HSE asked to ‘urgently examine’ ways for patients on waiting lists to ‘self-refer’ for private treatment

Department of Health secretary Robert Watt also uses letter to HSE chief to raise concern about modernisation initiative

The Health Service Executive (HSE) has been asked to “urgently examine” ways for patients on waiting lists to “self-refer” to private treatment options as part of efforts to cut waiting lists.

Department of Health secretary general Robert Watt tasked the HSE with looking at the idea in a letter to new chief executive Bernard Gloster.

The senior civil servant also raised questions about the implementation one of the HSE’s initiatives for cutting waiting lists – so-called “modernised acute scheduled care pathways”, saying the department had “not seen any progress” on this.

The Irish Times previously reported that Mr Watt told the HSE last September that the department could see “no prospective improvements” in the number of patients on hospital waiting lists despite an injection of “significant money”.


The targets for reducing waiting lists were missed last year, though the HSE and the department said that 2022 saw the first annual reduction since 2015 “as well as significant reductions in waiting times”.

They said there has been “excellent progress” in the area since the peak of the pandemic.

Mr Watt wrote to Mr Gloster on March 10th raising a number of matters relating to waiting lists.

He wrote that Minister for Health Stephen Donnelly is “exploring options aimed at empowering patients waiting longer than specific times for treatment to be able to ‘self-refer’ to private treatment options, including an associated web portal and phone line”.

He asked the HSE to “urgently examine options for such a ‘patient choice system’”.

In a joint statement the HSE and the department said the HSE is “progressing work on a phase-one patient portal with standard information on the current treatment options available to patients, eg Cross-Border Directive Scheme, the Treatment Abroad Scheme, GP Access to Diagnostics scheme, and treatment via NTPF [National Treatment Purchase Fund]”.

They said this will be finalised in early July and phase two, to be delivered by the end of July “will include waiting time per specialty and hospital”.

The statement added: “Under the 2023 Waiting List Action Plan, a number of reform enablers are being scaled up by the HSE this year, including patient-centred booking arrangements” and “patient-initiated reviews”.

In his letter Mr Watt also raised “the importance of the successful implementation of modernised acute scheduled care pathways”.

These pathways are aimed at transitioning care from acute settings like hospitals to care in the community.

He said that the HSE last year “advised it had designed and readied for implementation 37 care pathways with the potential to deliver very significant additional activity when fully mobilised”.

Mr Watt said: “However, despite endorsement and allocation of funding, €38 million non-recurrent in the 2022 plan and €43 million recurrent in Budget 2023, the department has not seen any progress nor detailed plans related to the implementation of these care pathways and, to date, has no evidence that their intended impact on waiting lists can be realised.”

He said it is “a crucial reform action to which a significant amount of funding has been allocated” and “it is of utmost importance that the HSE prioritises this work”.

Mr Watt added: “Otherwise, as indicated by the Minister at his waiting list meeting on February 27th, this funding may need to be reallocated to other initiatives that will deliver real impacts on waiting lists this year.”

The statement from the HSE and the department said that the €43 million for the pathways has been allocated “through the multi-annual approach to reducing and reforming waiting lists”.

They said that the HSE will “fully implement” seven prioritised pathways this year and the required funds for doing this in year one is “just €10 million”. The HSE is said to be “allocating the remaining €33 million to waiting list initiatives as a once-off during 2023″.

On hospital waiting lists more broadly the statement said waiting lists “were too long before the pandemic and they worsened with Covid-19″ but since the peak of the pandemic “excellent progress has been made”.

The statement said the goal in 2023 is to “eliminate long waiters completely” with a focus on achieving the maximum wait time targets set out in Sláintecare, the cross-party plan aimed at reforming the health service.

Cormac McQuinn

Cormac McQuinn

Cormac McQuinn is a Political Correspondent at The Irish Times