Oireachtas Joint and Select Committees
Thursday, 22 January 2026
Public Accounts Committee
St. James's Hospital: Financial Statements 2024
2:00 am
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
This morning, we will engage with St. James's Hospital to examine its financial statements for 2024. On behalf of the committee, I welcome everyone here before us this morning. From St. James's Hospital, I welcome Ms Mary Day, chief executive officer; Ms Catherine Mullarkey, chair of the board; Ms Aisling Collins, chief operations officer; Professor John Kennedy, medical director of the Trinity St. James's Cancer Institute; Ms Joanna Bennett, director of finance; and Ms Fiona Curneen, director of human resources. I welcome from the Health Service Executive Ms Kate Killeen White, regional executive officer; and Mr. Joe Campbell, regional director of finance, who are attending in a representative capacity. I welcome from the Office of the Comptroller and Auditor General Mr. Seamus McCarthy, Comptroller and Auditor General, who is a permanent witness to the committee, and Mr. John Byrne, audit manager.
Before we begin, 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 that 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 this privilege is not abused. Therefore, if their statements are potentially defamatory in relation to an identifiable person or entity, witnesses 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.
I call the Comptroller and Auditor General, Mr. Seamus McCarthy, to make his opening statement.
Mr. Seamus McCarthy:
St. James's Hospital is a voluntary hospital funded substantially by Health Service Executive grant funding provided under section 38 of the Health Act 2004. The hospital's financial statements, like some others in the health sector, are presented with separate income and expenditure accounts for recurrent and capital spending. This format is specified in the framework for hospital financial reporting directed by the Minister for Health. The hospital reported recurrent expenditure of €756 million in 2024. This included a deficit of €15.7 million brought forward from 2023, representing a first charge on 2024 funding. Of this expenditure, 63%, or €473 million, related to staff salary and pension costs. At the end of 2024, the hospital employed 5,184 whole-time equivalent staff.
The hospital’s income comes mainly from public funding sources, the bulk of which comprises recurrent grant funding from the HSE, referred to as the funding determination for the year of account. In 2024, St. James's recognised HSE recurrent grant income of €682.6 million. This was up from €578 million in 2023, a year-on-year increase of 18%. The hospital recognised patient income of €33.8 million, comprising mainly charges totalling €29 million for services to private or semi-private patients, and charges totalling €3.6 million in respect of long-stay patients. The latter includes €3 million billed to the HSE in respect of fair deal patients. The hospital also recognised income of €9.1 million in respect of employee superannuation contributions that it was allowed by the HSE to retain, and funding of €5.3 million from the HSE specifically in respect of the provision of mental health services.
In 2024, the hospital recognised capital funding of €20.8 million received from the HSE and €320,000 from another hospital. Total capital expenditure was €21.5 million, which exceeded income by just over €300,000, bringing closing capital surplus to €15.8 million.
I issued a clear audit opinion in relation to the financial statements on 28 July 2025, but drew attention to a number of disclosures made in the statement on internal controls. In 2024, St. James’s Hospital continued to incur a significant level of expenditure where the procedures followed were non-compliant with relevant public procurement guidelines. Only 86% by value of the procurement was compliant with the relevant guidelines, and this was unchanged from 2023. During 2024, private insurers rejected or were expected to reject claims by the hospital for payment of patient charges to the value of €396,000. The processing of the claims by the hospital was not within the agreed timelines.
I also drew attention to St. James’s Hospital's payment of €1.44 million to a company involved in providing certain medical services on an insourcing basis. Of the total paid to the company, €1.4 million was not subject to an open competitive procurement process and there was no formal contract for services in place with the company. Additionally, it was found that 18 directors of the company were staff of the hospital. Six out of the 18 directors had not submitted statutory statements of interest for 2024. The remaining 12 directors had not declared their interest in the company or the services delivered in their statements of interest.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I thank Mr. McCarthy and I now invite Ms Mary Day to make her opening statement on behalf of St. James's Hospital. As set out in her invitation, she now has five minutes to make her opening statement.
Ms Mary Day:
I thank the committee for this invitation to discuss the audited financial statements and accounts of St. James’s Hospital for 2024. I am the CEO of St. James’s Hospital, a position I have held since 2020, although I was seconded to the HSE for a period of 18 months from August 2022 until February 2024 as interim national director for acute operations. I hope the evidence my colleagues and I will provide will go some way towards alleviating any concerns that may have been raised at the public accounts committee, particularly in terms of the hospital's prudent management of taxpayer funds.
St. James’s Hospital is one of the largest leading academic teaching hospitals. We have over 1,000 beds and more than 5,000 staff providing services to an immediate catchment population of 220,000 and growing. We have the largest cancer centre in the country for surgery, haematology and oncology, and we are the only cancer centre in Ireland with international accreditation as a comprehensive cancer centre. The hospital’s cardiology department is one of the busiest and most advanced in the country and is one of the four comprehensive cardiac centres nationally.
At the outset, I wish to apologise on behalf of the hospital for the fact that some radiology services in 2024 were not procured through a public tender process. We did not meet the standards expected of us, and for this I apologise. I assure the committee that this was driven by urgent patient need in cancer in particular, but also in cardiology, to prevent delayed diagnosis and deliver the best possible care to our patients. Occasionally, due to unforeseen or unpredictable circumstances, we in the hospital have to balance the need for public procurement with the need to respond immediately to urgent needs for scans in order to avoid potential harmful delays in the diagnosis and treatment of our patients. For example, in 2024, there were 28 adverse incident reports at St. James’s Hospital related to delayed diagnosis associated with constrained access to diagnostic imaging. To give a sense of the time involved in procuring projects, the procurement of insourced MRI services took 12 months to finalise. Once this procurement was finalised, the procurement of CT and ultrasound commenced, but it was regrettably not finalised.
I assure the committee that the price paid per diagnostic scan was reasonable and within the preset maximum level set by the National Treatment Purchase Fund, NTPF, and that the hospital received the full scope of services agreed for each purchased scan, therefore creating effective additional capacity.
On the issue of non-compliant procurement, the hospital’s procurement compliance rate for 2024 was 86%, demonstrating in the main that strong governance structures, policies and processes reflecting the standards expected of a public acute hospital of our size were in place. However, we acknowledge that 14% of services were not procured that year, and we apologise for this. During 2024, the seven-person procurement team delivered 63 projects with a combined annual value of €25.9 million, many of which were highly complex, resource intensive and time sensitive.
On the issue of services provided through hospital employee companies, I will provide the information on the circumstances that led the hospital to pay €1.399 million in 2024 without a public procurement process to a company whose directors were hospital employees and the corrective actions we have taken since.
St. James’s Hospital's radiology department is one of the busiest in the country, performing over 215,000 examinations annually. In 2024, demand exceeded capacity by approximately 28%, with CT, MRI and ultrasound particularly affected. During the pandemic, emergency legislation was enacted that supported the application of emergency procurement procedures through direct award of contract. Many of the usual but vital services at acute hospitals were suspended or reduced dramatically so we could all focus on combating Covid. Cancer services were profoundly negatively impacted. Waiting lists grew and there was a huge concern about delayed diagnosis of patients. The NTPF made funding available to public hospitals through emergency diagnostic authorisation numbers to support the provision of outsourced diagnostics. In 2024, 74% of the €1.4 million was funded via the NTPF. Some 56% of this related to using emergency diagnostic numbers to provide capacity for time-sensitive work and 18% addressed waiting list initiatives, the majority of which were for patients on the breast cancer pathway. When the emergency funding for diagnostics ceased in 2024, 26% of this total was paid from the hospital’s budget allocation to mitigate the risks to patients of delayed diagnosis to treatment.
To give a sense of the rise in demand, the hospital had 190 requests for MRI scans for patients with suspected prostate cancer in 2016. By 2024, this had increased to 1,280 requests due to changes at the time in the diagnostic guidelines by the national cancer control programme. However, there was no investment in equipment or staff to meet this guideline change and the prostate MRI waiting list grew from approximately 50 patients to 700 patients in less than six months. For our patients with suspected breast cancer, the breast diagnostic pathway relies heavily on imaging such as mammography, MRI and ultrasound. There has been an 18% growth in the number of patients attending for breast diagnostics over the past six years. The current waiting list for urgent breast ultrasounds is 376. The waiting list for non-urgent breast ultrasounds is 1,660. The payments from the NTPF for this work were approved in stages, so the final amount paid to the company could not be determined in advance. While the NTPF funding support was in place, 94 patients were identified as having cancer and were diagnosed at an earlier stage than if the additional capacity was not available.
With regard to the ethics requirements, 18 employees of St. James’s Hospital were directors of the vendor company. They had all discharged their public work in compliance with their employment contracts. They had been notified by the hospital on multiple occasions of their obligations to complete a statement of interests in 2024. Twelve provided returns that did not disclose this interest while the remaining six did not provide returns for the reporting period. The director of HR and the board secretary discussed with the 18 staff the C and AG audit findings in respect of the Standards in Public Office Commission, SIPO, and their obligations to disclose. The staff members immediately addressed and rectified their returns, including outlining the compelling reasons for undertaking this additional work, which in this case was to provide time-critical cancer and cardiovascular diagnostics.
A range of other measures have been put in place to strengthen governance and oversight on these issues. In July 2025, the hospital paused insourcing and outsourcing activity except where a derogation was approved by the HSE. All derogations that St. James’s Hospital has submitted to the HSE since this date have been approved. The MRI work has been procured through the HSE and the HSE has indicated the end of January 2026 for contract award of the CT and ultrasound.
Once again, I would like to apologise on behalf of St. James’s Hospital and to assure the committee that we were committed to ensuring that all expenditure related to insourcing and outsourcing of services was compliant with legislation and the recent guidelines issued by the Health Service Executive. I reassure the public accounts committee that the hospital is confident that, throughout engagement with this vendor, value for money and vital services were delivered.
We welcome any questions the committee may have.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I thank Ms Day. We will suspend the meeting at approximately 12.15 p.m. for a ten- or 15-minute break and resume afterwards. I now open the floor to members. The lead speaker is Deputy Geoghegan, who has 15 minutes. All other speakers have ten minutes each thereafter. On conclusion, and if time allows, I will open a second round of shorter questioning from members.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I thank the witnesses for attending. I acknowledge at the outset that Ms Day has apologised twice before the committee about the issues. I wish to highlight that nobody in this committee or in the Office of the Comptroller and Auditor General is carrying out an inquiry into the need. I hope we can get through this session without conflating the issues of the absolute need and the governance issues and how the money is spent.
That is all we are looking at here today. How many times was this particular company provided moneys from the hospital for insourcing services, beyond what we already know?
Ms Mary Day:
Over a period of eight years, this company has received €4.7 million from the hospital and delivered 35,000 diagnostic scans for that money. The first tranche of that was 2017 to 2019. I was not in the hospital at that time. The hospital had experienced severe pressure in relation to meeting the urgent need to see breast cancer patients within ten days. That pressure was so intense that the hospital was escalated to the national oversight performance system between the HSE and the Department of Health. It was then that this vendor was allocated a very limited volume of work. This was purely-----
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
So-----
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
It is just my time is limited.
Ms Mary Day:
The very limited volume of work was purely just for mammography in relation to doing this. In 2020, we all know in relation to Covid-19. The NTPF made the emergency funding in the system to deliver the additional diagnostic scanning for the hospital. I assure the Deputy in relation to the controls that were put in place is that, for the radiologists in question, it did not interrupt their core work. We have seen that the core activity has increased over the years.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
We can come to that. I have to be able to ask the questions, but I appreciate that Ms Day has a lot to get out, but I have a lot of questions to ask well.
On the €4.7 million, and not just the €1.4 million that we know about but all the other payments that Ms Day said go back to 2017, were any ethics disclosures made in respect of any of those moneys?
Ms Fiona Curneen:
To answer directly to that specific question and I will explore further if the Deputy wants more details, there was the vendor, which was employees, who did not make that disclosure. In part, some of them did for different periods of time. There is evidence of that. In some of the years, some people made disclosures. In other years-----
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Can I just clarify, they made their annual ethics disclosures?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Under the new protocol that the witnesses have provided us with, in terms of how ethics closures are going to be made, they made clear that, in fact, you have to disclose at the point of the time. It is not just about the annual declarations, but if you have a conflict of interest, you disclose it at the time you are going to try to get the services. Did any of that happen in respect of any of the moneys that were provided to this company above the €1.4 million that we already know about?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
We know about the annual disclosure. Was the procurer ever told about the fact that the company that was trying to provide the services included 18 people who worked in the hospital?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
It is not just €1.4 million in 2024. It is actually €4.6 million since 2017 that did not go through public procurement. Is that right?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
In addition to the non-procured payments, has this company gone through procurement for payments for services as well with the hospital?
