Two hospitals misused taxpayers' money to pay consultants 'on the double' from a fund designed to cut waiting lists, Extra.ie can reveal.
Doctors at Naas General Hospital and University Hospital Kerry were paid to treat people 'on a fee-per-patient basis', using money from the National Treatment Purchase Fund. Both hospitals self-declared the improper use of the funds to the NTPF during a review in May.
The money should have been shared with nursing and admin staff to operate special out-of-hours clinics to reduce waiting times. But instead it was given to consultants for work carried out during 'core hours', meaning the public system was paying to support the consultants for work that was meant to be carried out at weekends, for example.
The revelation is included in a July briefing to Health Minister Jennifer Carroll MacNeill, obtained by Extra.ie under Freedom of Information legislation. However, the final report into the review's findings, published publicly four days after the briefing to the minister, does not reference the 'fee-per-patient' arrangement at the hospitals.
These details were also not shared with the Dáil's Public Accounts Committee during recent meetings with the CEO of the National Treatment Purchase Fund (NTPF) - despite specific questions on the issue being asked repeatedly by TDs.
Naas Hospital is in the Kildare North constituency of Social Democrat TD Aidan Farrelly, who sits on the PAC. He said the evidence obtained by Extra.ie has proved that 'consultants were essentially being paid on the double or the patients being charged on the double'.
Mr Farrelly said: 'I'm shocked, because the chief executive told us in direct questioning at the Public Accounts Committee that this was not what was happening.' Mr Farrelly told Extra.ie that the NTPF's silence over the review's findings represented a 'flagrant contempt' of the PAC.
He added: 'To come before an Oireachtas committee like that, and not be forthcoming with information, rides completely roughshod over any sort of sentiment of reform or reflection.'
NTPF chief Fiona Brady told the Oireachtas this month she did not believe the fund has created 'perverse financial incentives' for doctors to delay waiting lists cases.
Upwards of €200million in additional funding is provided to hospitals through the NTPF each year, with the aim of reducing waiting lists in public hospitals. Hospitals can seek funding from the NTPF once a patient has been waiting between three and six months. Funding to get the patient seen is allocated directly to the hospital.
The money is then used to run special internal clinics, outside of regular working hours, such as on weekends. This is known as insourcing. In some circumstances, where a public hospital cannot care for the needs of a patient, treatment is purchased from a private facility. This is known as outsourcing.
NTPF bosses, tasked with reducing waiting times, launched a review of insourcing arrangements in 38 out of 39 hospitals in May, seeking assurances from management teams that they were using the funding correctly. Three hospitals came forward - Kerry University Hospital, Naas General Hospital and St Michael's Hospital in south Dublin - to disclose they had improperly paid staff using the funds.
St Michael's Hospital disclosed that it had not paid staff in line with public pay policies, but that this arrangement had ceased just weeks before the review began. Kerry University Hospital and Naas General Hospital both admitted to using the funding to pay consultants 'on a fee-per-patient basis' instead of hosting special clinics.
Naas General Hospital further disclosed that the consultants completed this work within their normal working hours, when other patients on waiting lists should have been prioritised.
The details of the breaches in funding rules were included in an email from one Department of Health official to senior management and Ms Carroll MacNeill. The email was obtained by Extra.ie.
Insourcing arrangements were immediately suspended at Naas General Hospital following the disclosure, and an internal audit has been launched. The email stated that hospital managers in Kerry had suspended insourcing at their facilities. The email was sent to the minister four days before the final report into the review was published, which omits any mention of consultants getting paid per client.
Mr Farrelly was told during the PAC meeting that the NTPF was not looking to recoup the funds from the hospitals. Ms Brady told the Kildare North TD that she believed consultants were not being paid twice.
Several TDs repeatedly asked NTPF chief Ms Brady and her colleagues this month whether she believed the fund had caused any perverse incentives for doctors to delay waiting patients longer.
At the PAC on October 9, Ms Brady was asked by Fianna Fáil TD Albert Dolan if the NTPF incentivised consultants to delay waiting list treatments. She said: 'No, I do not believe that is true because the management of the waiting list lies with the acute hospitals.'
When presented with the information, Mr Dolan said yesterday: 'I find it very disheartening that this was not addressed at PAC.'
Fellow Fianna Fáil TD Paul McAuliffe, who asked 'blunt' questions at the PAC meeting, told Extra.ie yesterday: 'I'm disappointed that that detail was not revealed to the committee when we asked about the issue of perverse incentives.'
An internal audit is taking place at Naas General Hospital and remains ongoing. Neither Kerry University Hospital nor St Michael's have sought additional funds since the review's findings. A spokesman for the NTPF acknowledged the compliance issue. It is understood that Extra.ie's revelations today will be discussed at next week's PAC meeting