Health Service Executive board members have expressed concern about a “potential drift towards privatisation” through the increased use of short-term measures to cut waiting lists.
Faced with massive waiting lists and increasing numbers of new referrals, the health service has been increasingly resorting to the private sector to help reduce delays in treatment for patients. The National Treatment Purchase Fund (NTPF) was allocated €150 million this year to address treatment backlogs, with which it aims to take over 300,000 patients off waiting lists. In 2020 it paid €23 million to private hospitals for inpatient and outpatient hospital services; this figure rose to €47 million in 2021. By way of comparison, it spent €48 million in public hospitals in 2020 and €51 million in 2021.
Although activity is increasing year-on-year, so are referrals, partly due to a Covid-19 pandemic backlog, members of the HSE’s planning and performance committee were told at a meeting in August. The committee asked for details on waiting list management, particularly for patients who have been waiting for extended periods of time.
So-called dynamic purchasing solutions (DPS) are being used as a short-term solution, HSE national director for acute operations Mary Day told the committee.
DPS is an electronic tendering system used in place of traditional procurement that is used to give buyers access to a pool of pre-qualifier suppliers. It was originally used in the health service for drugs procurement but is now being deployed to access capacity in private hospitals, often to carry out common surgical procedures.
“The committee expressed concern about a potential drift towards privatisation and emphasised the importance of ensuring that this is monitored,” the minutes of the meeting state.
Ms Day said “very strict monitoring” of DPS is in place through monthly meetings. The system is “not a sustainable solution”, is only used in specialties with high numbers of long-waiting patients and will be reviewed at the end of this year, she told board members.
The NTPF funds additional staff and overtime to run weekend clinics in public hospitals. But it also funds the rental of operating theatres from the private sector to treat public patients.
Asked earlier this year how it ensures it is not paying for work that would have been done anyway on the normal public lists, a spokesman said the NTPF funds additional capacity, such as extra theatres, evening clinic or weekend work.
Meanwhile, HSE board minutes from September cast fresh light on the health service’s financial problems. At that point – before cost-saving measures such as a widespread recruitment embargo were put in place – the HSE was facing a deficit at the end of the year of between €1.7 billion and €2 billion, excluding a first charge of €185 million, board members were told.
The HSE will “greatly exceed” the forecasted addition of about 6,500 staff this year, the meeting also heard. Senior officials had looked at adding 3,000, 4,500 or 6,000 staff in 2024 under various scenarios, but were in September working towards a net growth figure of 5,100 new posts.
Last month’s budget provided funding for just 2,200 new posts in the health service.