Ms Joanna Bennett:
They were awarded the MRI contract last year. We are utilising the HSE framework to procure CT and ultrasound. That is going to come its conclusion at the end of January. We do not know the awards yet.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
What is the value of that contract?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
To put the question in another way, how much revenue is this company likely to receive? In euro terms, how much payment is this company likely to receive? When did this procured contract start?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
How much did it receive last year?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
It is small enough money in comparison. Of the 18 directors, are any of those directors on public-only contracts as consultants?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Were they all on the public-only contract from 2017?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
From what year did they become part of the public-only contract?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Was it before the €1.4 million payment that they were on public-only contracts or was it after?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
That is helpful and I am aware of that. That is why I wanted to tease it out. Obviously, if you are on a public-only contract, the limitations on you providing any services on a private basis are extremely small. That is why I am trying to inquire into if there are directors of a company who were receiving public moneys through this scheme funded by the NTPF and some of it from the hospital. Could that in any way be perceived as a way around if you are on a public-only contract?
Ms Mary Day:
No, absolutely not. I might ask Professor Kennedy to come in around the public-only contract and the consultant. The radiology group is a limited company. The real control that is in place in relation to these radiologists is that their core activity was not just maintained, it actually increased. What we saw in 2024 was that they read 9% more CT scans and 14% more ultrasounds. We are very comfortable in relation to that control that the core activity is increasing year on year. Even with the additional work that this is doing, we still are only meeting 75% of our total demand for diagnostics.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Will Ms Day explain how, in her opening statement, the €1.4 million was provided on an urgent basis and, when I asked her if this company had received any other moneys on a non-procured basis, the figure cumulatively is €4.7 million since 2017? How could it be urgent for seven years from 2017 to 2024?
Ms Mary Day:
From 2017 to 2019, there was a very limited volume of work. That work was mammography. It was one specialty. The reason that work was allocated is that urgent breast cancer patients were not seen within ten days. It was so serious that the national performance oversight group pulled the hospital in. In relation to the work from 2020 and 2021, that is diagnostics in general. That is CT, MRI and ultrasound. That is what we saw due to changes in how patients were treated during Covid, which I will ask Professor Kennedy to come in on, namely, increased waiting lists, increased admissions and increased patients waiting for cancer diagnostics.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
If Ms Day is apologising for the non-procurement of €1.4 million in payments, does she see there being wrongdoing in respect of the balance of payments up to the €4.7 million that has occurred since 2017?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Is this for the full totality of it?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I fully acknowledge the apology but Ms Day's explanation for the €1.4 million was urgency. That was her key explainer. Is that the same explainer for the other moneys?
Ms Mary Day:
Yes, and since Covid, that urgency continued. The National Treatment Purchase Fund gave us emergency diagnostics. It made that available. It was a national funding that was made available to all hospitals to access resources and because it was urgent, it was time sensitive work. It was to reduce waiting lists. What we saw was that the hospitals were dealing with Covid and then what we saw was that at our outpatient numbers were increasing and our diagnostic demand was increasing. We could not get to treat our cancer patients and diagnose them in a timely manner. That work from the NTPF funding was from 2021 to when it stopped in March 2024.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
When the hospital is paying for these services, does the company have any overheads or is the payment literally to it for providing that service and it geta access to all the capital infrastructure that is in this public hospital?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Do the directors of this company own the equipment?
Ms Joanna Bennett:
The insourcing MRI began in 2023, with weekend sessions. That was new. The first focus was to bring that into compliant procurement. That took 12 months. As Ms Day discussed, the CT and ultrasound grew over the Covid period. It was very challenging from a procurement perspective to go out to tender for that. In January 2021, it was level five lockdown. This consultant group operates in the private clinic that is located in St. James's Hospital. It pays a licence fee. It owns and operates all its own equipment and hires its own staff.
On the mismatch between demand and capacity, the hospital approached the consultant group to provide the service. Services were provided. It was paid on the receipt of those services. We can say that we got exactly what we asked it to do. We got the scans. We can also stand over the value for money. Even though there was not a procurement process, we did benchmark from private insurers. We sought quotes ourselves and used published websites. It was also within the NTPF's approved price for scanning.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Now that this form of funding has been paused under the current Minister, what does that mean for meeting patient needs? Is that posing a greater challenge? Has the hospital changed in how its managing patient need?
Professor John Kennedy:
I realise everybody accepts that inability to meet demand with core facilities is what is causing this problem but it is important that we understand what exactly is going on. Population has increased by 15% in the past decade. The number of people over the age of 65 has increased by 36% in the past decade. They are the people who get cancer predominantly. The complexity of therapy has changed dramatically. The wonderful news is that survival has increased. We have a quarter of a million people in this country probably cured of their cancers. People on therapy has increased dramatically because people live longer with modern therapy. We have a great success story to tell.
However, the implications for our resources are relentlessly increasing demand, particularly on diagnostics, pathology and radiology predominantly. Ms Day pointed out that it was continuing year-on-year back to the time of Covid. Covid really set this off but we have never gotten back to a stable situation since then. On our inability to meet demand, it also has to be considered that we have to have the appropriate radiology for our patients. Quite frankly, if I am asked who I want to read my patients' scans, I want an expert cancer radiologist who is a specialist in the area. I need them to come along to our conferences that we have every week to discuss new cases and to discuss a patient's scans and to deal with the subtleties. I need to be able to go down and find that. There are huge quality issues.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
My time is up. I have a red light. All my colleagues will give out to me. I am not trying to interrupt Professor Kennedy. To close out that point because Ms Day said, if I heard her correctly, that because of the pause of this form of funding, the hospital will not be able to meet patient demand in the same way it was meeting patient demand. Is that her position?
Ms Mary Day:
To clarify, this form of funding was a limited capacity. Our mismatch between demand capacity is currently 30%. This form of funding only provided 2% to 4% of that. That was an initiative that was put in place to try to mitigate patient risk but we do not have enough capacity in the system to meet the expediential increase in patient demand for diagnostics.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Professor Kennedy will have to ask the Chair.
Professor John Kennedy:
We have had a 50% increase in the number of patients waiting for a CT. We have had a 90% increase in the number of patients waiting for an MRI scan and 70% increase in the number of patients waiting for an ultrasound since March or April 2024 when this was suspended. Those are the numbers.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
I thank everybody for being here. To follow on from that point, what is not in doubt at all - and the witnesses are describing it comprehensively - is the need and demand on the service. To confirm, did this arrangement cease in 2024?
Ms Mary Day:
In March 2024, the emergency funding that the NTPF was making available, which was 56% of the 2024 volume, ceased. We had to go to the NTPF to get funding specifically for our breast pathway. Breast pathway patients are heavily reliant on diagnostics. As I said in my opening statement, we were seeing an increasing number of patients, not just on the urgent pathway but in the non-urgent pathway, who required diagnostics to diagnose them. During the time that this NTPF funding was in place, 94 patients were diagnosed with breast cancer. There were three elements of 2024. It was the emergency funding that ceased in March 2024. The NTPF funded a separate pathway for our breast diagnostic patients. That is currently-----
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
Was this with the same vendor?
Ms Mary Day:
Yes, with the same vendor. The third point of that is the 26% in March 2024 because the risk to our patients was so great. We did a risk assessment. As CEO, as I saw adverse instances coming through, such as delayed diagnoses, I made a decision to fund a limited volume - 26% - to mitigate the risk in relation to delayed diagnosis for cancer.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
What did that equate to in a financial sum?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
Where did the hospital source that income?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
Is this from the HSE?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
Would the HSE have signed off on this?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
That site is essentially off the main public hospital site. It was said it is a separate site and pays a lease agreement. That is still fully operational as per the decisions Ms Day made last year with regard to the breast checks. While one piece came to an end, two other pieces are still very much operational there. Is that correct?
Ms Mary Day:
The private radiology clinic continues to be in place because we need that additional capacity. These private radiologists have come together as a company. They have a private radiology agreement under licence agreement where they have their own scanners and employ their staff. That is an additional capacity. It is not just for St. James's Hospital. It is work from other referrals that come through, with GPs being a big part of it.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
That is fine. When are the current arrangements due to lapse? What we have heard in the opening statements is an apology for what has gone on. When are the current arrangements due to come to an end, and what are the plans envisaged to continue arrangements? Will they be done in a way that is compliant with procurement?
Ms Mary Day:
As regards the controls we have put in place, as I said in the opening statement, the MRI was procured. As regards the CT and ultrasound, we expect that the HSE will award that contract by the end of January. In relation to the other controls I have put in place as a chief executive, we have set up an oversight group in relation to all insourcing and outsourcing arrangements. That is to ensure accountability, controls and compliance and that reports directly into the board. We are also working with the HSE under the insourcing guidelines. If there is an urgent need and if we need a derogation, we apply through the region to the HSE to receive that derogation, so we have strengthened our controls.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
Are there any similar arrangements in place within other departments, within other specialties, within the hospital?
Ms Aisling Collins:
Not directly similar to the radiology group, but we have had arrangements where we have had another third party vendor employed. EHF is a third party vendor that we drew down from the HSE framework to deliver day surgery cases for a period from October 2023 to January 2025, where we delivered care for 2,700 patients who are long waiters on our day surgery waiting list. We stood that down when our south Dublin surgical hub stood up and was working at fuller capacity so we were able to meet more of the demand for our patients there.
We also had another initiative that was funded through the NTPF. It was a dermatology initiative. Up to December, it was still waiting for a full review from the region and the NTPF on that, but since 2022 we had employed a third party company called DermView to deliver services to support the management of our waiting list. Two of the dermatologists who work in St. James's are part of that company, but the conflict of interest, etc., was dealt with upfront, at the very outset, before the initiative was put in place and had been tendered by the HSE. We have nothing that is directly comparable to the private radiology group but we have had initiatives where we have employed the services of third party vendors that were through frameworks within the HSE.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
May I ask one brief follow-up question on that? I think what Ms Collins said about DermView was that, from a procurement perspective, this was all procured-----
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
Yes, and for EHF is it the same?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
Do the witnesses have a percentage, then, with those three companies in mind, of consultancy staff employed within St. James's who are also working for companies?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
Anyone who might be able to-----
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
Two employees, and there are no employees of St. James's in EHF.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
If I may move on, I have just a little time left. For 2024, could the witnesses tell us the figure of what was outstanding from patient fees?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
Yes. Well, what was outstanding.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
No. I mean patient fees, as in, if I owed a hospital a fee, so if I have to pay a bill as a patient. I receive a service; I receive the bill.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
On the website it says if you do not pay your fees, your details might be shared with a third party debt-collecting agency that may then be entrusted to chase that fee. In how many instances was a debt-collection agency used by St. James's in 2024?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
It was paid €38,000.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
Does Ms Bennett know how much its activities brought back in in terms of outstanding costs?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
If Ms Bennett could, I would appreciate that.
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
Again, from a procurement perspective, is that arrangement with the debt-collection agency an annual contract that is signed or is that-----
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
It is fully procured for three years, and that rolls into 2025. Is that still live?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
I will ask my last question if I have time. The outstanding balance owed by the HSE itself is also €61.9 million. What efforts has the hospital, whether it is the board or the senior management team, made in terms of conciliation or arbitration to recoup that €61 million that is owed to the hospital by the HSE?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
The outstanding balance owed by the HSE to the hospital is, from my notes, €61.9 million. What efforts have been made by the hospital, at a management level or from the board's perspective, to recoup that cost from the HSE?
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
Some of it is capital, some of it is non-capital. What-----
Aidan Farrelly (Kildare North, Social Democrats)
Link to this: Individually | In context | Oireachtas source
That is fine.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Thank you for that. I call Deputy Dolan.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
All the witnesses are very welcome and we appreciate their engagement with the committee. I will go down the same line of questioning regarding this €1.4 million. What exactly are the witnesses apologising for? Maybe Ms Day would be best positioned to respond.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
We talk about good governance and about how hospitals, public bodies and State agencies can build trust with the public that public moneys are being used effectively. May I just check that I have this right? There was no contractual basis for any of the payments that were made to this company. Is that correct?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
There was no tendering process for this company. Is that correct?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
But that is after the fact, so the €1.4 million we are talking about was not procured properly and there was no tender in place.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Are the 18 directors staff members of St. James's?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
They are employees of St. James's but they are not consultants.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Okay. Those employees who are directors of a company that received €1.4 million, and we now know €4.7 million, had not declared this in their declarations.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
It is convenient that they made declarations but failed to declare that they were directors of this company. What this looks like from the outside is a really sweet deal. It looks like people who were too close to hospital management navigated their way around without having to do proper procurement and with no contract. Could the witnesses imagine getting €4.7 million from a State body with no contract in place? Who signed off the payments, on what basis were these people being paid, and how were the witnesses given assurance that the patients that they believe were seen were actually seen?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
When Ms Day says, "allocation," is she saying the NTPF?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
With each case.
