The HSE, which is imposing a range of spending curbs as it heads for an over-run and bailout of up to €1.5bn, was being quizzed on what level of monitoring it has in place to ensure hospital consultants are doing the hours they are contracted and paid for.
HSE chief Bernard Gloster and Department of Health secretary general Robert Watt were before a special sitting of the Oireachtas health committee following complaints by both that the €22.5bn allocated to the health service next year is inadequate.
It comes amid calls for greater scrutiny of hidden inefficiences in the HSE and claims of money being wasted.
Mr Watt admitted there is a “productivity puzzle” in the health service and partly blamed the old contracts which allow hospital consultants both public and private practice.
Fine Gael TD Dr Colm Burke referred to consultants who are not turning up to clinics and leaving it to more junior registrars instead to see patients despite being contracted to run them.
The accusation has been levelled at some consultants over the years who it is claimed at off treating private patients instead.
“What checks and balances are in place?” he asked.
Mr Gloster said he was “surprised” by the claim and insisted there is a monitoring system in hospitals overseen by doctors appointed as clinical directors.
He said a new oversight system is being rolled out called a “health performance visualisation system” which will give better information on activity and performance in various medical specialities across hospital groups.
Later, Social Democrat TD Roisin Shortall accused the HSE and the Department of Health of having an “arms length” management of hospitals.
Mr Watt conceded that performance in areas like waiting lists varies across hospitals with some doing better than others.
Mr Gloster said there has been a lot of data but they must now “turn this in to knowledge”.
Asked about wastage within the HSE at a time when it has a recruitment freeze, and whether it will hit the pace of planned developments in areas such as cancer next year, Mr Gloster accepted “there is a control aspect in things we do.”
The HSE is still coping with problems with old infrastructure and inadequate technology which, if corrected would lead to more efficiencies, he argued.
But he rejected it was a “flesh eating thing ” on the public services.
He insisted: “The notion that we are a bunch of public wasters is wrong. I don’t accept that.”
Earlier, both men gave a sobering picture of the health service in 2024 when developments in areas such as cancer and maternity care will suffer with progress slowed.
Asked about home help hours next year, Mr Gloster said the same number at minimum will be planned for. He denied reports he has asked for cuts in home help hours this year although the planned number was previously reduced already to allow for private companies it contracts to pay carers the living wage.
Responding to questions from Sinn Féin TD David Cullinane, the HSE chief said the deficit this year will be between €1.4 and €1.5bn.
He said there will be another overrun of around €1.2bn in 2024.
Mr Gloster was described as “ballsy” by Fianna Fáil TD John Lahart.
Earlier Mr Gloster said the plan is to hire 2,200 more staff next year.
Responding to the recruitment freeze this year for junior doctors he said the planned number was for 500 in 2023 but around 770 had been recruited instead.
Managers around the country will next year be given a hiring limit they will have to stick to but can be flexible within areas they see as a priority. The HSE has grown increasingly reliant on expensive agency workers, at a time when staff were also rising.
He said the aim for 2024 is to have particular focus on two areas – emergency department and hospital waiting lists.
“Both of these and the initiatives associated with them are well funded in 2023 and this will continue in 2024,” he said.
Mr Watt said even accepting improvements in health outcomes there is a “productivity puzzle”.
It can be attributed to to poor physical infrastructure due to previous under-investment, lack of IT investment – including digitalisation – and low capital per person employed.
There are also weak processes and outdated pathways and inadequate inadequate hospital consultant led leadership including an outdated contract.
“There are two principal drivers of pay expenditure, the number of people employed and the rate at which they are paid. Since 2016 the pay bill has increased by €3.2bn. Our analysis estimates that 51pc of this growth is related to the recruitment of 27,487 additional staff and 49pc is due to pay increases centrally negotiated through public service pay deals,” he said.
“Measures will need to be taken on recruitment, overtime and agency as set out by the HSE chief executive.”
He said that a “growing area of spend is in medicines. The pharmaceutical budget has doubled in the last decade from €1.3bn in 2012 to €2.6 billion in 2022. This year expenditure is likely to be €2.9bn Including payments to contractors such as pharmacists, this expenditure rises to an expected €3.2bn by end 2023. This is nearly €1 in every €8 of public funding on health.”
He added: “Next year, for example, the first of a new class of drugs for Alzheimer’s disease is expected to launch. Lecanemab if approved, could have a budget impact of €100m annually at list price in Ireland based on 4,000 patients requiring treatment. We can though do much more I believe to better use the existing budget we do have by using generic and biosimilar medicines.”