Hospitals face cut in funding for poor performance in major Government policy change

The Government is to withhold State funding for new consultant positions from hospitals that cannot demonstrate that their existing medical specialists are seeing the same number of outpatients as their peers elsewhere.

Under a significant policy change, boosting the number of newly referred patients seen in outpatient clinics as well as the implementation of other reforms in individual hospitals will also become “a significant factor in determining how funding will be allocated/prioritised in Budget 2025″.

There were more than 593,000 people on waiting lists for an outpatient appointment in May.

Minister for Health Stephen Donnelly has argued that some hospitals had been “simply too slow” in implementing reforms and efficiency measures that could reduce these numbers such as allowing patients to initiate their review appointments as well as introducing centralised referral systems and text message reminders.

He said that putting in place such measures as well as delivering improvements on the new-to-return ratio for outpatients would play a significant role in determining budgets for hospitals next year.

Mr Donnelly told the HSE chairman Ciarán Devane that new research had revealed “stark variations” in the number of outpatients being seen by consultants in the same speciality in different hospitals, although he said in some cases there may be valid reasons for such differences.

He also expressed concern that there had been a fall in outpatient activity in some hospitals.

Mr Donnelly also sought the HSE to give a greater focus to people who are waiting for their first appointment to see a specialist in an outpatient clinic.

He said the Health Service Executive in the national service plan agreement with the Government had committed that there would be a ratio of one new patient seen for every two who were brought back for a repeat visit.

“The HSE is not meeting this target. This needs to be delivered to ensure more new patients are treated”, the Minister told the HSE chairman in a letter in late May which has been circulated within parts of the health system.

The Minister separately told the Health Service Executive board that he wanted it to ensure that each of the 2,000 medical specialists who had signed up for the new public patient-only contract with the State carried out “one additional outpatient clinic per week, specifically for new patients who are on the waiting lists”.

The move by the Minister to link funding for new consultant positions to productivity in hospitals from next year would represent a significant policy change.

However, he said it was “absolutely imperative that we push the system to deliver better access to patients, via improvements in productivity, in tandem with increased funding”.

A new system, known as the Health Performance Visualisation Platform (HPVP), will allow the Health Service Executive to publish data on activity in hospitals including “outpatient productivity by site and specialism”.

This data is expected to become publicly available in the coming days.

Mr Donnelly told Mr Devane the importance of comparative data was “to identify areas that require analysis and improvement. He said it would then be the responsibility of local management/leadership “to identify the root cause and correct it”.

Mr Donnelly said that in the budget for 2025 new consultant posts will be prioritised for large hospitals that were using the new HPVP system to demonstrate activity and where consultants were performing a similar volume of outpatient appointments to their peers in other hospitals.