Two hospital consultants have queried the methods being used by Health Minister James Reilly's Special Delivery Unit (SDU) to reduce public hospital outpatient and treatment waiting lists.
And the Dail Public Accounts Committee (PAC) has been asked to look into how waiting lists are being cleared.
It has been claimed that in an attempt to reduce lists cosmetically, some patients waiting long periods for outpatient appointments are no longer appearing on official waiting lists. They are reportedly being placed on a separate 'review list', but are still waiting to be seen.
And where public patients on outpatient lists are being seen, many are being transferred to private hospitals where consultants are reportedly being paid €150 per consultation. Where public patients awaiting eye operations are transferred to the private system, some consultants are receiving up to €700 per operation.
Consultant endocrinologist at St Vincent's and Loughlinstown Hospitals in Dublin Prof Donal O'Shea has claimed the some of the recent well-publicised major reduction in outpatient waiting lists was simply a 'book-keeping exercise' rather than a genuine attempt to get these patients seen by a consultant.
"What they have done, as far as I can see, is 'suspend' part of the waiting list. People who were waiting over a year for a first appointment at the Loughlinstown obesity clinic were recently written to and asked if they still wanted to be seen, and were given three days to respond on whether or not they wanted to be seen."
"If they didn't get back to the HSE within three days they were removed from the waiting list. If they were lucky enough to get their reply back in time they were designated as due to be seen sometime this year, but these patients no longer appear on the official waiting list - around 350 of our obesity patients have been suspended in this way. They are a 'suspended cohort of patients awaiting review'."
Dr O'Shea described this exercise as 'Yes Minister gone mad'. "These 350 patients are in limbo but they are officially off the waiting list. We will really struggle to see them all this year as our capacity is for only 200 new patients a year," he told irishhealth.com.
"This waiting list initiative is a numbers game that has occupied too much time for too many people to make a situation that is bad for a particular reason look good for no reason."
The cut in outpatient lists is has also been achieved through providing thousands of patients on the public lists with appointments at private hospitals, with consultants reportedly being paid around €150 by the HSE per consultation.
Around 8,000 public outpatient waiting list patients were recently transferred to the Mater Private Hospital in Dublin to be seen by consultants there, it is understood.
Meanwhile, in a letter to the PAC two weeks ago, consultant eye surgeon Mr Paddy Condon of Waterford Regional Hospital queried why 1,200 public patients awaiting cataract procedures were recently transferred to private hospitals for the operations at a cost of €1,900 to the taxpayer per patient.
Mr Condon claimed that due to massive changes in the technology used to do cataract operations, they could be done at much lower cost than that currently being paid through the SDU to private hospitals. He also said the operations could have been carried out in the public system at Waterford Regional by existing surgeons there 'if facilities had not been withdrawn from them during the last three to four years'.
The Waterford waiting list operations were carried out in a number of private hospitals as well as the Eye and Ear and Mater public hospitals in Dublin, the Sunday Business Post recently reported.
In his recent letter to the PAC highlighting this issue, Mr Condon said in some cases HSE-employed consultants were being paid 'top-ups' of €500 to €700 for cataract operations on public waiting list patients. 'which to many of us is considered a double payment by the HSE'.
"Admittedly this is not the case in all situations but I do think that the activities of the SDU are being used in a rather hamfisted way and require further assessment," Mr Condon said.
His letter states that in the interests of the taxpayer, 'the whole financial methodology employed by the HSE through the SDU for all surgical specialties, not only for eye operations, (should) be subject to closer scrutiny as to value for money'.
"It also brings into question why these monies are not utilised to improve the facilities in our own public hospital system, especially when HSE consultants are employed and available to carry out these procedures," Mr Condon said.
In a separate letter to local TDs and Senators in the south-east, Mr Condon claimed the build-up of waiting lists for eye surgery in Waterford in recent years had been due to reduced facilities for consultants to carry out procedures. He said there had been periods of up to a month without a single cataract operation being carried out at the local unit.
Minister Reilly recently announced a major reduction in the public waiting list for operations, with, he said, 99.99% of adult patients on the elective waiting list now waiting less than eight months for a procedure, and 95% of children waiting under 20 weeks for operations.
He also announced that the number of people waiting over 12 months for an outpatient appointment had been cut to to 4,626 in December, compared to 103,433 in March 2013. This included cutting the number on outpatient lists for over a year by around 50,000 between the end of November and the end of December.
The HSE told irishhealth.com that 23,037 extra outpatient appointments were 'outsourced' last year to other hospitals, including private hospitals, under an SDU initiative - this accounted for just over one-fifth of the additional outpatient visits provided to clear lists.
It said treatment waiting lists last year were cut by outsourcing procedures to two public and six private hospitals.
The public hospitals used to clear treatment lists were Cappagh Orthopaedic and Mullingar, while the private hospitals used were the Galway Clinic, the Mater Private, Barrington's in Limerick, the Hermitage Clinic in Dublin, the Blackrock Clinic and Mount Carmel Hospital (now closed).
The HSE said in addition, other public hospitals secured additional internal treatment capacity in 2013 to reduce waiting lists for procedures.
The health executive declined to provide details to irishhealth.com of how many public patients on operation waiting lists were referred on to private hospitals over the past year, what the average fee paid to consultants per operation was and what the total payout to private hospitals for these referrals was.
It also didn't answer questions on the total payout last year to private hospitals and consultants for seeing outpatients on public waiting lists, nor did it confirm that consultants were being paid €150 by the HSE per private outpatient consultation.
The HSE said an overall figure of €18 million was provided last year to ease emergency department trolley waits and reduce waiting lists.
The health executive also did not comment on Prof O'Shea's claim that in some cases patients were being removed from outpatient lists even though they were still not being seen by a consultant.
Minister Reilly's SDU initiative to tackle waiting lists was started in 2011. The SDU is now directly under the control of the HSE.
Reilly says hospitals must do more on op waits
How are they getting away with this - incredible
Well done Niall Hunter on a well researched article. When Mary Harney first designed this sleight of hand to reduce waiting lists much of the media cottoned on immediately and it was a hot topic so much so that one James Reilly declared that if (and when) he got into government this waste of public money would cease. Instead he has refined the system to waste even more public money but then PR needs must.