HSE finds no 'structured system' to monitor phasing out of private consultants in public hospitals
Seán McCárthaigh
There is no structured system at either the national or regional level to monitor the phased elimination of consultants who carry out private practice in public hospitals, according to the findings of an HSE audit.
A report by HSE internal auditors also revealed that the introduction of public-only contracts has not had a significant impact on the number of consultants available to work on evenings and at weekends.
“This increases the risks of failure to achieve the benefits of the contract and failure to achieve value for money,” the audit observed.
It found that only 12 per cent of consultants on public-only contracts worked on weekday evenings in February 2025 and only 11 per cent on Saturdays – a similar level to consultants on other types of contracts.
The audit revealed varying levels of consultants working across HSE areas, with consultants on public-only contracts, ranging from 5 per cent in the Dublin and North-East region to 72 per cent in the Mid-West Region.
Similarly, the share of such consultants working on weekday evenings ranged from 4 per cent in the Dublin and South-East region to 25 per cent in the Dublin and Midlands region.
The audit also revealed that one consultant was paid an on-call allowance of €6,470 between May 2024 and January 2025, despite being on sick leave over the same period.
Another consultant in the mid-west was placed on the wrong pay scale, while no dates were recorded for when increments were due to 61 other consultants.
Overall, the audit concluded that the adequacy and effectiveness of oversight of the implementation of public-only contracts by the HSE is “unsatisfactory.”
The audit report, which was released under freedom of information legislation, was published just after the Rotunda Hospital in Dublin became embroiled in controversy after it emerged that management was still allowing one consultant on a public-only contract to see private patients in the hospital.
The report said its findings showed there are weaknesses in the system of governance and controls “which create a serious and substantial risk that the system will fail or has failed to meet its objectives.”
HSE auditors said urgent action was required to improve the adequacy and effectiveness of oversight of public-only contracts.
On a positive note, however, the audit said an analysis of vacant consultant posts indicated the impact of public-only contracts had been positive as the number of vacancies was down 31 per cent over the past five years.
The report reveals that there was no record of private work carried out by consultants during a period when they were allowed to transition to public-only contracts.
Auditors said there was no system in place for clinical managers to verify that consultants were not engaging in private work in HSE facilities or that any other private work was properly approved.
An analysis of rosters operated in February 2025 found the number of consultants working on Saturdays and weekday evenings remained low and broadly mirrored patterns before the introduction of public-only contracts.
The report said the analysis of rosters indicated there was “limited realisation of contract flexibilities.”
The audit found that there has also been limited progress on the digitalisation of monthly work practice plans for consultants.
They set out the scheduled activities of consultants on an hourly basis such as theatre work, outpatient appointments, ward rounds and teaching.
The contracts also require annual performance reviews by line managers, who also grant permission for any external work carried out by public-only contract consultants.
The audit revealed that only 13 per cent of work plans for consultants had been inputted by August 2025 on an IT system designed for reporting and monitoring key elements of public-only contracts, rising to 73 per cent by February 2026.
It also discovered “control weaknesses” in the payroll system for consultants on public-only contracts, including administratively unapproved consultant posts, increment errors and inappropriate on-call payments during sick leave.
Other issues were inconsistencies in the format of work practice plans and an inconsistent use of implementation checklists.
The audit involved a sample of 30 consultants from the HSE Dublin and North-East Region and Mid-West Region, including five working in the Mater Hospital.
Public-only contracts, which were introduced in March 2023 as part of the Sláintecare programme of reform of the health service, sought to eliminate private practice by consultants in public hospitals.
They are also the only form of contracts offered to new consultants.
Under the contract, all consultants can be asked to work 8am-10pm on weekdays and 8am-6pm on Saturdays as part of a core 37-hour week, while they can also agree to be available on a wider timeframe of between 8am and midnight on Monday-Saturday.
The contract also requires that any private work by consultants is carried out outside their rostered hours, away from a public facility.
It allowed consultants transitioning to public-only contracts to gradually reduce private work in public hospitals until December 31st, 2025, when all such work should have ceased.
The audit showed that 3,090 out of 4,825 consultants employed by the HSE in August 2025 – 64 per cent of the total – operated under public-only contracts, which carry a basic annual salary of between €231,215 and €277,736. They included 943 new consultants.
The audit sought to assess the adequacy of the governance, risk management and internal control system of how public-only contracts were implemented by the HSE.
In response to the audit’s findings, the HSE said it accepted the recommendations, including the need to establish a formal national governance and reporting framework to oversee implementation of the phased elimination of private work in public hospitals and enhanced rostering.
