Hospitals in Naas, Dún Laoghaire and Kerry paid consultants all the funding they received from the National Treatment Purchase Fund (NTPF) for running special clinics to reduce waiting lists.
The funding should also have gone towards meeting the costs of nursing and administrative personnel.
A new report by the NTPF also indicated that at Naas waiting-list initiatives were not carried out beyond the core business hours of the hospital.
The report said the three hospitals had not been in compliance with their memorandum of understanding with the NTPF governing the waiting-list-reduction schemes.
RM Block
The State pays out more than €200 million a year to the NTPF to purchase care in public or private hospitals for patients waiting longest for treatment – through what is known as outsourcing or insourcing.
Outsourcing is where the NTPF buys treatment for public patients in private hospitals. By contrast, insourcing is where treatment or out-patient consultations are funded by the NTPF in public hospitals but outside of their core activity and in addition to their regular work paid for by the HSE.
However, the report said that the NTPF agency and its board had been “deeply concerned by recent allegations of breaches of its processes by public hospitals concerning insourcing initiatives and the reported potential misuse of NTPF funding for insourcing initiatives”.
In May, the NTPF wrote to 38 hospitals seeking assurances they were complying with agreements in place governing the operation of the waiting list schemes.
The report said three hospitals – Naas in Co Kildare; St Michael’s in Dún Laoghaire, Co Dublin; and University Hospital Kerry (UHK) – had “made disclosures that indicated they were operating outside of the memorandum of understanding” with the agency on the operation of the waiting-list schemes.
“In each case the hospital disclosed that the full package of agreed funding provided by the NTPF to the hospital to pay for the insourcing initiatives (outpatient appointments) was paid to the treating consultants involved,” the report said.
“Under the NTPF’s memorandum of understanding, the package of agreed funding is the marginal cost required to deliver the additional capacity, covering all costs associated with the insourcing initiative including nursing staff and administrative staff.”
The report says Naas did not provide assurances that “all insourcing activities are being carried out strictly outside of core activity and are not displacing or overlapping with services already funded under the HSE National Service Plan”.
It said HSE internal auditors were carrying out an investigation there.
The report said the waiting-list initiative at St Michael’s ceased in May.
It said that on disclosure of noncompliance, University Hospital Kerry suspended all NTPF insourcing initiatives.
“No NTPF-funded insourcing is currently taking place at University Hospital Kerry,” the report said.
“The NTPF were satisfied with the responses from the remaining 35 hospitals.”
In recent months there has been controversy over the operation of waiting list initiatives at the children’s hospital group CHI and at Beaumont Hospital, Dublin.
“Beaumont Hospital was excluded from the scope of this review as insourcing initiatives had been suspended on April 11th, 2025, due to reported potential issues in relation to NTPF-funded insourcing work”, the report said.
“HSE Internal Audit are currently undertaking a review of these potential issues.”
NTPF funding was also suspended for a time at CHI, but was later restored.
The Irish Times reported in July how Naas General Hospital had voluntarily paused the use of an initiative to tackle waiting lists after concerns were raised about the way public funding was used.
The NTPF report said that although the NTPF did not pay or engage third-party providers, 11 hospitals told it they did use third-party providers to deliver insourcing initiatives funded by the agency.
