HSE Chief Executive Bernard Gloster has said an increase in dependency on third party "insourcing" in hospitals can create a number of problems.
Mr Gloster said issues include disincentivising normal work delivery, limiting productivity and limiting opportunities to reform the service.
Insourcing is where third parties or companies deliver care in hospitals outside normal hours.
It is paid for by the State and, in some cases, is provided by HSE staff. The initiative was brought in to reduce long waiting list times for patients.
Speaking on RTÉ’s This Week, he said that a fundamental issue with third party insourcing is that a higher premium is paid, which means that some staff were being incentivised.
We need your consent to load this rte-player contentWe use rte-player to manage extra content that can set cookies on your device and collect data about your activity. Please review their details and accept them to load the content.Manage Preferences
Mr Gloster said that the majority of people who participate in insourcing are "good honest people" doing what they have been asked to do.
However, he said that third party insourcing can create "significant conflict of interest" and "seriously undermine" compliance with procurement regulations.
He said in a small number of instances, there have been indications of concern as to whether or not it is being used for what it is intended for.
Mr Gloster said that we have "developed a dependency" on something that is a disincentive to the other types of reform, like the public only contract being distributed beyond the five-day week, because the same staff are involved.
He said he provided a HSE report on the issue of insourcing and outsourcing to Minister for Health Jennifer Carroll MacNeill last Monday, which she has published.
He said the minister has committed to coming back to the Oireachtas Health Committee by the end of this month with a set of decisions and actions in terms of reducing dependency on third party insourcing.
Mr Gloster agreed that it is his strong recommendation that it be ended.
The HSE report, carried out by Mr Gloster, found that 83 current and former staff are directors in 148 companies providing this care.
He said that the holding of a company directorship is not illegal but he said it brings a level of "perverse incentive" that is not sustainable.
Asked if third party insourcing was stopped too quickly and would it push waiting times up, he said that this is why he has recommended a longer time frame to phase it out with additional controls and oversight.
In relation to audits on three hospitals over concerns about the use of these waiting list funds,he said that he has to wait for the internal audit reports to see if the complaints have any substance.
He said the purpose of the report he has given to the minister is to come to a sensible set of actions, aimed at improving waiting list management and reducing risks.
Asked if money was being used appropriately for outsourcing initiatives, he said that oversight, corporate governance and the avoidance of conflict of interest is easier in outsourcing arrangements.
Commenting on the CHI internal report being referred to gardaí, he said there were issues in relation to the individual care of people and how they were or were not managed on waiting lists.
Asked if he was confident that CHI was the right entity to manage the new children's hospital he said that he has "every confidence" in the new CHI CEO Lucy Nugent.
However, he said is in no doubt that this is an entity that faces a scale of challenges and historical and cultural issues.