Ms Mary Day:
Yes, and there is a structured process for applying. The NTPF will not pay us for a case unless it sees that the patient is taken off and the scan is done. For the other control put in place in relation to scheduling, those radiologists could not schedule those patients. They are not scheduling the patients they are taking in to do the scanning. It is people like Professor Kennedy, an oncologist, and other clinicians who are ordering the scans. There was an independent scheduling system set up in the hospital where they were allocated the time-sensitive, urgent clinical patients who needed their scanning. If those scans were not going to be delivered, we would be doing patient harm. That was the control piece.
The other control piece, which is really important, is that the core activity did not reduce; it increased. Year on year, when we looked at every modality that these consultants were delivering, they are actually more productive. They are increasing year on year in relation to the work they are doing.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I am not questioning the consultants' productivity. There are over 5,000 people employed in St. James's Hospital who do incredible work, day in and day out. This should not be the reputation that the hospital gets itself. That is why I asked at the start why Ms Day was apologising. If the consultants are so productive and doing so much work, why the hell do we have to be outsourcing it or, in this case, insourcing it to people who are so close to hospital management that they were able to not go to tender and procurement?
Ms Mary Day:
The reason this capacity was used is that we do not have enough capacity in the system. The core reason this vendor was used was, number one, it did have capacity and, number two, the scanning was done on-site to provide safer and better care. Most important are numbers three and four. Number three is that they had access to the records of the patients. I will ask Professor Kennedy to talk about this. When you are diagnosing a patient they have their other scans. More important is number four, which was faster decisions. I think it is an important-----
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Who shouted "Stop" here? Was it the NTPF or St. James's Hospital?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
The NTPF paused insourcing so it could do a review, and St. James's formed part of that review.
Ms Mary Day:
The emergency funding for diagnostics was before the pause of insourcing. They paused diagnostic funding. The limited amount of additional capacity we were getting was paused. That is the reason in relation to that element.
I think it is important to take the Deputy back. I will ask Professor Kennedy-----
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Who approved all the payments along the way?
Ms Joanna Bennett:
In 2024, when the NTPF funding stopped nationally, Ms Day, as CEO at the time, looked at the demand and the capacity that would be needed until the end of the year. This was at limited capacity. It was not at the same level we were doing during NTPF. It was limited. It was just to mitigate the risks as much as possible. That was approved by the CEO to 31 December and the balance approved was just under €400,000.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I want to be clear. I am not questioning the value for money. I am not questioning the merits of the need for the scans or the treatments that were required. The process was that the patient gets referred to this private radiology group. The hospital then applies to the NTPF to draw down the funds on that case to pay the private company. My problem with all of this is that there were 18 directors, a massive number, and they had not declared it. They were doing annual declarations, and they left that out. You do not forget that you are a director of a company. You do not forget that, especially if it is a company that is funding a significant amount of your day-to-day work. I know I am short on time, but my real question is this. What will be the repercussions?
Ms Fiona Curneen:
This again relates to the period in 2024 we are talking about today. Employees have designated positions of employment, and it is regrettable that the eight employees did not make their full disclosure at the reporting period. I also note that, on review and in discussion, we met with every one of the 18 employees the Deputy referred to, who are consultant radiologists, relating to their obligations of disclosure. They immediately took action to correct the omissions relating to their disclosure.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Does the hospital believe that these consultant radiologists were not aware of that obligation until that point?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
What percentage of people who were obligated to return are currently returning? I know for Beaumont Hospital, it was approximately 25%. It was really bad.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Will the hospital undertake to get that to 100%?
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I have one other recommendation. One thing I have been trying to do across the public service and the civil system is have more transparency because the more the public can see, the greater the trust. As I said, I do not doubt that these radiologists were entitled to the money for carrying out the scans. Fair play to them - they are doing a great job and providing a good service. I just do not like how this deal was brought about, and that is wrong. However, if the hospital were publishing its purchase orders, I would have been able to see that this company had been in receipt of that money. I ask that they look at starting to publish their purchase orders online quarterly, or whatever they are mandated to do, so the public can see where the money is going. Ultimately, that will feed into a tracker I have online, and people can make their own assessments of it then.
Professor John Kennedy:
Let us say this vendor was not used. Let us say we used another vendor. I would be rechecking every single scan they did. I would say that my patient had a CAT scan with this vendor. I do not know who they are or who this radiologist is and that I am not really happy with the report. I would be reading every single scan on one of my patients with one of my radiologists if that was a vendor. I guess that is an issue. Certain things can be outsourced, and that is great. They can be sent to other vendors, and they can get back. My scans cannot. I need to be able to sit down with the radiologist. They need to be able to call me. I need to be able to find them. They need to know who I am, and we need to have a collaborative, multidisciplinary approach. I am not trying to take up time, but that is incredibly important to me.
If somebody had said to me that they were putting this out to procurement in the middle of Covid crisis and it will take a year to get your scans done or your radiologist can read them tomorrow, that would be fantastic. There is a qualitative issue here. I have to have complete trust, on behalf of my patients, in my pathologists, my radiologists, my surgical colleagues and my nursing staff. Outsourcing, or getting somebody from wherever, when I do not know they are and know nothing about them and I cannot trust them because of that, means every single scan is going to have to be reread. I hope that is helpful.
Albert Dolan (Galway East, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I appreciate that explanation.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I thank everyone for coming in today. I have three sections to talk on. I have a few smaller questions in relation to the insourcing. I would then like to talk about the capital projects, including the Trinity St. James's Cancer Institute. In the previous Seanad, I was chair of the cross-party group on cancer. It is something I am interested in, and St. James's is in the constituency I represent. I am aware of the work the hospital does on a local basis treating local patients, but it is also a national hospital and is treating patients from all over Ireland. I also want to discuss the issue of car parking, which is something my constituents bring up with me a lot.
I turn first to insourcing. Professor Kennedy mentioned that since insourcing ceased nationally, the waiting lists have increased.
The waiting lists have increased. Has the hospital in the past or does it now use its own scanners and radiologists in terms of paying overtime, like we might see in hospitals in the UK?
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
That is at weekends.
Ms Mary Day:
In the past two weekends, because we were in red escalation in relation to our flow of patients going through our emergency department, we have paid overtime in relation to doing additional work. When we talk about overtime and a radiologist doing overtime, it is not just a radiologist. We are looking at the radiographer, the nurse and the administrative support. It is a whole package. The key message I need to get across is that when we benchmark against the Royal College of Radiologists, looking at the number of scans and radiologists per scan delivered, we are short 12 radiologists. With what those 12 radiologists would do for me, I would be able to deliver an extended day, 8 a.m. to 8 p.m., and I would be able to deliver a Saturday. That means that I could use my current scanning equipment much more productively.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Is that an ask Ms Day has put in to the Department of Health?
Ms Mary Day:
On the submission for diagnostics, we have highlighted diagnostics, especially over the past two years, as we are seeing this huge exponential increase in demand, and we are very concerned in relation to patient harm. We have submitted, through our estimates processes and the national estimates, business cases for diagnostics. In the cancer bid, in the past two years, we have actually prioritised diagnostics as the key enabler in delivering good-quality patient care.
Professor John Kennedy:
Our radiologists run CAT scans and ultrasound 24/7 in the emergency department. They are there until approximately 11 p.m. or midnight reading scans. Most of the extra activity is between 8 p.m. and midnight. It cools down after midnight. I asked them how many CAT scans on average do they do a night and 35 was the answer. I was flabbergasted when they told me that. There are 35 extra CT scans done every night in the emergency department of St James's Hospital to try to improve patient flow. To try to make sure patients do not have to be admitted to the hospital to get something done, the scan is done in the emergency department. That is another big workload. They say that when they come in the morning - they might have gone home at midnight - another 15 scans were done after midnight, and they have to read all of those before they start their day's work. There is huge complexity to what is going on in terms of demand and pressure on them.
I am old enough to remember that in 2013 or 2015 we tried to implement 8 a.m. to 8 p.m. scanning without extra resources. We had to abandon it after approximately two years because our radiographers were leaving for the private sector. We need extra resources to run 8 a.m. to 8 p.m. I have been talking about this for years. We must run 8 a.m. to 8 p.m. but we need resources. We cannot ask people who are currently working five days a week, nine to five, to come in and work seven days a week, 8 a.m. to 8 p.m.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Are those the same people who are working for the company?
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
In relation to capital projects, there was a surplus of €15.8 million in 2024, and there is significant capital expenditure anticipated in the hospital. I am interested in the Trinity St. James's Cancer Institute. There are potentially more planned projects. Would our witnesses like to tell us about them?
Ms Mary Day:
In relation to the capital, we have a very exciting and extensive capital redevelopment for St. James's Hospital. The one thing about St. James's is that the campus needs to be rebuilt. It is very low lying. We have four priority projects in relation to planning. The first is the additional capacity in relation to them. Another capital development is the critical care capacity. We saw how Covid was such a strain on critical care. That also would involve new theatres, a new diagnostic area and additional beds.
The third project is in relation to a facility across the road on James's Street, which is an institute for inclusion health. As we know, in St. James's, we have a lower demographic, and this is really to provide that special care and support in relation to our inclusion health.
The last project I will comment on is that because the campus is congested, we need to decongest. We have a capital plan for Davitt Road, and that would be for outpatients and ambulatory care.
Professor John Kennedy:
I will explain what we are trying to do in regard to the cancer institute. We have a big, busy cancer hospital, and we have a fantastic university, Trinity College Dublin, with vast amounts of science going on there. We are bringing the two together. We want to be able to offer our patients not just state-of-the-art treatment but the next treatment - cellular therapies, molecular diagnostics and improved genetic evaluation. That is what we are trying to do.
Back in the nineties, we had dreadful outcomes for cancer patients in Ireland. The wonderful news now is that our outcomes are way better but we are at risk of falling behind because we are not nimble and fast enough to take advantage of the rapid progress in the science of cancers' diagnostics and treatments that we need to be able to offer our patients. The institute's goal is to do that.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
How far is the hospital with that project?
Professor John Kennedy:
It is a process. It goes on forever. Our programme has been recognised by the Organisation of European Cancer Institutes as the only comprehensive cancer centre to meet accreditation standards in Ireland. There are approximately 40 all over Europe. We are incredibly proud of that.
We need to build a building. We need a cancer centre for our patients. For the next epidemic, which, by the way, will be here within the next 20 years, we need to have no interruption to our patient care. We need a completely separate facility for cancer patients, so that we do not have to go through what we had to go through with Covid. There are two big elements. There is a programmatic element, which we are working on all the time, and we need to build a proper cancer facility. Our patients deserve proper facilities. We have patients who are being treated in multi-occupant wards. That is unacceptable in the modern world. Our capital projects need to be advanced.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I thank Professor Kennedy.
In relation to parking, and this might be for the director of finance, how much does St. James's Hospital generate annually from its parking?
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Is there a reduced rate for long-stay patients and their families? Is there a policy for supporting them?
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Is that widespread and do families know about it?
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
This might be a question for Professor Kennedy. Does he think the parking charges can sometimes act as a financial barrier to people attending clinics or scans? We must acknowledge that €15 is quite a significant amount of money per day.
Professor John Kennedy:
I am sure it is. The solution to this, in my opinion, is to get extra capacity off site with parking. We cannot build parking on the grounds of St. James's. We do not have capacity on site, unless a Dublin corporation is going to allow us to build a tower, which is unlikely. When patients come in for routine scans, simple visits, physiotherapy or an outpatient appointment, that should all be off site. The St. James's site is now going to include the children's hospital. It is going to get very congested. It needs to be reserved for complex, urgent emergency care, including high-end surgery, etc. For people coming back in for a routine scan and having to pay for parking for two or three hours for a scan, that should all be off site and they should not have to pay for it.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
On the Davitt Road site, will there be a diagnostic centre there?
Ms Mary Day:
Yes. The plan is to have diagnostic access there. As patient treatments get more complex, as we are seeing increasing admissions, the one thing we are trying to do is to separate out our outpatient diagnostics and GP, so that we actually have acute diagnostics in the acute sector, and we can respond to urgent, acute demand. What we are seeing is that acute demand is increasing but the OPD is also. The plan is to separate those two ambulatory diagnostics, and Davitt Road would be the plan for that. We have the surgical hub in Mount Carmel, which I alluded to. It has been very beneficial in relation to providing that hub for surgery patients. We are looking at a plan in relation to increasing OPD there but also increasing OPD diagnostics in that area.
Catherine Ardagh (Dublin South Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I thank our witnesses for coming in today.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I thank the Deputy. I call Deputy Neville.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I thank our witnesses for coming in today. For clarification, I will revisit some of the issues raised because, for example, insourcing and outsourcing is not something we are all familiar with but, the more we attend these meetings, we hear about it more. Some €1.4 million was spent in 2024 on an insourcing arrangement with a third party. Is that correct?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
In that context, in simple terms who was doing the insourcing and who was doing the outsourcing?
Ms Aisling Collins:
Insourcing, as defined by the HSE, is that we bring a third-party vendor in to use the equipment and facilities in the hospital. In this scenario with the radiology, it was our own radiographers, our own admin, nursing and facilities. The outsourcing is where the full package of the scan goes out to the facility of a third-party vendor.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Did the outsourcing in that case have any links? Is it the same consultants?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
So the insourcing is using the hospital's own equipment.
