I have been told by people working within the health service that there are senior healthcare professionals at the moment, including some consultants, who are creating their own private companies and diverting patients from public waiting lists to their newly created private companies. It has been alleged in one case that a consultant, who created a private firm to read scans, used the hospital public waiting lists to funnel work through rostering into his own private company. It is an incredible situation and a major conflict of interest for anybody in a public role to be doing this in relation to their own businesses. The Minister must admit that we cannot allow anybody on the public payroll to be in a position where they are creating a private company and funnelling public work to their own private company.

I put a parliamentary question to the Minister for Health a couple of weeks ago to see if this practice is widespread within the sector and the response I got is quite shocking. An internal audit report carried out by the office of the chief internal auditor was written less than a year ago and its job was to ascertain if private companies were used to provide additional services such as this. It found that there was a major breakdown in terms of compliance and value for money.

For example, UHL was found not to have conducted an open procurement process with €14.2 million paid to these types of providers just in one year, 2023. Management confirmed that there were no dedicated procurement functions within the group for this. In UHL two private providers were owned or part-owned by two separate UHL employees. A third company was owned by a HSE employee with another hospital. This corroborates the allegations of this practice happening that have been made to me.

That report states that the Government was getting a handle on it, but we are actually hearing of this happening in real time at the moment. Hospitals have work coming at them at a fierce rate at the moment. I know of one hospital with a backlog of 960 biopsies at the moment. Within that backlog, there are people with cancers. There are delayed diagnoses, delayed treatments and more negative outcomes as results of this. It is clear that we do not have enough beds within the system. It is clear that investment is not getting to the front line and is getting caught up in administration. The population of the State grew by 100,000 people last year. The Government's pay and numbers policy is an effective recruitment embargo on the health service.

The INMO is having its conference today. Will the Minister send a message to that conference today to say to nurses and doctors that the Government has their backs? Will he send a message to say that the Government will end the practice of public staff creating private companies and funnelling patients from public lists into their own private companies in future?

The matters the Deputy has raised are very serious and need to be properly and thoroughly followed through by the HSE. There are references there to conflicts of interest and value-for-money concerns, which are extremely concerning. Under initiatives to reduce waiting lists, the HSE can outsource to private hospitals under the surgical services framework and the private provider framework.

The HSE looks internally within and across hospital sites to deliver insourcing pathways. As part of the waiting list action plan, there is a focus on deploying additional weekend, evening and out-of-hours activity to reduce overall waiting lists. I understand that at the request of the Minister for Health, the CEO of the HSE has initiated a detailed survey of all insourcing activity in the HSE which will be assigned by finance, internal audit, HR and access integration functions. The CEO has also issued an instruction that all insourcing where existing staff are hired, engaged or paid by a separate entity to work on initiatives in their own place or type of work must now be paused. Only insourcing where the HSE directly engages its staff through payroll can continue until this survey has been completed.

The ultimate aim of the work is to move beyond the dependence the Deputy referenced on insourcing or outsourcing in favour of planned and stabilised rostering of all staff. An internal audit referenced by the Deputy on insourcing in UHL found that consultants carried out insourcing in the hospital. The audit found that consultants set up private companies and referred patients to their own companies, and that tender processes were not appropriately followed. The CEO of the HSE has instigated a review of insourcing across the HSE, as I said, not just because of the audit I have mentioned but also due to broader concerns about how it operates and value for money considerations.

On the instruction to pause work where existing staff are hired or engaged by a separate entity to work on initiatives in their own place, it is examining all arrangements and contractual agreements in an effort to pause this work as quickly as possible. I appreciate, having been made aware of this issue, that it is serious. If appropriate procedures have not been followed, there has to be full follow through from the HSE. All dimensions of the respective financial frameworks regarding insourcing and outsourcing should be followed by anyone working in the HSE. I have tried to provide some clarity on the matter today.

I welcome the pause in insourcing, but we have to ask why this is happening. I spoke to staff in a hospital in the midlands today. They told me they had a red escalation over the bank holiday weekend, which is unheard of in the middle of summer. It is something that usually happens in December and January. They have been told to get patients out of the hospital and free up operations and other elective engagements so that they can orientate staff towards the people in emergency departments.

There are 461 people on trolleys today - 461 people who were crowded into hospitals overnight with the lights on and did not get any sleep, etc. Some 50,000 hospital appointments have been cancelled so far this year. Over the past four years, 800,000 hospital appointments have been cancelled. Today, there are 800 vacancies for consultants. We have a major crisis in terms of resources in the hospital and that is why this is happening. It is not good enough to pause what is happening; we also need to get rid of the pay and numbers embargo on staff so that we can resource the treatment that needs to be delivered to patients.

One of the main areas of focus for the new Minister for Health has been the need to address work time during the evenings and over weekends. The Minister has been proactive in managing that over the past number of weeks, in particular, to ensure we have a greater presence of senior consultants and others across the hospital system in order to try to accelerate discharge and provide senior oversight in the clinical environment over the weekend period. We are seeing the positive outworking of that in the ongoing management and work between the Minister for Health and the HSE.

With regard to the pay and numbers strategy, a significant increase in the health budget was agreed last July between the Minister, Deputy Donohoe, and the then Minister, Stephen Donnelly, which gave multiannual two-year certainty to the HSE to manage its overall pay and numbers in the context of a two-year framework. That was welcomed at the time by the HSE and the hospitals within it, in particular tertiary hospitals and others, so that they could accelerate recruitment over that window of time. That has provided a benefit to the HSE in terms of managing increased clinical workload.

Before we move to Other Members' Questions, I would like to mention our visitors from Ballyadams National School in County Laois, who are here at the behest of Deputy William Aird. You are welcome.