Paul Murphy Confronts Hospital Over €4.7m No-Contract Payments

Sorry. I mean, I have to say all this is just shocking to me. I had some awareness that this exists, but to see in reality the corrosive impact of private money, private profit in the public health system is quite something. I mean, effectively what we're saying here is that since 2017, a company owned by 18 doctors in James' got 4.7 million in payments without a procurement process and without a contract. It's really shocking. Can I ask firstly, in the opening statement, you're apologising for the 1.4 million and then questioning from James Gagin, we got the 4.7 million since 2017. So it was 1.4 in 2024 and then 4.7 since 2017. Why wasn't the 4.7 million mentioned in the opening statement? I suppose the purpose of coming before here this morning, Epity, was that we were to discuss the accounts of 2024 and that was the reason. And at what stage did you become aware there was any money going in this sort of process without a contract, without procurement to this company? So I suppose, again, just as I highlighted earlier, Deputy, the process started in 2017. I was not in the hospital in 2017. And it was very limited. It was a very limited volume of work that was given in 2017. I was not in the hospital in 2017. And it was very limited. It was a very limited volume of work that was given for a real patient need in relation to breast cancer. And it was from mammography. Without procurement. Without procurement, without contract. Yeah, without contract. So limited as it is. I know, absolutely. And I do appreciate that. And, you know, and we do regret that. But then we do need to take you back to COVID. So, like... No, 2017 is pre-COVID. So is the board aware of it in 2017? No. No. I wouldn't think so. I don't, yeah. Okay. Is the board aware of it here? I wasn't there either. Yes, okay. I would imagine it was not aware. The value of payment in 2017 is €14,000. So just to put a bit of context, I have the €4.7 million. 2018? 2018, €67,000. 2019? €36. So it's just nearly €120,000 over three years. Okay. And then 2020... Zero. Yeah. 2021? And that was COVID. And that was the... So then we're getting into the millions in 2021, 2022, 2023? Yeah, but the funding... We're tens of thousands in... And I think... Sorry, Deputy. Just in relation, if you don't mind. In 2021, when the system, the health system, was in the midst of COVID, there was emergency legislation in place. And we utilised that. That was for procurement. That we could go to award a contract. That we should have... And I do regret, and that's what I'm apologising for, that we should have fixed that earlier. But there was a circumstances there that we do need to be aware of. Just... And then I'll move off this a bit. Are you apologising for the €4.7 million or not? Yes, I am apologising. All of it. So including the COVID. So it was a mistake. I'm not... No, I'm not saying... You don't apologise for things that weren't a mistake. I'm not blaming you personally. It was a mistake in relation to oversight and governance. But the reason it was delivered is that we were looking at exponential increases in service and to keep our patients safe. Yes. But you made a mistake. We made a process mistake. Sure. I'm just wondering what my reaction would have been if I was told in the middle of COVID that we were going to get urgent... Like we were going to get urgent radiology scans done for our patients. But it would be after a procurement process that would take a year. Then I wouldn't be apologising for not doing the procurement process. You either have to apologise or... You apologise and say it's a mistake or you don't apologise because it's not a mistake. I'm just fixing it faster. You need to choose a position. No, it was a process. We've admitted to that. We've apologising that it was a process mistake in oversight and controls, but that it was driven through safe patient care and do no harm. Okay. Just to move on. I mean, do you accept there's a conflict of interest here that effectively these public consultants, the slower they go in their public job, the more money they make from a private contract? Let's just deal with the hypothetical, first of all. Isn't it the case that the less patients they deal with in their public time, the more money they would make through a private company? No, not in this case. What our consultants were seeing were more patients in the public time. No, that's not what I'm asking. If they saw less consultants in public time, wouldn't they make more money from private? No, not. You're saying they didn't. No, they wouldn't. Why not? No, because we have... Like the controls that we've put in place, I can only speak to, is religion that we look at core activity. We look at work practice plan. We measure their activity they deliver. We look at, you know, so that... So if they saw, if I'm a doctor and let's say I'd normally see 10 patients in a given period of time, and I begin to see five instead, right, in the same period of time. Yes. Would that not result in more patients being in source? Well, what that would result in would be that that consultant is not utilising his clinic, and he would be brought into a meeting in relation to saying, why are you not utilising your clinic, and why are you underseeing your productivity level? So we have those controls in place to ensure that that doesn't happen. Sorry, Professor Kelly. Yeah, go for it. I'm going to agree with you, and I'm going to disagree with you. Potential conflict of interest is baked into the system of funding. Yes. Okay, so we have a system of funding in the public sector basically based on you're appointed, you turn up, you're paid. The private sector has a basis of funding that you can turn up, you do something, you get paid. Yes. That's a separate discussion. Yes. These radiologists do not decide what x-rays get done. The patient gets scheduled for an x-ray by a scheduling department. The patient turns up at 8.15 in the morning or whatever, and they get put into the scanner, and they have their scan. It might take 25 seconds if it's a routine scan, it might take an hour if it's a lung biopsy done percutaneously, and then they have to report that. So they don't get to decide how much scanning they do. They don't get to decide how many patients get done in the public system. The system decides how many get done. Do you understand? It's a process. Yes. They don't do the scans, they don't schedule the scans, they don't order the scans, they don't make sure it gets done or not done, they