Ms Aisling Collins:
It is our own equipment but we hire the radiologist - the consultant piece - to do the reading of the scan. The scans themselves are delivered by our own radiographers. Whereas, with outsourcing, the patient goes to the facility of the private radiology group and they get their scan done there by staff employed by the radiology group.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Are the consultants in the outsourcing group still involved with the hospital?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
So they are two sides of the same coin.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
That is the reason the third-party clinic was brought in.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Where is the third-party clinic?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I am sorry but can I just clarify that point? I was curious about that earlier and nobody asked a question about it. I was waiting for that question to be asked. I was surprised because I thought it might be five miles away. It is actually in the hospital itself.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Is it renting space off the hospital?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Did I not hear from the previous speaker that we are short of space?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Yet the hospital is leasing out space.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
How many?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Of who?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
What is the number?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
There are 57 and 20% of the consultants have that facility.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
When Ms Curneen says "access",does she mean the company has access? Are they all together in a group or are different companies operating out of there?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
But at the same time, there are 18-----
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Are those 18 within the context of the 57?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
So some of them are. That is as clear as mud. I will not deny it.
Ms Fiona Curneen:
Maybe I can clarify the older contract. There are 57 of our consultant group who are on the older contract. Part of the older contract is that there is an obligation to provide up to 20% of time to access private work on site. That has been the place for older contracts for some time.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
So essentially, part of the public hospital is privately used.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
That is despite the fact that we need more space. How long does that contract go back?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Okay. I might come back to that later, because there are other issues. I did not expect all that to go off in that direction. Is it correct to say that the insourcing process has been stopped?
Ms Aisling Collins:
We do all our MRI insourcing at weekends. That is procured and it is under derogation from the region. We are currently finishing the breast pathway initiative with the radiology group. That was insourcing and it is due to finish by the end of the month. We also have an endoscopy insourcing piece. That was procured. Any of those sessions are run under derogation from the HSE and funded by the NTPF.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I will just go back to look at the tender from an audit perspective. The €1.4 million and the €4.7 million in total was given out without a proper tender process in place. Is that correct? What governance steps were missed with that? Who decided that the hospital could do that? What main step was missed? I get the point about the requirement. I am just looking at it from an audit background.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Did the NTPF know there was no tender? Was it told?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I am sorry, but was the NTPF told that there was no tender in place for that money that the hospital required? I ask that just out of curiosity.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Was that afterwards or before?
Ms Mary Day:
Afterwards. I just want to highlight that we declared in the submissions that went in to the NTPF to do the additional NTPF-funded work that the work would be undertaken in the private radiology clinic, so they were aware of that. We do have a really close working relationship with the NTPF. From talking to the CEO of the NTPF, she sees that the day-to-day running of the hospital is the responsibility of the executive and the NTPF does not oversee the running and the oversight. We have put additional controls in place. There is an executive oversight group to ensure that we do get accountability, compliance and controls for all insourcing work. It is an additional control that we have.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I thank Ms Day very much for that. I want to switch gears. One issue that came up with the HSE is the IFMS roll-out that was really done well. It was a system that was badly needed across the HSE. A proper system is in place for financial tracking and financial spend. The question I asked Bernard Gloster at the time is if the voluntary hospitals have done it, and the answer was "No". That was a number of months ago. Has St. James's taken steps towards it?
Ms Joanna Bennett:
It was probably late September when we first received notification that ourselves and Tallaght were the first targets for the section 38s. Myself and the CEO invited the HSE CFO and the project manager from IFMS for an initial meeting to understand timelines.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Is Ms Bennett happy enough that she is engaged with the process?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
That is fine.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
So St. James's was able to link up quicker because of that, because they are on SAP as well.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
That is brilliant. That is very good to hear. I am delighted to hear it. Did the hospital spend roughly €600 million on it?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
The total spend of the voluntary sector was about €5 billion so St. James's is roughly around 12% of the total. That was a big question that none of the €5 billion was being captured. Was there any pushback internally on that from Ms Bennett's team? The feedback we were getting is that the voluntary hospitals were pushing back. It is good to hear that St. James's is engaging, but was there a process to get through? Was there any pushback internally? How did that work?
Ms Catherine Mullarkey:
I will take that question. We in St. James's are slightly different from other voluntary hospitals because we are established under statute and effectively we are a hospital for the Minister, whereas other voluntary hospitals are faced with slightly different governance issues and issues of independence.
For the likes of the Mater hospital, which is a public limited company, there are issues in adopting the IFMS in terms of loss of control, that is, loss of the independence of complete control over the financial statements, record-keeping and all of that. I can appreciate the issues the purely voluntary hospitals have because the HSE is looking to push-----
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Ms Mullarkey does not have to stick up for them.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I am just saying she is happy that St. James's Hospital has engaged with the process.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Ultimately, the €5 billion comes from the taxpayer. That is the case and we need transparency.
Ms Catherine Mullarkey:
I appreciate that but a director of a company is also bound by corporate legislation that cannot just be ignored. The fact a company's funding comes from a source does not relieve the director of his or her obligations under corporate legislation. That is a fact that needs to be taken on board and addressed in some form to give comfort to those directors. For us, it is less of an issue because, as I said, we are established under statute.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
As I said, €5 billion is a lot of money and it is money that has been spent.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
The main topic we have discussed here to date is governance and tracking of spending. Unfortunately, this money has been spent and that is exactly the type of issue a proper financial management system would stop happening because it would not be possible to get around it. The system we are trying to put in place in voluntary hospitals, as in the rest of the hospitals, would mean something like this might not have occurred. That is the issue we have mostly been discussing and the point I am making.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I welcome the witnesses. I have been listening to the ongoing saga this morning in relation to the €1.4 million that was given to a private company. Would Ms Day say there is a commercial practice operating in St. James's Hospital?
Ms Mary Day:
The radiology company is a limited company where the radiologists pool their private activity. They have set up their company. Every consultant is entitled to do private work. In regard to this group of radiologists, they formed together and developed a company. It is not just for St. James's Hospital, as I said in my opening statement. They provide GP scanning and other services. They license the property and they own their equipment and manage their staffing.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
They have a commercial property on the grounds of St. James's Hospital. Is that correct?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Does that mean they rent it?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
How much rent do they pay for it?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
How much does that equate to per month or per year? How much are they paying for that property on the grounds of St. James's Hospital?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Can Ms Bennett not say how much rent they are paying?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
That is not the case in here. It is all documented in here.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
They pay €52,000 a year in rent. Okay.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Who bills them?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
How much does it bill them? How is that worked out?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Okay, so the witnesses are saying there is a commercial practice operating on the grounds of St. James's Hospital.
Ms Joanna Bennett:
Yes, there is a private clinic there and part of it is the radiology suite. Phlebotomy services are also provided at the clinic, as well as cardiology services. Then there are consultants who are on the type B contract and are able to rent rooms in the clinic for sessions under their contract. That facility is not unique to St. James's Hospital. There are private-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
There are private clinics like this right across the board operating in State-owned HSE buildings. Is that correct?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
How long is that radiology clinic in operation?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
To clarify, the commercial consultants have been operating in the clinic for decades.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
What is that?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Does that mean consultants are under duress to do only public work?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
How are the 37 hours calculated and who monitors whether the consultants are doing those hours in the public hospital?
Ms Mary Day:
In relation to this particular group of radiologists, we have a very good indicator that they are not only doing 37 hours but are, in fact, doing more than that. We look at everyone's activity levels. We have a directorate structure. We manage performance, we undertake reviews of consultants' work practice plans and we look at the activity they undertake. For this group of radiologists, it was very clear that they are actually exceeding their level of activity but, going back to my earlier point, we are still not meeting demand. We are still short by 30%.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
On the issue of demand, Professor Kennedy said it is he who would refer patients to the private clinic. Is that correct?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
How are these decisions determined as to whether somebody is sent to the public system, which will cost that person nothing, or to the private system, which will have a cost? How does Professor Kennedy determine where a patient is sent?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
However, if people go to a private consultant, they have to pay a fee of €200.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
No, it would not.
Ms Aisling Collins:
Regarding how that work is done, say, for example, John goes to the public clinic in St. James's Hospital. If he needs a scan done, that generates an order on our system and that order goes to our radiology department where it is triaged by the physicians there based on urgent versus routine need. Then it goes to the hospital's management team and scheduling team. An arrangement might be in place, for example, that patients can be sent to a third-party vendor or it might be decided to do the procedure on an inpatient basis. Need is balanced against access. Some patients will have their scans done in the public system. They will not pay if they go to the private hospital under a public order. The patients do not pay; it is just that we are trying to get more access, and more timely access, for patients.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
However, if a patient is sent to a private operator, he or she will have to pay €200.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I will move on. Ms Day said at the start of the meeting that she recognises the issue here and why the committee wishes to investigate it. When did she realise there was an issue and what did she do as a consequence before the matter came to the Comptroller and Auditor General? It is all good and well coming in here and giving apologies and all of that but I want to know where she went up the line when she realised there was an issue in relation to the declarations of interest not being filled in.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I do not want to know about that. I want to know what happened to those people who had not made declarations of interest. What were the protocols and what did Ms Day do at that stage when she noticed they had not filled in the declarations?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Yes, thank you.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
If she can, Ms Curneen might speed it along a little as I am short of time.
Ms Fiona Curneen:
Sure. As we know, 18 employees were identified who were directors of the vendor being discussed today. We noted earlier that 12 of them did make a disclosure but not a full one and six did not make a disclosure. Our first action or control was that in respect of the 84% who completed their returns inclusive of a nil statement, I, as director of HR, undertook a review of those declarations. The process is that this report then goes to the board secretary and the CEO to review the disclosures made. It was through this process that actions were taken regarding the 18 employees.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Which actions?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Speaking to them. That was it.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
That was the only-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Speaking to them.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Did anybody lose their job because of this?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
There is a commercial enterprise operating on the grounds of St. James's Hospital and nobody lost their job as a result of not making a declaration in respect of it.
Ms Fiona Curneen:
To clarify, there are corporate governance measures that we put in place to engage with these individuals in order to allow them to make right their admissions, which they immediately actioned. They did engage and took immediate action. I also acknowledge that their clinical responsibilities to their patients involved dealing with cancer care and cardiovascular diagnosis.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I know. I will ask the question again. This is a commercial enterprise being run on the grounds of St. James's Hospital whereby staff who are working in the hospital-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
-----are not acknowledging or declaring that they are working on the grounds of the hospital for that enterprise. This is very serious stuff. I want to know where this went. Did it go to the board of management? If it did, where did it go from there? Did the HSE find out about it? Did the Minister find out? Why was this not-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
If this is going on in St. James's Hospital, then it is going on in all HSE hospitals. It is going on right across the board-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
-----and nobody is doing anything to correct it.
Ms Catherine Mullarkey:
When it came to light that the returns and the standards expected under the ethics Act were not fulfilled, the individuals involved all rectified their returns immediately. Mary and I met with representatives of the radiology group recently to reiterate and stress the importance of these returns and how crucial they are.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
The word "crucial" does not do it for me. I want to know what the HSE did about it.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
It is just not good enough, folks.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
No, it is good enough. Nothing has happened. These people are still employed, and they lied on their documents.
Ms Kate Killeen White:
I can come in on that from a HSE perspective. The CEO of the HSE did commission a wide-scale review of insourcing and outsourcing activity and has made very clear that the intent of the HSE is to move away from the reliance on insourcing and outsourcing. Since then, updated and strengthened governance controls have been put in place by the HSE, which St. James's Hospital is working with us on. In order to do this, a derogation must be sought. However, it must be sought in a clear way, and there is a listing of priorities that the hospital must satisfy before a derogation can be considered. These include things like core work always being a priority.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
How many derogations has the HSE given out this year?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Or exemptions.
Ms Kate Killeen White:
-----derogated a number of clinics for St. James's Hospital. Over the course of 2024 and 2025, the number of these has decreased significantly. They are being phased out. We are working with the hospital in the context of trying to put these services on a stabilised and sustainable footing in order that we can move away from relying on insourcing and outsourcing.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Is the Minister aware of this?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Who notifies the Minister? Does the Minister not-----
Ms Kate Killeen White:
It is my understanding that the CEO briefed the Minister in relation to the review that was conducted around insourcing and outsourcing at the time. It is important to clarify the steps that must be signed off on before a derogation can be issued. That is that core work is always the priority, including maximising the levers available.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
That was not what was happening. That did not happen previously.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Did the private-----
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I am sorry. We are way over time.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Did the private commercial operator's work increase also?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Maybe we need to get the income and expenditure sheet of the commercial operator in order to see what exactly was going on.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I thank Deputy Bennett. We will take a short break for ten to 15 minutes.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Before I call in our next questioner, I want to allow Deputy Bennett to clarify a remark she made earlier.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I apologise. In the heat of the debate before we left the room, I used the word "liar". I want to retract that. I did not mean to say it. Apologies for that.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I thank Deputy Bennett for that and call Deputy McGrath.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I thank everybody for being here. I acknowledge the difficult environment the witnesses are working in. Anyone working in the health service is in a difficult environment. We understand the pressure they are under.
