sectors members of boards would tend not to be paid. They would be seen more as making a social contribution.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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That is okay. I thank the witnesses for answering my questions.
John Brady (Wicklow, Sinn Fein)
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That concludes the Deputies' questions and our engagement with the National Treatment Purchase Fund and Beaumont Hospital. I thank Ms Fiona Brady and her officials and Ms Anne Coyle and her officials for attending. Is it agreed that the clerk seek any follow-up information and carry out any agreed actions arising from the meeting? Agreed. The committee is now adjourned until 9.30 a.m. on Thursday, 16 October 2025, when we will meet with the Health Service Executive to discuss its 2024 financial statements.