The Irish Times view on insourcing in the health service: not a longer-term solution
third-party insourcing
to cut waiting lists. It follows a review of the practice by the chief executive of the Health Service Executive, Bernard Gloster, who has recommended that it be phased out by the end of the year.
What appeared to be a novel solution to reducing waiting times in the wake of the Covid epidemic has come to be seen as a costly problem. Under the initiative, introduced by then health minister Stephen Donnelly, private companies were encouraged to use spare capacity – in terms of trained staff and equipment – at public hospitals to provide services to patients on public waiting lists.
The underutilisation that the initiative capitalised on was due in part to working hours and rostering limitations at public hospitals. The services were provided on a commercial basis and followed the precedent set by the outsourcing by the HSE of the treatment of public patients to private hospitals.
The initiative succeeded in its primary objective of reducing waiting times, but its cost has proved problematic. Over ¤100 million was paid out in the 27 months to March to third party outsourcing companies, many of which are run by or employ existing HSE staff.
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Concerns were raised at the outset about the possibility of conflicts of interest and the creation of perverse incentives whereby doctors and staff involved with third-party insourcing businesses stood to benefit from long public waiting lists. Some of these concerns appear to have been borne out, with a number of controversies prompting the review by Gloster.
The Minister's dilemma is that while there may be political pressure to wind down the third-party insourcing initiative, there is even greater pressure to address waiting lists which are being driven ever upwards by demographic trends. The insourcing initiative is generally accepted to have made a material difference to waiting times.
The HSE has agreed to new rostering arrangements for staff and hospital consultants which should see equipment and facilities used more efficiently, particularly over weekends and in the evening. However, this is unlikely to be sufficient to plug the gap created by abandoning third party insourcing. The existing reliance on private hospitals will most likely be exacerbated.
The decision facing the minister is not a simple accounting exercise in which costs and benefits can be traded off. The HSE has clearly lost confidence in the initiative, and it is increasingly becoming a political liability for the Government. It may well have run out of the road, though phasing it out without adding to waiting list pressures will not be easy.
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