At the outset, I thought I had a clear idea of what insourcing and outsourcing involve. I am more confused now than I was. Can I ask for a quick definition of "insourcing"?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Surely the top person can answer it.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
For Ms Day, it is about using the equipment in the public hospital as opposed to having a private centre on the grounds of the hospital.
Ms Aisling Collins:
Yes, insourcing. Insourcing is where - and this is all across the HSE as well - a third-party vendor is contracted to supply staff to provide additional capacity using the hospital facilities outside normal core hours, often at weekends.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Ms Collins referred to hospital facilities. Does it have to include hospital staff?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
But it can.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
And very often does.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Are the witnesses saying that, in this case, the radiology entity - the private entity operating on hospital grounds - does not involve insourcing as such?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Where they used the equipment in the hospital was insourcing.
Ms Mary Day:
Yes. The private radiology group does not have an MRI, so it uses the equipment in the hospital. That was insourcing. The radiographer and the nurses who were supporting that work were paid under public pay. The vendor was giving a component to read the scans. The funding that was got from the NTPF was the total funding.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
If they did not use hospital equipment but the doctors from St. James's were carrying out work in the private radiology service, Ms Day does not describe that as insourcing.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Even though the clinic is on the grounds of St. James's and even though we are talking about the same doctors, Ms Day does not describe that as insourcing.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
These are doctors in a public service who are dealing with patients and who could also potentially be dealing with those patients in the private clinic. Am I right in saying that?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I understand that, but they are the same-----
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I understand that, but the same doctors doing the work in St. James's public hospital are doing it in the private clinic.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
And potentially dealing with the same patients.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
If a patient is referred from the public hospital to the private clinic, the doctors could be doing work-----
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I understand that. I am getting at what I perceive to be a conflict between doing work in the public sector and in the private sector. The waters are totally muddied, as far as I am concerned. There is a spectrum that involves pure insourcing at one end and pure outsourcing at the other. There is a whole range in between where things get muddied. That is what we are trying to get to the root of today.
Ms Mary Day:
As our regional executive officer said before the break, the national controls being put in place for insourcing are very robust. We are in compliance with national policy around insourcing. The executive oversight group we set up in the hospital is providing an additional layer of assurance-----
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Ms Day spoke of the €4.7 million over an eight-year period from 2017. Why did it start in 2017? What triggered it?
Ms Mary Day:
In 2017, a limited volume of work was given to this vendor. The reason that this work was given was purely for mammography. The hospital was not able to meet its ten-day deadline for seeing a consultant and having an investigation for urgent breast cancer care. It was so serious that it was escalated to the oversight performance review.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Was this private entity there prior to 2017?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
But it was not getting work referred to it by the hospital.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
What changed in 2017?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
There were activities prior to 2017.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I understand that but were there referrals to it from St. James's Hospital prior to 2017? No. That only commenced in-----
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Going back to the apology, I am again trying to understand. The apology seems to be centred on the procurement processes as opposed to the principle of patients being referred to a private clinic on the same grounds with the same doctors. The hospital is not apologising for that.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Does Ms Day not think there is a cosiness there? These are doctors she is in the canteen with every day, doctors she has a cup of coffee with, and they are getting work referred to them in a private clinic just 100 m down the campus.
Ms Mary Day:
Professor Kennedy outlined why we used this vendor. It would be helpful to outline that again. Just before he comes in, I will mention a second thing. Controls were in place. There was an independent scheduling system. It was not that the radiologists were taking the work. The work was given to them. Their core activity was met and exceeded. It is not just that it was met but they were actually doing more.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I understand that.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I am sorry. I am really caught for time. I have three minutes. On the 18 directors, I assume there are doctors who are not directors. What is the total number of consultant doctors who are working in St. James's and doing work in a private entity and who are not directors? I presume there are people who are not directors.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I understand that but were they all directors? Were people who are not directors in these dual roles?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
They were all directors. It was only the 18 across all-----
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
The consultants also do work in the public hospital at St. James's.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
That is what I am trying to say. How many are we talking about?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Around 50 consultants were working in the public hospital and also carrying out work in the private radiology service.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Where are the others?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
We are talking about separate disciplines.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
The other consultants are effectively just renting a space.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
They are renting that space under the overall lease we referred to earlier.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
They are not renting it from the hospital but from the entity that leases the building.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
There is a series of leases.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
How many arrangements for space are in place within that outside building?
Ms Mary Day:
The reason that space is there is that not all of our consultants are on the public-only consultant contracts. We have to provide a private facility for consultants who are not on the POC contract. That represents 20% of our consultant workload. Not all of these consultants use this facility, but it is available.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I am still trying to understand. The radiology services have a lease but they are-----
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
They have a licence, a lease, whatever. There are other spaces that St. James's is paid for. How many other spaces are we talking about? How many other arrangements are in place?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
We are just trying to understand. What I seem to be hearing is that there are consultants who are using this building on the grounds of St. James's to carry out private work while also working in the public hospital. They are not part of the radiology services. They are renting space. How many are renting space?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Is that insourcing or outsourcing?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I understand that. I have one final question, if the Chair will allow it. It was mentioned that, after 2024, consultants were brought in on public-only contracts. Are those consultants doing any outside private work?
Ms Fiona Curneen:
To clarify, the public-only contract was introduced in 2023. It came into effect in March 2023. The radiologists we are referring to would have transferred over to the public-only contract in late 2023. Throughout 2024 and into 2025, we reached a figure of 80% of consultants being on the public-only contract.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Some of those doctors who were on the public-only contract after 2024 were carrying out work in this other building on the grounds.
Ms Mary Day:
It is not them all. On the public-only contract, the radiology facility is separate, it is under licence and is at arm's length from the hospital. The issue of public-only contract holders is currently under review. Those contract holders are not using the private clinic. It is more for those who hold other contracts.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
There are still some.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
That is what is under review.
Ms Mary Day:
That is what is under review. We are working with the regional HSE to ensure we are compliant. We are compliant with the public-only contract.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I am familiar with St. James's Hospital. I know many good people who work there. The witnesses are very welcome. I will follow on from Deputy McGrath's questions. Consultants on the new contract are required to provide 37 hours to the hospital per week. Do they ever do overtime? Are they paid for overtime? Is it routine for consultants to do overtime?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Consultants do not push back on providing overtime, however.
Ms Fiona Curneen:
In relation to the contract, the contract is for 37 hours. The work practice plan sets out the duties to be fulfilled therein. On-call arrangements are also fulfilled. The contract allows for the hospital to request consultants to work overtime on an exceptional basis. That happens routinely across disciplines. The contract facilitates that. Overtime can happen.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Consultants are doing overtime.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Are they doing it?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
My question is whether consultants are doing overtime.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
In terms of a cost-benefit analysis between overtime, insourcing and outsourcing, which is cheaper for the State?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
It was more effective for diagnostics but that is not the case across the board, is it? Has that been looked at for each discipline?
Ms Kate Killeen White:
I can come in on that. In the context of seeking a derogation for third-party insourcing, there are levels of assurance we need to go through before a derogation can be sanctioned.
The first is that core work is always a priority, including utilising the levers available to us in terms of productivity and utilising the POCC.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Is there a possibility for the HSE to push back and say that instead of insourcing or outsourcing this work, people should be asked to do overtime? Does that happen?
Ms Kate Killeen White:
Once we have exhausted the piece around the core work, the 5/7 roster and the POCC, then there is the option for regular insourcing through the use of standard overtime, and that would be directly organised by the hospital or the service. If that was not an option, agency staff-----
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Does the HSE produce an annual report, broken down by hospital, on that?
Ms Kate Killeen White:
In terms of the Dublin-midlands region, the derogations we have received are from St. James's Hospital, and one other hospital in the region has made one application for a derogation. We look at that in the context of the applications that are being made. We are looking at it in the context of trying to-----
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Thank you very much, Ms Killeen White. In terms of maximising the public hospital's assets, in particular every hour of the shelf life of the MRIs, ultrasounds, etc., what is the average run-time of, let us say, a CT scanner on a seven-day basis, not a five-day basis?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Five days a week?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
What is the average?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I would appreciate it if Ms Day could write to us to let us know the average run-time of key assets in the hospital, on a seven-day basis, not a five-day basis.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Outside of the emergency department, I want to know about all of the assets.
Professor John Kennedy:
We have three CT scanners. Two of them are in the main department and one is in the emergency department. The one in the emergency department runs all the time. The other scanners run Monday to Friday, 8 a.m. to 5 p.m., and the MRI similarly. If we ran the CT from 8 a.m. to 8 p.m. and-----
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I am very caught for time.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I absolutely agree.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Is that a priority in terms of recruitment? I know staff numbers have been increased over the last couple of years.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I am asking about the priority within recruitment. How many-----
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I will move on to funding. In terms of the insurance, I noticed that the State did not manage to recoup €396,000 because of administrative issues within the hospital. We did not recoup nearly €400,000 from private insurance firms. That strikes me as a kind of casual attitude to taxpayers' money. On the one hand more money is being sought from the State and on the other hand we are not recouping €400,000 from private entities. Can Ms Day give me any confidence that we will not see a repeat of that in the 2025 accounts-----
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
-----and that the issue has been fully addressed? I know it is not unique to St. James's Hospital but it is a serious issue and one that really annoys me.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
It is still four ultrasound scanners. The health budget is huge. There is no point in equating it to that. We are talking about always wanting more money but not recouping from private insurance.
Ms Joanna Bennett:
This memorandum of understanding is with one insurer in particular. It is a national agreement that the HSE made. We - the hospital - have invoiced on time. It is that the fully collated claim can be very difficult to get across complex cases where there are multiple inputs, whether it be the patient signature or alternatively or the number of consultants across it.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
What is the key driver for this €396,000 not being claimed? Is it the lack of a patient signature?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Does Ms Bennett have a breakdown of what the mix is?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Ms Bennett should write to the committee and let us know what the breakdown is, because I do not want to be here next year hearing the same excuse. There are steps that need to be taken. If a patient signature is needed, it should be obtained at the time.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I have been through emergency departments. I nearly signed my life away-----
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
It is really important to address this. In terms of the 2025 accounts, will we see a repeat?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Yes, but even if it is than 1% of a huge budget, are we looking at €400,000?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Just give me an approximate figure.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
There has been slight progress, but it still equates to two ultrasound machines in real life. In terms of non-compliant procurement, in 2023 the hospital was approximately 86% compliant in monetary value. Is that right?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Okay. When Ms Bennett refers to a full sample, does she mean all contracts or just a sample of contracts?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Okay, so 14% of monetary value was non-compliant. Obviously, we are looking at huge budgets. Am I right in saying that equates to €37 million?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
The 86% compliance rate looks great on paper, but it is the real figures that we need to be concentrating on, not the percentages. Does any of that €37 million fall into this insourced-outsourced category outside of the €4.7 million or what we have been speaking about already?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
The ones Ms Bennett was speaking about earlier, but there are no others. Is there anything else in the insourced-outsourced category that we have not been speaking about?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Good. How will that be addressed?
Ms Joanna Bennett:
We have a corporate procurement plan that is revised every three years, so it is up for renewal this year and we have it in draft. Out of that €36.6 million, we have addressed €6.6 million since that report, so in 2025 and into 2026. We have a further €1.3 million targeted for quarter 1 this year, which we are drawing down in HSE tenders. Then from quarter 2 to the end of this year we have a further €4.4 million of the €36.6 million, across 22 vendors, which we have planned.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Is this a priority for the hospital to address?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Does the hospital have any ICT projects? If so, are there any implementation issues or cost overruns with them?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Well done. I love to hear that.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
I have to say all of this is just shocking to me. I had some awareness that this exists, but to see in reality the corrosive impact of private money and private profit in the public health system is quite something. Effectively, what we are saying here is that since 2017, a company owned by 18 doctors in St. James's Hospital got €4.7 million in payments without a procurement process and without a contract. It is pretty shocking. In the opening statement, there was an apology for the €1.4 million. Following questions from Deputy Geoghegan, heard that the figure since 2017 is €4.7 million. It was €1.4 million in 2024 and €4.7 million since 2017. Why was the €4.7 million not mentioned in the opening statement?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
At what stage did Ms Day become aware there that any money was going to this company in this sort of process, without a contract and without procurement?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Without procurement and without contract.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
So, limited as it is, you have got-----
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
No, 2017 is pre-Covid.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Was the board aware of it in 2017?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
It was aware of it in-----
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Yes, okay.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
And 2018?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
In 2019?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
And then in 2020?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
And 2021?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
We are getting into the millions of euro in 2021, 2022 and 2023.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
It is tens of thousands in-----
Ms Mary Day:
I am sorry, Deputy, if you do not mind; in 2021, when the health system was in the midst of Covid, there was emergency legislation in place, and we utilised that. That was for procurement whereby we could go to award a contract. I do regret this, and that is why I am apologising. We should have fixed that earlier. However, there were circumstances there that we do need to be aware of, and I think-----
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
I will clarify and then I will move off this. Is Ms Day apologising for the €4.7 million or not?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
All of it.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Including the Covid.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
So, it was a mistake.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
You do not apologise for things that were not a mistake. I am not blaming Ms Day personally, but-----
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Yes, but you made a mistake.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Then I would not be apologising for not doing a procurement process. You either apologise and say it is a mistake or do not apologise because it is not a mistake. I just-----
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
You need to choose a position.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Okay. I will move on. Does Ms Day accept there is a conflict of interest here in that, effectively, the slower these public consultants go in their public job, the more money they make from a private contract?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Let us just deal with a hypothetical first of all. Is it not the case that the fewer patients they deal with in their public time, the more money they would make through a private company from insourcing?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
That is not what I am asking. If they saw fewer consultants in public time, would they not make more money from private?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Ms Day is saying they would not.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Why not?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Therefore, if I am a doctor and, let us say, I normally see ten patients in a given period and I begin to see five instead in the same period, would that not result in more patients being insourced?
