National Maternity Hospital disagrees with HSE audit findings

The National Maternity Hospital in Holles St has strongly criticised a HSE internal audit report into the institution and says it disagrees with the findings.

It said the nub of its disagreement was the failure of the HSE auditors “to accept that the National Maternity Hospital is not owned by the HSE but is an independent entity”.

The hospital said it had concerns about the methodology used by the HSE internal auditors, the omission of some factual issues and the lack of understanding of others.

“However at the heart of these reports and the very long process that has led to them is the issue of integrated public and private practice. Current Government policy is dictated by the 1970 Health Act and by the consultant contract drawn up by Government in 2008. It mandates an integration of public and private practice. The report identifies “close linkages” between public and private practice, but this merely reflects Government policy. It should be noted that there is no private obstetric hospital in the state and that under current health policy, National Maternity Hospital is obliged to treat private patients.”

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“A reading of the reports could lead to a misunderstanding of the cross-subsidisation between public and private practice at the National Maternity Hospital. The net cross-subsidisation that occurs is from private to public. Approximately one third of National Maternity Hospital income is private bed income, without which the hospital could not deliver its existing public services.”

The hospital also maintained that it provided services to patients which were not provided by the State .

“ We are one of three EU countries that do not provide State-funded IVF services. One of the ‘entities’ discussed in this report provides that service on a not-for-profit basis. Another of the ‘entities’ is an ultrasound clinic, set up by specialists in fetal medicine to increase ultrasound capacity at National Maternity Hospital. It should be noted that National Maternity Hospital provides ultrasound services to women from HSE hospitals who do not provide advanced fetal medicine services or even routine ultrasound in some cases .”

The hospital argued the Government had mandated that there should be an inter-linked public and private healthcare system.

It disputed the internal audit concerns of “perceived conflicts of interest” in how this system is operated at the National Maternity Hospital.

“Despite over 3.5 years in preparation, HSE internal audit has not identified any actual conflict of interest in relation to the interaction of these entities with the National Maternity Hospital. There are clinical cross-directorships between entities because of clinical governance requirements and not financial considerations. This is the appropriate way to run the hospital.”

“The National Maternity Hospital is a hospital which strives to deliver the maximum amount of clinical service possible within the constraints of the current financial climate and within the health system that has been laid down by successive governments. “

The hospital said it noted the HSE had explicitly recognised its right to engage in other activities separate to the provision of public care under its service agreement with HSE.

The hospital maintained that the production of the internal audit report had been been enormously time-consuming both for itself and the HSE .

“In our view their net effect is simply to describe the operation of the hospital system under current policy. We acknowledge that there are some processes and systems that can be improved on and we are committed to continuous improvement.”

"We believe it is time for a public policy debate on the current Government model of interlinked public/private healthcare and whether it is the model Ireland wishes to see continue into the future."