Dáil Éireann Debate, Tuesday - 28 April 2026
1038. Deputy Ken O'Flynn asked the Minister for Health the evidential basis underpinning the decision to cease or substantially reduce the use of third-party insourcing arrangements within the public health system by 30 June 2026; the specific reviews, analyses, or policy papers informing this decision; and if she will provide the dates and authors of such documents. [29806/26]
View answer1039. Deputy Ken O'Flynn asked the Minister for Health whether her Department has conducted a formal impact assessment of the planned cessation or reduction of third-party insourcing on public patient waiting lists; if so, the projected effect on overall waiting list numbers and waiting times; and if she will provide the modelling assumptions used. [29807/26]
View answer1040. Deputy Ken O'Flynn asked the Minister for Health the additional in-house public system capacity, measured in theatre sessions, outpatient clinics, or equivalent activity, that is planned to replace activity currently delivered through third-party insourcing; and the timelines for delivery of this capacity.; and if she will make a statement on the matter. [29808/26]
View answer1041. Deputy Ken O'Flynn asked the Minister for Health her assessment of current waiting list trends, including total numbers and those waiting over 12 months, as reported by the National Treatment Purchase Fund; and how the planned reduction or cessation of insourcing aligns with the objective of reducing waiting lists. [29809/26]
View answer1042. Deputy Ken O'Flynn asked the Minister for Health the specific governance, procurement, or clinical concerns identified in relation to third-party insourcing arrangements which have informed the policy decision to reduce or cease such activity; and the steps taken to address those concerns short of ending insourcing. [29810/26]
View answer1043. Deputy Ken O'Flynn asked the Minister for Health whether a comparative cost-effectiveness analysis has been conducted between third-party insourcing, outsourcing via schemes such as the National Treatment Purchase Fund, and direct in-house provision; and if so, if she will provide a summary of findings. [29811/26]
View answer1044. Deputy Ken O'Flynn asked the Minister for Health the contingency measures in place should waiting lists increase following the reduction or cessation of third-party insourcing; and whether provision exists to reintroduce such arrangements if required to protect patient access. [29812/26]
View answerI propose to take Questions Nos. 1038, 1039, 1040, 1041, 1042, 1043 and 1044 together.
We are focused on having a public healthcare service in which everyone has timely access to high-quality scheduled care, where and when they need it.
Government is committed to improving access to hospital care & reforming and reducing waiting times for patients through a range of measures, including those to increase capacity such as the establishment of surgical hubs.
Insourcing and outsourcing have been used as tactical responses to waiting list pressures. While they have delivered real benefits, they must be seen as transitional tools, not permanent fixtures.
In 2025, in light of concerns about an overreliance in the system on supplementary capacity, I asked the HSE CEO, to undertake a detailed survey of all insourcing activity within the HSE.
The review considered the background to, impact of, and future use of insourcing and outsourcing, with a specific focus on third-party insourcing. It also considered the reasons, benefits and safeguards in relation to third-party insourcing, and examined volume and costs. I published the full review on 1st July last year.
The review led to several measures being introduced to restrict the practice, with a view to cessation by the end of June 2026.
These measures have had an impact, and the current volume of third-party insourcing is not material, with less than 1% of activity in the first quarter provided in this manner as advised by the HSE Regions.
A number of initiatives are in place to manage any potential deficits due to cessation. These include:
• The progression of an HSE/NTPF Working Group to develop a private provider framework to coordinate outsourcing in planned care for OPD/IPDC and GI Scopes.
• Continuing the implementation of POCC contract, 5/7 working and implementation of Seven Day Services; increasing the level and volume of services that will be available earlier in the day, in the evening and at weekends in acute hospitals across 2026.
• Regular insourcing through the use of standard overtime for specialist clinics, directly organised by senior management that can be paid for by the HSE or the NTPF.
• Ongoing developments which enhance regional capacity such as the surgical hub in Dublin South, and the Merlin Park OPD initiative. Surgical Hubs in Cork, Galway, Limerick and Swords are all due to open on a phased basis this year.
• Productivity measures such as the OPD toolkit and the theatre capacity optimisation programme.
The multi-annual Action Plan approach was initiated in September 2021 to sustainably reduce and reform hospital waiting lists and waiting times. We have seen significant progress in reducing the length of time patients are waiting under this approach, including a reduction of c.53% or c.150,000 less patients waiting over 12 months since September 2021. In the same period there was an improvement of c.43% or c.5.3 months in the Weighted Average Wait Time (WAWT) that patients across lists have been waiting.