Ms Mary Day:
No, what that would result in would be that consultant not utilising his clinic. The consultant would be brought in to a meeting to explain why he was not utilising his clinic and why he was underseeing his productivity level. We have those controls in place to ensure that does not happen.
Professor John Kennedy:
I am going to agree and disagree with the Deputy. Potential conflict of interest is baked into the system of funding. We have a system of funding in the public sector basically based on the idea that people are appointed, they turn up and they are paid. The private sector has a basis of funding whereby people can turn up, do something and get paid. That is a separate discussion. These radiologists do not decide what X-rays get done. The patients get scheduled for an X-ray by a scheduling department. The patient turns up at 8.15 a.m. or whatever and they get put into the scanner and have their scan. It might take 25 seconds if it is a routine scan. It might take an hour if it is a lung biopsy done percutaneously. Then, they have to report that. They do not, therefore, get to decide how much scanning they do. They do not get to decide how many patients get done in the public system. The system decides how many get done. Does the Deputy understand? It is a process.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Yes.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Do the witnesses know for certain that none of the insourced-outsourced work that these doctors were doing happened on public time?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Does Ms Day know that for certain?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
That does not tell us that.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
That does not prove that. That is not proof-----
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
-----just because the core activity increased. Maybe there was extra slack and people could do a bit extra around it.
Ms Mary Day:
No, that was not the case. The level of the core activity increase tells me that they are actually doing more in the public space, but the independent scheduling system we put in place ensured they were not taking patients from this list and taking them over here. Also, the funding that was given for this by the National Treatment Purchase Fund, NTPF, came in three separate tranches, and the NTPF also has very tight controls in place in relation to these initiatives. It will not give us the money until we take the patient off, so there were very tight controls both from the National-----
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
The real reason Ms Day is saying that they cannot possibly have done any of this work in public time is because it would turn up in a scheduling system.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Yes, okay.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
In terms of the use of the MRI scanner as part of the insourcing, does this company pay any fee for that? Where it is using public equipment, is the company paying a fee for the use of that equipment?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
It is baked into the fee that is paid.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
In terms of the space, the medical centre at the top of the building, what comes as a part of that? Obviously, they are paying a certain rate, which is for the space, but is there anything included in that to which they are getting access?
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
There is no medical equipment or anything like that as part of that.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
Obviously, it is because of the potential for a conflict of interest. I am not arguing in this case that these particular doctors did it or whatever, but the potential for conflicts of interest is why we have registers of interests. The exact same process applies to TDs with the Standards in Public Office Commission, SIPO, in January. We have to do this at the moment. Obviously, and we have been over this, none of them declared the interest. Then, as has been outlined, this was discussed with them and they were told that they had to do it and then they immediately addressed that and did it. Beyond that, there were no repercussions for the staff. We have heard that there was no deduction of pay or any formal sanction, and none of them lost their jobs. Apart from the fact that they were caught and then changed it, there were no negative repercussions for the staff.
Ms Mary Day:
I am sorry for interrupting; yes, the Deputy is correct, and Ms Curneen will go through the process again. We have strengthened the process and controls going forward, but I believe that with the increase in awareness and education we have put in place and the information portal, there is a very heightened awareness across the hospital in relation to this issue.
Ms Fiona Curneen:
Again, I just want to start by saying that the non-full disclosures are a regret within the hospital, which we acknowledge have been immediately addressed, and the continuation of the services to deal with cancer care and cardiovascular diagnoses was critical. There is the part of the corporate governance that has been addressed and rectified, and there is the aspect of the performance of the consultants providing excellence to patients, again, routinely working above their contractual hours and on-call arrangements. It is the combination of the consultants in question, the activity they carry out in their core responsibilities, their immediate actions to rectify their omissions and then, as an organisation, our culture of ensuring that we are strengthening our controls around this and our commitment to reach 100%, which we are saying is mandatory. That is how we are improving and strengthening all the time.
Paul Murphy (Dublin South West, Solidarity)
Link to this: Individually | In context | Oireachtas source
I have one final question. It relates to the issue of the radiotherapy treatment machines called linear accelerators. It is an issue that Deputy Boyd Barrett raised after his own experience. As I understand, the machines have a maximum lifespan of ten to 15 years but are not being replaced generally until much later than that, which leads to breakdowns, cancellations, etc. I understand that in St James's Hospital, there are four machines, they are 14 years old and they will not be replaced until they are 17 or 19 years old. Will the witnesses speak a little bit about that?
Ms Mary Day:
Before Ms Killeen White comes in, the radiotherapy centre on the St. James's Hospital site is operated, governed and run by the HSE at St. Luke's. That question does, therefore, need to be directed to the REO.
Ms Kate Killeen White:
I can come in on that. St. Luke's Radiation Oncology Centre, or SLRON as we know it, operates across three sites - Beaumont, St. James's and St. Luke's Hospital in Rathgar.
It is undergoing a major multi-year equipment replacement programme to upgrade the ageing linear accelerators, linacs, as was quite rightly pointed out.
The programme is designed to replace 14 linacs and associated imaging equipment, with completion expected by quarter 3 of 2030, and then additional enhancements in Beaumont scheduled for completion by quarter 3 of 2031.
Professor John Kennedy:
We have the pleasure of having some of the oldest linear accelerators in western Europe. There are problems with this. They have to be replaced and continue to function at the same time. It is like building the flyovers on the M50 after the first effort at it. Second, they were all commissioned around the same time so they all have to be replaced at the same time, which is another problem, and buying and installing a linear accelerator is not a simple problem. We then get to the issue of replacement of complex equipment which needs to be planned for on a multi-year basis in the health system, and that does not happen.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I have several questions before I open it back up to members again.
As regards the company involved - St. James's consultant radiologist group unlimited company - it was stated a several times that the first payments to it were in 2017 and those figures from 2017 onwards were cited. The witnesses might furnish the committee with a copy of those figures on an annual basis and what exactly those charges were for. That company was set up and registered on 4 January 2010. Do the witnesses have any knowledge of any work engagement between those intervening seven years between 2010 and 2017 when it was first cited here?
Ms Mary Day:
First, I was not in the hospital from 2010 to 2020 but the private radiology service was provided to provide private radiology work. What we saw in 2017, as I explained, was that we had a specific issue and then in 2020, 2021 and 2022, we saw the demand for diagnostics in the system just completely-----
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
No, I get that. I am trying to establish-----
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I will get to that. I am just trying to establish whether there were any transactions between 2010, when the company was first set up, and 2017. Was there nothing whatsoever?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
There were no payments, categorically.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
A quick search on the companies' register shows the company has 18 directors, which we know, and a number of those are directors in 13 other companies. Are any of those directors involved in other companies doing work within St. James's?
Ms Fiona Curneen:
Again, I will answer the employee disclosure part. The 18 employees, as part of their full disclosure, disclosed where there was potential conflict and have listed this entity, the vendor we have talked about - the radiology private - with others but they are not parties that are of conflict for St. James's. I can only speak for to employees making full disclosures.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
They are making full disclosures.
On the companies' register, 13 are still directors of other companies. Are those directors, staff within St. James's, doing work for other companies?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Okay.
It is disappointing, and I agree with Deputy Murphy, that although in the opening statement sincere apologies were expressed for the €1.4 million, at no point, despite the fact this issue had been highlighted by the C and AG and is a cause of serious concern for the Committee of Public Accounts, was there a reference to the other €4.7 million that had to be extracted through questioning from Deputy Geoghegan. That is unfortunate. It would have been helpful for full disclosure, given the topic of concern and one of the reasons for the questioning and engagement today. I know it has been addressed but-----
Ms Mary Day:
With regard to the C and AG audit findings for the 2024 accounts, we were asked to come to discuss the 2024 accounts and that is the reason we concentrated on that. That was over an eight-year period and it delivered 35,000 scans. When we look at 2021, 2022 and 2023, I feel Covid was the main driver in relation to-----
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I get that. Going back to 2017 and the decision to start using this company, how did that come about? Who made the approaches and what were the discussions? I know there was no tendering process and there was no contract put in place. Was there any type of agreement put in place between the company and St. James's?
Ms Mary Day:
Unfortunately, I was not CEO of the hospital in 2017 to 2019. My understanding of the transaction that took place was that it was very specific to one element, which was mammography for breast cancer patients, because they were not meeting the ten-day target. The reasons it was put in place was for safe, better care and getting access to-----
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I get all of that. I am just trying to establish how it came about. Who made the approaches? Was it St. James's to this company or what actually-----
Ms Mary Day:
As I said, it is difficult as I was not in the position but my understanding is that it was a request, specifically because the hospital was so concerned in relation to that KPI. To be called up in front of a national performance oversight group is quite serious. From my experience, even at a group level, for a chief executive and a clinical director to be called up in front of NPOG, which is the national performance oversight group, would have been very unusual.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I assume there is an audit and risk committee within the hospital. Is anyone here from that?
Ms Catherine Mullarkey:
I might take that. An internal audit was requested into payroll and procurement and was presented to the ARC and the board in July 2023. It covered the preceding 12-month period, from 1 July 2022 to 30 June 2023. It highlighted the private radiology group was providing an external service to the hospital to meet an urgent clinical requirement.
At the time, the ARC and the board understood, or we were told, the MRI procurement was in hand, which it was. It had started in January of that year. It was understood the CT and ultrasound procurement would commence once the MRI procurement was finalised. It is regrettable that it took longer than anticipated for the procurement to complete but to be fair, when the board is making decisions around procurement and governance, the patient is always centre in our decision-making. It is always a difficult balance between keeping the patient safe, meeting our delivery requirements and meeting all the governance.
At the time, the sense was we would not call for a cessation of the services with the private radiology group because of the risk of adverse patient outcomes.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Ms Mullarkey might furnish the committee with the minutes of those meetings she has referenced - I think it was July - and that review that was carried out.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Ms Mullarkey might furnish us with that.
Might we have furnished to us a comprehensive list of the derogations sought and granted, and also a copy of the review carried out by the HSE on the insourcing?
I get the privatisation dimension and that there is a policy that has been handed down over many years. It is not specific to St. James’s, which has to work within the parameters laid down by successive Governments. What is happening is absolutely scandalous and completely wrong and it has created huge problems. Having listened to some of the members, I agree with the line of questioning implying the source of the cause is much higher. It has resulted in many difficulties, even in terms of the floor space that is being rented out to what I suppose is a private operation. I think a figure of €52,000 per annum was given.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
What is the square footage?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Over how many years has the €52,000 charge been in place?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
It is €1,000 per week. It was mentioned that that includes heating, lighting and cleaning. Someone said there are separate bills for electricity. Am I right about that?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
For machinery but all other costs, including those of heating, lighting and cleaning, are covered.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Any private business would give its left arm for a deal of €1,000 per week for 1,200 sq. ft, including all the services and costs captured. I ask that we get a copy of the review carried out in 2024. It would be interesting to see how it came about.
