David Cullinane (Waterford, Sinn Fein)
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1. To ask the Minister for Health the steps she has taken to ensure that Health Service Executive and National Treatment Purchase Fund spending on insourcing initiatives is transparent and accountable; and if she will make a statement on the matter. [34742/25]

David Maxwell (Cavan-Monaghan, Fine Gael)
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Deputy Clarke is asking this question on behalf of Deputy Cullinane.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I thank the Cathaoirleach Gníomhach for facilitating us.

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The Government remains committed to increasing capacity in the public system. The commitment is underpinned by unparalleled levels of investment as we move to universal access to health care. However, until the capacity is in place to meet the increased levels of demand, it is necessary in the interim to make use of all available capacity in the public and private systems to ensure that patients have access to the care they need.

The waiting list action plan 2025 includes targeting the delivery of additional capacity in the public and private systems through a co-ordinated approach by the HSE and the National Treatment Purchase Fund, NTPF. NTPF insourcing initiatives are governed by a memorandum of understanding, MOU, between the NTPF and the relevant public hospital. Under the MOU, the public hospital confirms that any such work is additional work over and above core hospital activity and is specifically carried out to reduce waiting lists.

In early April I requested that the HSE CEO initiate a detailed survey of all insourcing activity within the HSE to include activity funded directly by the hospital concerned and by the NTPF. The review is being co-ordinated through his office, assisted by finance, internal audit, HR and access and integration functions. The outcome of this review is expected shortly and will determine the appropriate next steps. We need to move away from this model by maximising internal underutilised capacity, whilst at the same time not negatively impact on patient waiting times and outcomes.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I want to begin by acknowledging the great work done by staff in Children's Health Ireland, CHI. However, in the past month details of an unpublished report conducted on the clinical department of CHI at Crumlin hospital has been put into the public domain. One of the revelations in the report was a finding of several inappropriate and unnecessary NTPF-funded Saturday clinics conducted by a consultant. The report details how a consultant was facilitated to set up hundreds of appointments for patients who did not need to see him. He then placed these patients on his own waiting lists, which resulted in patients waiting twice as long as they would have otherwise. The report states that 95% of those patients could have been accommodated during normal working hours, that is Monday to Friday, without the need for NTPF funding. How confident is Minister that the audit will be able to identify this type of misuse of funds?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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It is an excellent question. It is exactly what I have asked Bernard Gloster to do. Of course, I have to wait for the report to be able to express my confidence in the quality of the work that has come back. The Deputy may take that as a reference example. As I said my opening reply, if there was underutilised capacity, that is, as the report states, other people in the hospital could have held surgeries at an earlier period but did not due to the waiting list management process, that is very serious.

In advance of receiving the insourcing report, we have mandated a centralised referral mechanism so that if someone is referred to surgery, they are not referred to Jennifer, Sorca or whoever. Rather, patients are referred to the system and will then be allocated an appointment according to capacity rather than an individual consultant having the capacity to manage their lists or patients in a way that is unhelpful.

Sorca Clarke (Longford-Westmeath, Sinn Fein)
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I thank the Minister. There has been a significant increase in Saturday clinics over the past years. An example of this concerns scopes. More than 10% of scopes are now done on a Saturday but the distribution is very uneven across hospitals. Of the scopes carried out in Cavan hospital, one third are now done on a Saturday, that is 900 out of a total of 2,700. However, hospitals are still conducting fewer scopes than they were in 2019 when all services were provided between Monday and Friday. Waiting lists did not reduce during 2024 but they have reduced this year.

The system may be working and I do not doubt Cavan hospital in that regard. However, the CHI revelations are startling and there is real concern that this may be the tip of the iceberg. There is also concern that the quality might be suffering in some of the Saturday clinics or productivity could be higher during Monday to Friday. How is the Minister ensuring that hospitals are preventing the misuse of public funds and controlling spending and waiting lists initiatives? What is the breakdown of weekend hospital activity between the new public consulting contract and the fee paying service clinics? What action does Minister intend to take if she is not happy or there are unanswered questions when Bernard Gloster and the HSE bring forward the audit report?

Jennifer Carroll MacNeill (Dún Laoghaire, Fine Gael)
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The Deputy raised the issue I am concerned about, namely that there are incentives to be under productive during the working week with a view to, or which have the outcome of, very busy clinics on Saturdays or bank holiday Mondays. That is exactly the sort of incentive I need to see stop.

I cannot speak to the relative activity because I do not have that data. The Deputy's example is precisely the sort of example that prompted me to conduct the work on insourcing. I wish I was a couple of weeks ahead and had the data and could give her a better answer, but I will have the information during the next Priority Questions session. The Deputy is highlighting exactly what I might be concerned about.

To be fair, Saturday clinics and the NTPF meet those who have waited the longest and there is a need for that work, as she acknowledged. These sorts of incentives or opportunities are precisely what I am trying to identify, along with variations across hospitals or specialisms within hospitals, which is also important. I want to find ways to make sure that we are not permitting those incentives and there is a standardised approach that we can stand over and thereby reduce our dependence on such a system.