simply report it. And do you know for certain that none of the in-sourced, stroke-outsourced work that these doctors were doing, none of that work happened on public time? None of that work happened. And you know that for certain how? Absolutely, because the core activity has increased. That doesn't tell you that. That doesn't prove that. That is not proof. Just because your core activity increased, maybe there was extra slack and you can do a bit extra and. No, that wasn't the case in relation to the level of what the core activity increased tells me that they're actually doing more within their public. But the independent scheduling system that we put in place controlled that they weren't taking patients from this list and taking them over here. And also the funding that was given for this NTPF as it came in three separate tranches. And the NTPF also had very tight controls in place in relation to these initiatives. So they won't give us the money until we take the patient off. So it was very tight in controls both from the national. The reason, the real reason you're saying that they can't possibly have done any of this work in public time is because it would turn up in the scheduling system. Sorry, I also want to say we can see what time the reports are done at. And we can equate that to their work practice plan because they're meant to be on site. Okay. In terms of the use of the MRI as part of the insourcing, do they, does this company pay any fee for that? For that, where they're using public equipment, is the company paying a fee for the use of that equipment? No, but they've got a reduced fee. Yes. Is it kind of baked into the fee that's being paid? The fee that I have paid reflects the fact that they're just reporting on the MRI. Yes. In terms of the space, the kind of medical centre at the top of the building, what comes as a part of that? Obviously they're paying a certain rate, which is for the space, but is there anything included in that that they're getting access to? Yeah, we get basic light-powered cell phone and cleaning, and we do charge them separately for their electricity for the machinery and equipment. There's no medical equipment or anything like that as part of that? No, like we do keep an eye on like maybe consumables in some of the procedure rooms, but it's very small. Okay. And obviously it's because of the potential for a conflict of interest, and I'm not arguing in this case that these particular doctors did it or whatever, but because of the potential for a conflict of interest, that's why we have registers of interest. The exact same process applies to TDs with Zippo. In January we have to do this at the moment. So obviously none of them, and we've been over this, declared the interest. Then they were, as has been outlined, they were discussed with and told that they have to do it, and then they immediately addressed that and they did it. And beyond that, there were no repercussions for the staff. There was no deduction of pay, any formal sanction, none of them lost their jobs, we've heard. There was no, apart from they were caught and then changed it, there was no negative repercussions for the staff. I think that you don't mind interrupting. Yes, you're correct, and Fiona will go through again the process. We have strengthened the process and controls going forward, but I believe that the increase in awareness, the education that we've put in place, the information portal, that there's a very heightened awareness across the hospital in relation to this issue. So I don't phone it, Fiona, do you want to? Again, I just want to start with, it is regret within the hospital of the non-full disclosures, of which we acknowledge have been immediately addressed, and the continuation of the services to deal with cancer care and cardiovascular diagnosis is critical. There is the part of the corporate governance that has been addressed and rectified, and there is the aspect of the performance of the consultants providing excellence to patients, again routinely working above their contractual hours and on-call arrangements. So it's the combination of the consultants in question, the activity that they carry out in their core responsibilities, their immediate actions to rectify their emissions, and then as an organisation, our culture of ensuring that we are strengthening our controls around this, our commitment to reach 100%, which we are saying is mandatory, and that's how we are improving and strengthening all the time. Thanks a lot. Just one final question. It relates to the issue of the radiotherapy treatment machines called linear accelerators. It's an issue that Richard Boyd-Barris raised after his own experience. As I understand it, the machines have a maximum lifespan of 10 to 15 years, but aren't being replaced generally until much later than that, which leads to breakdowns, leads to cancellations, etc. I understand that in James' there's four machines, they're 14 years old, and that they won't be replaced until they're 17 or 19 years old. Can you speak a little bit about that? Yeah, so I just, just before you come in, the radiotherapy centre in St. Luke's, oh sorry, the radiotherapy centre on St. James' hospital site is operated, governed, and run through by the HSE at St. Luke's. So that question does need to be directed to you. I can come in on that, Deputy. So St. Luke's Radiation Oncology Network, or Celeron, as we know it, operates across three sites, Beaumont, St. James' and St. Luke's Hospital in Rathgar, and it is undergoing a major multi-year equipment replacement programme to upgrade the age in linear accelerators, Linux, as you quite rightly pointed out. The programme is designed to replace 14 Linux and associated imaging equipment with completion expected by quarter three of 2030, and then additional enhancements in Beaumont scheduled for completion by quarter three 2031. Yeah, we have the pleasure of having some of the oldest linear accelerators in Western Europe. There's problems with this. They have to be replaced and continue to function at the same time. That's the first, like building the flyovers on the M50 after the first effort at it. Secondly, they were all kind of commissioned around the same time, so they all have to be replaced around the same time of their problem. And buying and installing a linear accelerator is not a simple problem. But we get to the issue of replacement of complex equipment, which needs to be planned for on a multi-year basis in the health system, and that does not happen. Thanks, Deputy Murphy.