Tuesday 24 April 2018

Holles Street provided 'backroom' support to semi-private clinic - HSE audit

Dr Rhona Mahony Picture: David Conachy
Dr Rhona Mahony Picture: David Conachy

Eilish O’Regan

A SEMI-PRIVATE clinic, which was part of the National Maternity Hospital complex in Holles St in Dublin, had backroom services subsidised by public funds at one stage, a HSE internal audit has found.

The clinic was provided with supports such as administration, staffing and managerial services.

Two nurses, whose salaries were paid for from public funds , also worked on a part-time contract basis at the clinic, the audit showed.

Four senior managers in the publicly funded hospital were also given additional payments linked to work  in the semi private clinic although this was against public pay policy.

The audits said there were "close linkages and blurred boundaries" between the public hospital and its semi-private clinic.

The master of Holles St Dr Rhona Mahony was paid €40,000 sourced from private fee income.

The HSE says the findings raise, at the very least, questions of possible/potential conflicts of interest and subsidisation of private entities by publicly funded bodies.

It also says the issues raised are perhaps not unique to Holles Street and highlight areas where public and privately funded health facilities co-exist.

The clinic provides scans and also fertility treatments.

In response the  National Maternity Hospital said it rejected findings contained in the internal HSE audit.

A spokesman said the national maternity hospital  is not owned by the HSE and is an independent entity.

He insisted that the  payments to some medical and non medical staff  were for private work and not from the public funds,fundraising or donations.

Payments were made to medical and non-medical staff.

Under public contracts agreed by the State, consultants are entitled to earn private money from treating private patients, in addition to their public income.

The private income from the semi-private clinic was pooled and the net income was distributed among the consultants.

It said it welcomed the HSE's acknowledgement that the €40,000 payment to Dr Mahony "to which the HSE drew so much attention over a protracted period" is sourced from professional fee income, as the hospital has always stated.

However, the HSE report said claims sources of extra payments to certain other staff has still not been disclosed by the hospital.

The HSE audit says there was an interest free loan of around €1.4 m from the public hospital, to allow for the €6m refurbishment of the semi-private clinic.

In exchange, the public hospital was able to use some of the upgraded office facilities.

The clinic paid €4.5m towards the cost of the work.

The Holles St  spokesman said :”A reading of the reports could lead to a misunderstanding of the cross-subsidisation between public and private practice at the NMH.  The net cross-subsidisation that occurs is from private to public. 

“Approximately one third of NMH income is private bed income, without which the hospital could not deliver its existing public services. 

“It should also be understood that NMH provides services, some of which are not provided by the State.  We are one of three EU countries that do not provide state funded IVF services.  One of the “entities” discussed in this report provides that service on a not-for-profit basis.  Another of the “entities” is an ultrasound clinic, set up by specialists in fetal medicine  to increase ultrasound capacity at NMH.

“It should be noted that NMH provides ultrasound services to women from HSE hospitals who do not provide advanced fetal medicine services or even routine ultrasound in some cases .”

While Government policy has mandated an interlinked public and private healthcare system, the report consistently refers to “perceived conflicts of interest” in the way NMH operates this system.

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