It was said that the consultation space in the public hospital has been rented out. On what basis? How are the calculations arrived at?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Okay. The review was carried out in 2024, so Ms Bennett might give us a breakdown of how much was billed for and how much was paid from 2024 to date but also in the five years prior to that. It is just to get an insight. The figure for renting the floor is for the post-2024 period. Might we have sight of what the figure was prior to 2024?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Who in the organisation is responsible for ensuring the statements of interest are adhered to?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
No. Retrospectively, there has been a robust process but-----
Ms Fiona Curneen:
Maybe I will set out the process for the Cathaoirleach. The role of HR is to gather, identify and validate the designated employees to make a return. On identification, HR operations engage and request all persons identified to fulfil their obligations in a return. I joined in late 2023 and saw in early 2024 the opportunity to enhance our compliance. I digitised the process for the period. We saw the compliance rate go from 40% to 75%. We are not fulfilling the requirement to be at 100% but we are committed to doing so. However, the figures show our corporate governance is increasing year on year. In 2024, the rate reached 84%. That is the initial process of gathering. Then there is the review period. In my role as director of HR, I carry out a review of disclosures made. I have set out the process in the appendix. The information is then directed to the board secretary and the CEO for due diligence, to have a further review of the disclosures.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
What role, if any, does the audit-and-risk committee play in this?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
But the audit and risk committee would have been aware of the low rates of compliance. There was a rate of 40% when Ms Curneen took over.
Ms Catherine Mullarkey:
Yes, and we would have been urging full compliance. Again, there has been a process. Even with individual consultants, it is a matter of an education piece first and foremost. It is not that people are reluctant or that they mean not to be transparent. It is actually just about appreciating what a return actually means and the importance of it.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Did the committee identify it as a risk and elevate its concern to the board?
Ms Fiona Curneen:
Can I add to that? On joining in late 2023, the internal auditor did discuss the matter relating to our returns. At that point, we took action to strengthen our controls to make all efforts to reach 100% and put the necessary steps in place. There was action taken in late 2023 and early 2024. We digitised in early 2024. We started doing awareness and communication sessions with all parties involved. As a result of those very intentional steps, we were seeing a greater compliance and full-disclosure undertaking. We accept and regret that the employees did not make a full disclosure but their actions and immediate rectification of the omission continued in their subsequent disclosures through to 2025.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I thank the witnesses for that. I will now open the discussion to members for a second round. The time will be reduced, so members should try to keep each contribution to within five minutes, if that is acceptable to our witnesses. We will try to get them out of this as quickly as we can.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I thank the Cathaoirleach and thank the witnesses for staying on.
How many POCC consultants are currently employed by St. James’s Hospital?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Eighty percent of 307, which means approximately 250 POCC consultants.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Okay, so it is 284. If a consultant wants to do private work in excess of the 37 hours they must do, is there an unconditional right to do so or are there specific circumstances that permit a POCC consultant to carry out private work?
Ms Fiona Curneen:
The contract is to fulfil the 37 hours and there are on-call arrangements. Under the work practice plan, the consultants commit to fulfilling their duties in full. That is the contract of employment obligation. Thereafter, consultants can carry out private activity if they so wish. However, the POCC relates primarily to fulfilling the requirement to do 37 hours, and the consultant is on call.
Ms Mary Day:
Ms Curneen is absolutely right but we can no longer see private patients on public facilities.
Public only consultant, POC, contract holders cannot see any private patients on public facilities. Once they have done their 37 hours and their on-call duties, they can access private facilities, but not on public facilities.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
What are the governance mechanisms of the hospital employer in terms of the fulfilment of the 37 hours and the private work? How does that work?
Ms Mary Day:
Basically, every consultant, when they join the organisation, sits down with their clinical director and fills in a work practice plan, which clearly outlines the direct clinical care, non-designated time, NDT, work, and the education and research, if there is any. That work practice plan is signed off with the clinical director - because we work in directorates - and then it is reported to HR. What we will do as a hospital, and we are already looking at, is use the internal audit as an audit mechanism for checks and balances.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Does St. James's Hospital have a system that knows whether consultants who are carrying out private work have met their 37-hour thresholds? Does the hospital track private work done on top of the 37 hours as well? Do consultants have an obligation to notify the hospital if they are carrying out private work, once they have completed their 37 hours?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
If they are carrying out private work on top of their 37 hours, do they have any obligation to notify their employers?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Who signs off on that? How does that work?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
The clinical director signs it off.
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Is there any tracking of the private work that is carried out or is that a private matter for the individual?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Does overtime compete with private work that is done on top of the 37 hours or what is the structure? If the hospital had funding and wanted a clinician to do overtime, which takes precedence? Does overtime take precedence over private work consultants may wish to carry out on top of their 37 hours? Does either take precedence?
Ms Mary Day:
Basically, the whole purpose of the POCCs is in relation to productivity, fulfilling the core working hours and looking at how we are increasing that. It is unusual, even in my hospital, that we would look at overtime, because there has to be a specific risk or clinical need for us to use it. Often, it is not just a consultant doing the overtime. If a consultant is running a clinic-----
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
The hospital has to get all the others, the whole thing, and that is the point Professor Kennedy made about the CT and MRI scans.
The hospital apologised for a systems failure. Another way to look at it is as a governance failure. I do not know whether the witnesses agree, but I think it is a governance failure. In fairness to Professor Kennedy, he asked fair questions, such as how this need would have been met in the absence of the decisions taken. Ultimately, however, this boils down to these clinicians having an advantage because they knew the clinical needs of the hospital. There was a funding mechanism available to the hospital to draw down. Everything was above board. It was all done correctly. Nothing was breached, but there was a governance failure in the sense that overall the hospital did not acknowledge in any formal way that it was providing moneys to people who were directors of companies or employees and the structure of that was not properly known or understood, or if it was understood, it was not spoken about or deliberated on. Is that fair?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Was the board informed about these issues the C and AG identified through the random audit, before he identified them? Had the board discussed the big funding? I am not talking about the €46,000 back in 2017 or 2018. Did it go to board level? Was it discussed and assessed? I am not asking about the ethics declarations. Everyone in the hospital knew who these people were and that they worked for the hospital. They did not know whether they had filled out the forms, but they knew they worked in the hospital and that it was giving money to them, even though the board members might not have.
Ms Catherine Mullarkey:
As I alluded to, it came to our attention on foot of an internal audit, which I have promised we will provide, in July 2023. At that point, €1.1 million had been paid to this private radiology group over the preceding period of 12 months. This was of concern to the audit and risk committee, ARC, and the board, but we were somewhat assured that the moneys had been tendered for under a national procurement programme, as in a national programme was providing the funding and there were strict controls around it. Furthermore, we were keenly aware of the deficit in capacity in the hospital and that this was basically a safety valve for us to meet our demand and not have to give rise to adverse incidents.
When we discovered that these were not properly procured, we were told the MRI was in train and it was envisaged that the procurement of the CT and ultrasound would happen immediately thereafter. It was our understanding that it would happen within a much shorter timeframe than has unfolded. However, we did not feel it was in the interest of the hospital, and most importantly our patients, to call for a cessation of the service from this particular vendor because we understood the critical need for the service to be provided.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Is there a full internal audit team in place?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
When was that person or role put in place?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
The first time this was flagged in an internal audit report was in 2023. Is that correct? Is that what Ms Mullarkey said?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Did it ever turn up in an internal audit report before that?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Does the report go directly to the board?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Can we just get clarification, when Ms Mullarkey comes back in with information, whether it was ever raised before 2023?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Did it ever pop up in an internal audit report before that?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
What was the number in 2021? It was €4.7 million and €1.4 million and small amounts up to 2020.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
The years 2021, 2022 and 2023. We went up to that and then we stopped.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Okay, so it kept growing. When was the last one done? Is the €500,000 still ongoing?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
That is the full year of 2025. When in 2025 did it stop? Was it cut off in June or anything?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Is it ongoing in 2026? That is my question.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
It has been fully procured. That is what I was wondering. When was that final procurement clarified?
Ms Joanna Bennett:
It was on a HSE framework that we used for the MRI insource in January 2024 and the contract was signed in April 2024.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
It was in April 2024 that the contract was finally signed and it was done correctly from then onwards.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Jumping to another item, were there termination payments in 2023?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Was it to one person?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
What was that in relation to?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
This is a significant amount for one person.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
There has to be a very good reason, though, for confidentiality.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
No one seems to know this person.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Okay.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Was the person there long term?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
That is a lot of money for someone who was there two-to-three years.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Let us think about this one for a split second because sometimes you can wonder about these things. You can pass them off. If I gave €179,000 to someone who has only been in place two-to-three years, that is a lot.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Even if it was five years, it is still-----
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
What sort of situation would it be for a termination payment like that? That is a significant amount of State money, if somebody walked away. How do you define a "termination payment"?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
That is a catch-all word we can always say. Is that a redundancy? Is that someone being told to leave? Is that someone who raised something and was given money, like €179,000 go-away money?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
So you gave a person money to leave.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I know but at the same time a termination payment can also be some-----
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Was there disciplinary action?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Okay. Does Mr. McCarthy want to come in?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
They said you did - I am joking.
Mr. Seamus McCarthy:
I did look at the process around the termination payment in the context of the 2023 audit. I would need to go back and refresh my memory on it but I certainly was satisfied at the end that the process that should have been followed was followed.
I would generally not try to get under the bonnet of why a termination was agreed unless it was the chief officer of an organisation or perhaps the head of finance function. Otherwise, I would not normally be drawing it to the committee's attention, unless, say, a sanction that was required had not been sought.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
The amount indicates someone who is at a senior position.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
The other issue was-----
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Briefly, if you can.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
No, I noticed everyone else is getting two or three extra minutes here. We can all see the clocks.
The other issue was there were other consultancy payments of €793,000. What were those costs relating to, because they are not itemised? It is a significant sum. I think it said legal and "other" and I am curious what "other" concerns. Ms Mullarkey may want to come back with that information.
Finally, on the parking, does the hospital lease out it? Is it the hospital's own parking? Is it privately owned? Is it leased parking?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Does the hospital own the site?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Okay, you own the space and it is operated by somebody else.
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Do they pay a percentage of the parking or how does that work?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Are staff charged?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Lastly, would cars be clamped? Would many cars be clamped in the year? How many cars were clamped last year?
Joe Neville (Kildare North, Fine Gael)
Link to this: Individually | In context | Oireachtas source
It is pay, in and out. That has changed. It is electronic, in and out, like Liffey Valley. That is clear. All right, that is fine.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I thank Deputy Neville and call Deputy Bennett.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
My question was actually Deputy Neville's last question in relation to the €793,000. What was that for?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
It just said "other" consultancy costs.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
How much does the hospital spend on PR and marketing engagements?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
On the PR and marketing, can Ms Bennett tell me what the hospital spends on PR and marketing?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
What would the hospital be marketing?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
That is why I am wondering. I am just wondering-----
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
-----what would you be marketing in a hospital. That is what it says in the books. I am just going on what it says.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I am still confused. What public relations and marketing would you need in a hospital?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
In the financial statements, it says it is. It says: "public relations/marketing", €144,000.
Ms Mary Day:
I do not know. It is not marketing. We would use the public relations company in supporting our internal communications team, for instance, when the comprehensive cancer centre accreditation was awarded and we wanted to promote the hospital. We are proud of St. James's. We are proud of the hospital and we want to promote aspects of that. We utilise the support of PR to enable us to do that and also to help us in relation to ensuring that the reputation of the hospital is, as it is now, of a high standard.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Please.
Ms Joanna Bennett:
PR and marketing is a kind of standard format in the accounts. The PR is the large balance on that, to which Ms Day spoke to. Some of the marketing is kind of marketing communications. It might be like communications to staff, brochures and that kind of stuff. That is the smaller fraction of that figure.
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
So it is €144,000. Did Ms Bennett find out what the €793,000 is for consultancy costs?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Would there be any of the staff who are working in the hospital involved in consultancy costs?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Would they be part of any companies or anything that are involved in those consultancy costs?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Employee costs went up by €60 million from 2023 to 2024. Why did it go up so much?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Would it have nothing to do with the staff who had been paid in the radiology private clinic that were moved back into the hospital?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Has it anything to do with the staff who were paid by the private radiology clinic and then moved back into the hospital? Is the €60 million the additional cost that it would have cost to do that?
Cathy Bennett (Cavan-Monaghan, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Can you tell me what the termination payment was in relation to? Are you allowed to identify that? No. Those are all my questions.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I thank the witnesses for bearing with us. Can I clarify something in relation to the declarations, the ethics and so on, is it the case that all medics working in St. James's publicly have to declare private work they are doing?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
If I am a doctor working in St James's as a consultant on a public-only contract, do I have declare private work I am doing?
Ms Mary Day:
On a public-only contract - and I keep going back to reiterate - once a consultant has completed the core 37 hours, she or he sits down with a clinical director and the clinical director has to be satisfied that the public commitment in the public facility is fulfilled. They have to declare it to the clinical director, if they want to do private work.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
They have to declare it. So they do declare it.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Do they declare the value of that work?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
It is just that they do the work. We do not know what consultants are earning privately outside of the public contracts?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Can I go back to the private radiology company that has been the focus of a lot of attention here this morning? What is happening there now? A lot of its activity has reduced in terms of St. James's. Has the scale of its activity reduced significantly?
