HSE decision to scrap insourcing ‘could add 4,000 patients per month’ to waiting lists

Up to 4,000 additional patients per month could be placed on a regional waiting list to see a consultant after an initiative aimed at improving access to healthcare was scrapped, an internal Health Service Executive report warned.Insourcing is where private companies are paid to use HSE staff and equipment after hours to hold special clinics to treat patients on waiting lists, in an attempt to deliver more timely care.The Minister and the HSE last year announced it was abolishing the initiative from this July due to concerns around governance, value for money and perverse incentives.Tony Canavan, regional executive officer of HSE West and North West, which represents six acute hospitals in Galway, Mayo, Sligo and Donegal, sought approval for alternatives to the abrupt ending of the insourcing arrangements.READ MOREThe report, sent to chief executive Anne O’Connor and HSE director of access Sheila McGuinness on April 20th, said the sudden removal of the initiative would create a “significant risk of unintended harm to patients”.According to the report, third-party insourcing has become a “critical enabler” of service delivery across the region.It accounted for 13 per cent and 11 per cent of new outpatient activity respectively for 2024 and 2025. For 2025 and 2026, it accounted for 20 per cent of endoscopy capacity.“Third-party insourcing has allowed for rapid scaling of activity without the need for capital investment and has been instrumental in supporting access to care, managing waiting lists and working to meet waiting list targets,” the report said.ExplainerHSE region issued stark warnings over ending of insourcingPhotograph: iStock (andresr/Getty Images) Senior management in the health service had anticipated that restricting the use of insourcing to tackle hospital waiting lists would likely result in reduced access to care for some patients.The HSE leadership last year believed controls introduced at the time on insourcing would have “some impact” and that about 4 per cent of patients who received treatment under such arrangements could be affected. However, the warnings in the confidential internal report from the HSE in the West and North West region – that the complete ending of insourcing would lead to a rapid growth in waiting lists, affecting many thousands of patients – are much more stark. It added that it is no longer supplementary and has “become embedded in baseline care delivery” across the region, in key areas such as endoscopies, breast triple assessment and various specialities. “Without replacement capacity, this reduction cannot be absorbed within existing core hours,” it added.There was a national pause on insourcing between May and October 2025 when concerns were being reviewed by HSE head office. The report said this resulted in an increase in “waiting list volumes” in the region during this period.It added that the cessation of the scheme is estimated to result in an increase in the outpatient waiting list of between 2,000 and 4,000 patients per month.The outpatient waiting list is a queue for patients who have been referred by a GP to see a hospital consultant. The report warned that an abrupt ending of the scheme risks “rapid growth” in waiting lists, a loss of momentum, increased reliance on outsourcing “at potentially higher costs to the system and our patients” and “significant risk of unintended harm to patients”.It also highlighted the risk of a “significant increase in the numbers of patients breaching urgent colonoscopy and breast targets” as well as “widening existing inequities in access, particularly in rural and peripheral areas”.The report proposed a “regionally tailored approach to cessation” to avoid “unintended deterioration in patient outcomes and system performance”.It advanced five options to mitigate against the risks highlighted in the report.These are: permitting the region to continue its use of third-party insourcing, to introduce regional flexibility, to maintain insourcing for high-demand specialities and long waiters, to have a phased and supported withdrawal or to have a planned review after cessation and to reinstate it if additional capacity does not meet demand.A HSE spokeswoman said a range of measures were progressed to support regions, including service developments, capacity measures, planned overtime and use of appropriate outsourcing arrangements.“All third-party insourcing activity has now ceased. A number of initiatives in the West and North West were subject to a short, managed close-out in early July to complete appointments already scheduled for patients,” she said.“This was agreed solely to ensure continuity of care. No new third-party insourcing initiatives, extensions or additional arrangements are in place or will be progressed.”The HSE West and North West region said the report “did not take into account alternatives to managing the waiting lists” and the region is “now putting in place alternative processes for patients”.