2026-07-09

85. Deputy David Cullinane asked the Minister for Health the data collected on private practice in public hospitals; the level of private activity occurring in public hospitals; her plan for removing this in its entirety; and if she will make a statement on the matter. [52167/26]

I thank the Deputy for raising this matter. It is my view and his view that care in our public hospitals must be based on clinical need, not ability to pay. He will also be aware of - and shares - our commitment to ensuring full compliance with the terms of the public only consultant contract, POCC. The position regarding consultants on the POCC is unequivocal: they are not permitted to engage in private practice within public hospitals. There can be no local discretion, exemptions or deviation from the terms of the contract without express written permission from both me and the HSE, which is imagined in certain circumstances of great emergency to give us that flexibility. Where issues have arisen, such as in the Rotunda Hospital, I have been very clear that immediate action must be taken to ensure full compliance. There has been clear instruction from my Department and the HSE since early 2025, setting out the requirement for compliance. This includes HSE CEO circulars of 14 February, 21 July and 25 September 2025, which required implementation of the POCC rostering provisions, extended consultant-led services and the completion of consultant work schedules. I also established regular workshops with regional and hospital senior management teams to monitor implementation of the contract and rollout of extended working. I met with each region in September 2025 and again in early 2026, as well as online in April 2026. While progress has been made, it has not moved quick enough. However, that is on the implementation of the contract. The HSE CEO wrote again to all regional executive officers on 15 June 2026, making clear that regions must ensure compliance and address any additional issues. This was then followed by letters from the HSE chief clinical officer, Dr. Colm Henry, on 24 and 30 June, to all regional executive officers and regional clinical directors, stating that POCC consultants could not carry out private work in public facilities, and we have asked for formal assurance on its implementation. Crucially, we have also asked for formal assurances on the implementation of the type B contracts to ensure that does not exceed 20% of workload, as per their contract, and that extended-hours rostering is being fully implemented. Responses are due by 10 July, with a further rostering return due by 31 July. I have more to say but I have run out of time.

I acknowledge all that work. Data is important in this area because it allows us all to hold hospitals and consultants to account and to ensure that the terms of the contracts that people have entered are being honoured. As the Minister knows, the Oireachtas health committee met recently and had witnesses in from the Rotunda hospital, the Department and the HSE. I have been asking questions for the last number of weeks. I asked the Minister parliamentary questions, which were answered by officials or by whom the information was gathered, about private activity in public hospitals and seeking a breakdown on the level of that activity. I am not getting any answers. The same answer comes back which simply has the number of consultants on type B contracts, as opposed to activity. I also asked the Rotunda about whether it can provide data about those consultants on type B contracts who are going beyond the 20%. The hospital said it was not happening or that it had no evidence that it was happening, and that the Department was collecting data on it. However, there does not seem to be information or, if there is, it was not shared with members of the health committee and, by extension, the public. I am asking what information the Minister may have that we do not have.

As I said to the Deputy privately and am happy to say to him on the floor of the House, we did a productivity analysis in the Department of the actual activity being carried out in each of the four big maternity hospitals to try to determine what the level of private and public activity was. It certainly showed instances of type B contract holders going way beyond the 20% that would be implied in their contract, but it is not information that I felt was of a sufficient standard to be able to publish, share and stand over with the committee. On that basis, I have been a little reticent. However, it is certainly more than enough for me to have done the following. I have written to all the hospitals, asking that the clinical directors confirm compliance with the type B contracts. It is my intention, once I know there is compliance or issues to work on, to initiate a broader audit of how that is done. I have also cross-referenced the admitting rights of public-only consultant contract holders with private hospitals. None of this is enough for me to be able to publish and stand over, but I want the Deputy to be aware that I am doing this work and am trying to do it in a way that is verifiable and robust. It will lead to a much more significant analysis of what is happening in different hospitals.

That is a sensible approach. I do not disagree with it. I welcome the fact that there will be an audit because data is rich when it comes to allowing all of us to see what is happening under the bonnet of hospitals and the level of private activity. I am not against private healthcare, by the way, but it needs to happen in private hospitals. Where it happens in public hospitals, it has to be within the rules. The Minister and I might disagree on many different issues, but where we do agree is that we need to send a message to the healthcare system in its totality that Sláintecare is not up for reconsideration. Removing private healthcare from public hospitals is supported, I hope, by every party in this Dáil. Making sure that contracts that were signed in good faith are honoured is something that we all have to get behind. It is also about making sure that if there is any pushback at all, or any attempt to undermine any of that work, then all of us have a responsibility to watch what is happening and play our respective roles in that. This is one of those important issues in healthcare. I know the Minister is active and vocal with regard to it, but this House and the health committee have a role to play in it as well.

I could not agree more. I thank the health committee for its robust engagement. This is a shared project, making sure that this contract and structure that we have all agreed are implemented. I have concerns about the operation on a hospital by hospital basis, for example, how intensive care facilities might be used between private and public and what the reimbursement structure is. I do not have robust answers to questions about the use of diagnostics, for example, if I am in a private hospital in a region and suddenly need intensive care facilities, and how that transfers. I do not believe those things have ever really been delineated or tested in different ways. It will be quite the challenge to do that. The first step in that is that it is the responsibility of clinical directors, both hospitals and in regions, to make sure that if work is being done outside the public-only consultant contract in a private hospital, it does not impact the public and it does not create and disincentives and that, crucially from a patient safety perspective, not too much of it is being done. It is crucial that a type B contract holder has a maximum of 20%. I do not want to see any instance where a type B contract holder has been doing more than that in a public hospital.