Ms Mary Day:
As I said earlier on this morning, the private radiology clinic does not just service St. James's. It also services GPs' work. In relation to what we discussed this morning, this is where we utilise that capacity with funding to deliver public work in the private facility. If I just talk to that, at the moment, the only work that is taking place in that private facility is any work that has received derogation, and that is just the breast work. All that is in compliance with the new insourcing guidelines from the HSE. A derogation request goes up to the REO and the REO then either approves or does not approve that.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Has the scale of activity between 2023 and 2024 compared with now reduced dramatically?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I am trying to understand things. We are talking about a significant reduction in that activity.
Ms Mary Day:
The reason that activity has reduced is that the emergency funding from the NTPF was paused. The funding in relation to the breast pathway continued because there was an urgent need, but that received a derogation. That highlights, as Professor Kennedy said, that we are still not meeting our total demand. We are 30% off the total demand for diagnostics that we need to meet.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I understand.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I understand.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
They can scale up that work, but in terms of the overall activity, it sounds as if it is down. We heard earlier that the clinic is 1,200 sq. ft. Are the other spaces being used by medics working in St James's separate to that 1,200 sq. ft?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Is the 1,200 sq. ft the size of the building in totality?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Is it a 12,000 sq. ft building?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
What is the other 90% used for? Is it used for work?
James Geoghegan (Dublin Bay South, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I do not think that what the gentleman said is being recorded in the transcript for the hearing.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Can we get clarity? The 1,200 sq. ft space is for the radiology clinic. Is that 10% of the private facility?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
The payment of 50-something thousand euro was made for the 1,200 sq. ft space. How much income is generated by the other 90% of the building?
Professor John Kennedy:
This is the third floor of an old building. It was there back in 1916. It is a preserved building. Several years ago, someone renovated the inside and turned it into a private clinic. At the far end of it is the radiology facility where they have a CAT scanner, an MRI scanner and a DEXA scanner. It is not very big. It is probably about 15% of the floor. The rest of the floor is a corridor. On either side there are rooms and those are consultation rooms. Consultants who are able to do so because they have the old contract can go in there and see patients for consultation.
I have to say, I think it is winding down. Increasingly, newer consultants do not want to do private practice. They are paid well and frequently have other duties because they have families at home. There is far less of this going on than there used to be and there are lots more consultants.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I am trying to understand things. In terms of the usable space of this building, 10% of it is taken up with the private radiology clinic.
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Is this all private work?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
Broadly speaking, what is the square area of the private usable area outside the space used by the radiology company?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
What level of income does the other area bring in?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
There are private medical services being provided in a building owned by St. James's. Is that correct?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
What sort of income does it bring in?
Séamus McGrath (Cork South-Central, Fianna Fail)
Link to this: Individually | In context | Oireachtas source
I have to stop at that. I thank the witnesses for their contributions.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
For clarity purposes, will the witnesses send us in a comprehensive note on how that is all broken down?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
One of the witnesses mentioned the annual disclosures of private work. Is that to the board as opposed to what is disclosed in the SIPO returns or are they the same thing?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
That is grand. I wanted to confirm that was what was meant. In terms of the 84% compliance rate, I do not want percentages, I want numbers. How many reports is 100%?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
There were 311 reports. How many of those were nil? Were there any nil reports?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
That was what I was getting to. There were 60 reports with disclosures. What was the nature of those disclosures?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
What does that mean?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Is that private work?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Absolutely. What is the disclosure limit or is it above zero?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Are 36 of the consultants earning private income over €2,600?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
What about the others?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
The directorships are not necessarily in conflict with their job and their core work.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Would the board then go through the 36 in relation to the income and the 22 in relation to the directorships to make sure there is no conflict? A report would be prepared.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Is there no report prepared on the basis of those SIPO returns with the 60 declarations? Is the board not getting sight of that?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Why is not routinely given to the board and the chair?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Could Ms Day give me an example of a particular concern? I am just trying to get a flavour of how this process works.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
There are none.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Is that not subjective? You are making your call.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I will ask the witnesses a different way. On the income being earned privately, what would they say is tolerable income that would not need to be referred to the board? Where is the line?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
How can the conflict ever be assessed?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
You have no sense of how much a consultant is earning in their private time.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Okay, that is fine. That is what it is. I still do not understand how conflicts can be assessed, but anyway. In regard to the 37 hours for consultants, it is not that I do not believe they do good work. They absolutely do. I have never worked in a job where I only worked 37 hours.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Is it the fact that consultants would work over 37 hours?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
I refer to consultants in the public service and the HSE.
Ms Mary Day:
If you walked into St. James's Hospital at six o'clock tomorrow morning, you will see surgeons rounding on patients. Hopefully you will not but if you passed our theatre facility at ten o'clock tomorrow night, you would see surgeons operating on patients. Thirty-seven hours is your core - and we all have a core - but, of course, consultants work way beyond those 37 hours.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Unpaid.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Is a report done on what the average is per doctor every year, even from a health and safety perspective?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
What would be the average amount of hours a consultant would do per month?
Professor John Kennedy:
I do not think it is as bad as it used to be. There are more consultants than there were. Back in the day, there were huge amounts of unreimbursed work going on. I remember a gynaecological oncologist, who is now retired, a wonderful woman. I met her one morning about a patient and she said, "I operated on her last night". I said, "What? I saw her at nine." She said that she operated at 11 o'clock. That was common. It is much less common nowadays as we have more consultants in the system and the hours are more human.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Good, but the witnesses are confident there is no health and safety issue in relation to hours.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Finally, if the Chair will indulge me - I know he probably wants to get in - in regard to the board, I notice there seems to have been a huge changeover on the board in the past two years. Is there a particular driver for that?
Ms Catherine Mullarkey:
I took up the chair of the board in 2022 and there was a number of long-standing board members who had been reappointed by the Minister before I took up the position. I was keen, from a governance point of view, to move those individuals, even though they had been great servants to the board. They had a huge amount of institutional knowledge and were a big loss to me, quite frankly, but from a corporate governance perspective, nine years is the absolute maximum. A number of them had been there 11 years so there was a transition period. This year, there has been a number of new directors brought onto the board. In 2019, I think about four or five us came in and then a lot of them basically retired by rotation.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
One director lasted less than two years. Is there a particular reason for that?
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Mary O'Connor.
Grace Boland (Dublin Fingal West, Fine Gael)
Link to this: Individually | In context | Oireachtas source
Okay.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I thank Deputy Boland. I have a number of concluding questions. In December 2024, St. James's Hospital was one of five Dublin hospitals that received what was described at the time as a bailout of €200 million to pay for staff costs. Is that accurate? How much did St. James's get in relation to that?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
It was 2024. It was reported in December 2024.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Okay. There were no additional staff costs or anything like that.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Okay. In relation to financial penalties imposed on some hospitals for not meeting set criteria, whether it is waiting time targets or whatever, were any financial penalties imposed on St. James's at any point?
Ms Mary Day:
No. We work diligently to meet our waiting list targets. The surgical hub in Mount Carmel has had a huge impact in relation to improving the number of patients waiting. What we have especially seen is that in a number of specialties, the number of patients waiting over 12 months has been dramatically reduced. If we look at our pain clinic, it was 12 to 18 months or two years. It is now below three months, so we value that additional public capacity.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
All right. I am just asking the question. It was mentioned earlier on that a business case was made in 2023 or 2024 looking for additional resources, finances, etc. Someone might talk to me about that.
Ms Mary Day:
As part of the yearly estimate and the HSE service plan, we bid for resources. Every year, as an organisation working with the region and up to the HSE, we would identify where we have key gaps in the service. We utilise that through our risk management system as well, where we see there is increasing risk in an area and then we would put in a submission in relation to key areas to prioritise where we believe we require additional resources. That is then sent up to the region.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Okay. When was that sent in? Is it every year?
Ms Kate Killeen White:
Yes, I can come in on that. As I said at the get-go, the region is focused on sustainable solutions rather than these short-term workarounds and reliance on insourcing and outsourcing. Every year, we would work with all of our stakeholders, including St. James's Hospital, around identifying where there are capacity or risk issues. Business cases are submitted to inform the estimates process.
Not all business cases are approved because we have to look at all business cases that come in right across the services within the region, but we work with St. James's Hospital. We identify where there are gaps in capacity and where there are risks. We endeavour to support as best we can.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
How successful has that been in terms of the asks?
Ms Mary Day:
It varies. We are never going to get 100%. It is a finite budget. It would be great if it was not and it all came to St. James's Hospital but that is not the case. For instance, in relation to new money, in 2025, we got approval for a 0.5 breast radiologist post, which was very welcome. That person will be starting in the next couple of months. That includes the cancer control programme. There will be other services in relation to safe staffing for nursing. That has been very successful in relation to the investment that has been made in that. In addition, we have got 93 staff to run the surgical hub in Mount Carmel. That investment was made in the hospital in 2025.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Obviously, there are big gaps there.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
A lot of that has been touched on. There are extra pressures and extra demands. What are the key risks from a medical perspective that need immediate investment, as Professor Kennedy sees it?
Professor John Kennedy:
It is now well recognised that delays in starting treatment for patients with cancer have an impact on survival. For three of the commonest cancers - breast cancer, colon cancer and lung cancer - it is well recognised that we see inferior survival rates when there are delays of more than six weeks in getting to treatment, whatever that may be; it is usually surgery. That is what drives and worries us.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
In terms of the staff configuration within the hospital, the witnesses gave a figure of approximately 5,000 staff. Are those staff all directly employed by the HSE? How many of them are agency staff?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
So there is no agency staff whatsoever in St. James's Hospital.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I want to conclude by discussing the issue of car parking charges, which a number of Members touched on. It is an issue of real anger for many people out there. When people go to visit loved ones in the hospital or go to the hospital for treatment, they see these charges a tax on ill health. As far back as 2018, the then Minister for Health, Deputy Simon Harris, initiated the review and made all sorts of promises to cap charges on car parking within medical facilities and to grant concessions for regular hospital users. Here we are now in 2026. St. James's Hospital has one of the highest car parking charges of any of the hospitals. That is despite commitments in programmes for Government and all sorts of plans to scrap charges or reduce them. Why does St. James's Hospital have one of the highest charges, at €15 per day, when at some hospitals the charge has been capped at €10 a day and some hospitals have further reduced charges?
Ms Catherine Mullarkey:
I believe the biggest problem at the St. James's campus is congestion. If I had my way, I would take all car parking out of the campus because people park their cars in areas of the campus where you are not supposed to park. If we were to introduce a new system where car parking rates were reduced or eliminated, the campus would just shut down. Ambulances would not be able to get in and out. Public transport would not be able to move through the campus. If anything, we would probably advocate for an increase in car parking charges, rather than the alternative, maybe with special dispensation for people attending for long-term or lengthy treatment on site.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
In 2024, some €1.8 million was brought in.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
It is seen as a cash cow.
Ms Catherine Mullarkey:
No, but it is not material. In the last couple of years, we have taken all staff parking off site because it is a critical issue for us now and it is going to become even more important when the children's hospital opens. That is why we are really driving our efforts to get our outpatient facilities on a separate campus so that we are not bringing our outpatients to the campus and the campus itself is confined to truly acute care.
Professor John Kennedy:
It is a complex problem. Large numbers of patients come to the site for a very short interval, for an X-ray or a very short visit. All of that needs to be moved off the campus. I am old enough to remember that before there were charges for parking on the St. James's campus, it was chaos. The general rumour was that most people who were parked there were dropping their cars, getting on a bus and heading into Dublin. Well, I should not say that. They were civil servants heading into town. They left their cars on the St. James's campus and headed into town on the 123 bus. There had to be some kind of solution.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I hear that.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Anecdotal evidence has been given from other quarters here. The real people who are being penalised, as I see-----
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
-----at other hospitals, are those who bring a loved one into the accident and emergency department and come out to find that their car has been clamped or whatever.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I am not saying that is the case at St. James's Hospital but it is an issue of real concern. There is a real failure at national level going back to 2018 when this review was brought in. There was a drive to cap these costs at €10 a day but despite that, St. James's Hospital maintains it at €15. We have heard that if St. James's Hospital had its way, it would double the charge and that is all of real concern.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
I would like to ask about the two-tier payment mechanism in the hospital. It has been reported in the past that the parking charges of those who avail of private services, or the private entity, are capped at €3 a day. Is that still the case?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Are they using the same car parking facilities as those utilising the public health services?
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
There was a report in 2017, when this issue was identified, that people paid centrally but the charge was capped at €3 a day and those people were using the same parking arrangements as those using the public side.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
So that is not happening any longer.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Okay. The witnesses can give us assurances that everybody pays the same rate.
John Brady (Wicklow, Sinn Fein)
Link to this: Individually | In context | Oireachtas source
Okay. That concludes our engagement for today. I thank the chief executive officer and her officials from St. James's Hospital for attending. I also thank the officials from the HSE and the Office of the Comptroller and Auditor General for their attendance. Is it agreed that the clerk will seek any follow-up information and carry out any agreed actions arising from the meeting? Agreed. The committee's next meeting is on Thursday, 29 January, when we will engage with officials from the Corporate Enforcement Authority.