Medical consultants who provided special clinics to clear waiting lists at Naas General Hospital were paid “significantly higher” amounts than would have been the case if services had been delivered through standard contractual or approved overtime arrangements, Health Service Executive internal auditors have found.
An internal audit report, released on Monday, also indicated that two companies – where consultants based at Tallaght Hospital were directors – which provided services to tackle waiting lists at Naas had been engaged without appropriate tendering or public procurement rules being followed.
Internal HSE auditors maintained in the report that consultants who operated services aimed at clearing waiting lists at Naas General Hospital had been paid on a fee-per-patient basis.
“This deviates from public pay policy guidelines which do [not] contain any provisions for consultants to be paid on a fee-per-patient basis. Analysis indicates that this approach resulted in significant variance above approved public pay and overtime rates.”
An example set out in the report shows that in January last year two new and 25 returning patients had been seen at one waiting list clinic in Naas. The consultants were paid a fee of €200 per new patient and €150 per returning patient, or a total of €4,150 in total.
Auditors maintained that if the doctors had been paid on the basis of actual hours worked, or under existing contractual overtime rates, the total payments involved would have been €1,111 – generating a saving of €3,039.
The internal audit report also found that two external companies, in which consultants employed by Tallaght Hospital were directors, had been paid almost half a million euro for providing what are known as insourcing services, financed by the National Treatment Purchase Fund (NTPF), at Naas between 2022 and 2025.
The HSE internal auditors maintained there was no record of a competitive tender process being undertaken by the consultants’ companies providing clinics or consultations as part of NTPF-funded initiatives.
“Engagement with consultants appears to have occurred without documented evidence of compliance with standard public procurement procedures. There was also no evidence of approval being sought by hospital management for a derogation from standard public procurement procedures”, the report said.
Auditors maintained that in addition to the €473,320 paid to the two external companies, payments of €1.5 million were made to consultants between 2022 and 2025 for the provision of such insourcing services.
Insourcing is where existing public hospital staff or facilities are used outside of normal working hours as part of initiatives to reduce waiting lists. In some circumstances staff and facilities can be hired by third-party companies to provide such services under funding provided by the NTPF or the HSE to reduce waiting lists.
Insourcing clinics are supposed to be held outside of regular working hours in public hospitals.
However, the internal audit report found that in Naas, hospital management could not “confirm with certainty that all NTPF-funded consultations across all specialities were scheduled strictly outside of core funded activity”.
Former HSE chief executive Bernard Gloster told an Oireachtas committee last July that concerns had been raised about the operation of insourcing arrangements at Naas General Hospital.
The Dublin Midland Health Region said on Monday that significant work to implement the auditors’ recommendations had been undertaken and was continuing at Naas.
“This includes strengthening governance, ensuring alignment with public pay policy, and enhancing oversight and financial reconciliation processes in relation to NTPF-funded initiatives,” it said.
“Naas General Hospital had already paused NTPF-funded initiatives earlier in 2025 pending completion of the review and will continue to work with the HSE and the National Treatment Purchase Fund to ensure that all future activity is fully compliant with national policy and governance requirements.”