The recent decision by the Health Service Executive (HSE) to scrap the insourcing initiative has sparked concern among healthcare professionals and patients alike. This move, aimed at improving access to healthcare, could result in a significant setback for waiting list management, potentially adding 4,000 patients per month to the regional waiting lists. The insourcing initiative, which involved private companies using HSE staff and equipment after hours to treat patients, was abruptly ended due to governance and cost concerns. However, the HSE's own report highlights the critical role this initiative played in service delivery, particularly in endoscopy capacity and managing waiting lists.
The report, sent to HSE executives, warns of a "significant risk of unintended harm to patients" if the initiative is abruptly terminated. It emphasizes that third-party insourcing has become a "critical enabler" of service delivery, accounting for 13% and 11% of new outpatient activity in 2024 and 2025, respectively, and 20% of endoscopy capacity in 2025 and 2026. This rapid scaling of activity without capital investment has been instrumental in supporting access to care and meeting waiting list targets.
The HSE's senior management had anticipated reduced access to care for some patients if insourcing was restricted. The report's stark warnings about the impact of ending insourcing are eye-opening. It suggests that the complete cessation of the initiative will lead to a rapid growth in waiting lists, affecting thousands of patients. This is particularly concerning given that insourcing has become embedded in baseline care delivery across the region, including endoscopies, breast triple assessments, and various specialities.
The HSE's decision to pause insourcing between May and October 2025 further underscores the initiative's importance. During this period, waiting list volumes increased, indicating the immediate impact of its cessation. The report estimates an increase of 2,000 to 4,000 patients per month on the outpatient waiting list, which is a queue for patients referred by GPs to see a hospital consultant.
The potential consequences are far-reaching. The report warns of a "rapid growth" in waiting lists, a loss of momentum, increased reliance on outsourcing at higher costs, and a significant risk of unintended harm to patients. It also highlights the risk of breaching urgent colonoscopy and breast targets, as well as widening existing inequities in access, particularly in rural and peripheral areas.
To mitigate these risks, the report proposes a "regionally tailored approach to cessation." It suggests five options: permitting continued use of third-party insourcing, introducing regional flexibility, maintaining insourcing for high-demand specialities and long waiters, a phased and supported withdrawal, or a planned review after cessation with the possibility of reinstatement if additional capacity does not meet demand.
Despite the HSE's efforts to support regions with service developments, capacity measures, and planned overtime, the decision to end insourcing has raised concerns. The HSE West and North West region argues that the report did not consider alternatives to managing waiting lists and is now implementing alternative processes for patients. However, the abrupt end to insourcing could have profound implications for patient care and waiting list management, leaving many questions unanswered and a sense of uncertainty among healthcare professionals and patients.
In my opinion, the HSE's decision to scrap the insourcing initiative without a comprehensive plan to mitigate the impact is short-sighted. While concerns about governance and cost are valid, the potential harm to patients and the disruption to healthcare services cannot be ignored. A more thoughtful and inclusive approach, considering the insights from the report and the regional healthcare community, is necessary to ensure that patient care is not compromised and that waiting lists are managed effectively.
