Almost 100 patients who were originally considered to be non-urgent cases were found to have cancer when seen under outside arrangements put in place using funding provided by the National Treatment Purchase Fund, St James’s Hospital in Dublin has said.
The hospital has told the Dáil Public Accounts Committee (PAC) its waiting list for urgent ultrasound scans at its clinic for women with symptomatic breast conditions stands at more than 370 patients and its core radiology capacity cannot meet the demand for imaging services.
It has identified as “a critical risk” that the hospital does not have sufficient staff, equipment or space to meet the demand for radiology and diagnostic services.
It has estimated it has a capacity shortfall of 10 consultant radiologists.
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The hospital has made a submission to the PAC following revelations by the State’s spending watchdog, the Comptroller and Auditor General, that St James’s had last year paid €1.44 million to an unlimited company owned by members of staff to provide diagnostic services.
The comptroller, Seamus McCarthy, told the committee in November the vast bulk of this money had been paid without the services provided to the hospital being subject to a public procurement process.
He also said the staff concerned had not set out their interest in the company in their annual declarations under Standards in Public Office requirements.
Management at St James’s Hospital are expected to be called to appear before the committee in the new year.
However, in a submission the hospital said its radiology department was one of the busiest in the country, performing more than 215,000 examinations annually.
“Since the Covid-19 pandemic, St James’s Hospital has faced an exponential and sustained increase in demand for radiology services, particularly in cancer and cardiovascular diagnostics. In 2024, demand for radiology services exceeded capacity by approximately 28 per cent overall, with CT, MRI and ultrasound particularly affected.”
It said the hospital did not have sufficient capacity to deliver the increased demand for radiology within core resources. It said it had utilised what are known as emergency diagnostic authorisation numbers, funded by the National Treatment Purchase Fund, to access additional radiology capacity.
“Since the NTPF support has been in place, 94 patients who were in the non-urgent category have been identified as having cancer and were diagnosed at an earlier stage than if the additional capacity was not available,” the hospital said.
“All insourced and outsourced imaging is scheduled by the hospital’s scheduling office, via an independent model focused solely on time-sensitive referrals, particularly for cancer staging. This ensures clinical appropriateness and transparency in case selection. The directors of this vendor company who were employees of the hospital had discharged their public work in compliance with their employment contract with the hospital.”
The hospital said MRI services had been regularised through a competitive tender facilitated by the HSE and the CT/ultrasound procurement is in the final stages of completion.
It said last July the hospital paused insourcing activity, except where a derogation was approved by the HSE.
“According to Royal College of London benchmarking, 9,567 diagnostic sessions would be required to address the radiology service demand in the hospital.”
It said it would require 32 consultants to provide such services.
“The current consultant radiologist complement is 22 whole-time equivalents (WTE), leaving a capacity shortfall of 10 WTE consultant radiologists.”
“The hospital has a significant gap in terms of workforce, equipment and space to meet the diagnostic demands on the service which has been escalated to our corporate risk register and the HSE/Region as a critical risk for the hospital.” It said it had sought HSE approval to expand its workforce as a priority.
