Reduced income from the National Treatment Purchase Fund (NTPF) and private health insurance (PHI) may curtail surgical activity at National Orthopaedic Hospital Cappagh (NOHC), indicate internal minutes.
The NOHC executive management team (EMT) meeting on 1 April discussed “current challenges facing the hospital arising from the 2026 HSE allocation and the substantially higher level of inpatient activity targets that have been assigned to the hospital compared to those assigned in 2025”.
The HSE had advised the hospital that “NTPF income will be materially reduced in 2026 and the impact of the consultant [public-] only contract will result in a substantial loss of private insurance income”, stated the minutes released under Freedom of Information law.
“It was noted that both these income sources have significantly contributed to the strong levels of surgical activity the hospital has been able to complete in prior years.”
The HSE had “acknowledged” that the NOHC was performing within budget. The “current substantial deficit” primarily arose from the loss of NTPF and PHI income, as well as inflationary costs for certain non-pay expenditure and increased activity in 2026.
The minutes added that the HSE required hospitals to achieve a breakeven position at year-end and perform within notified expenditure limits.
“Arising from this it will unfortunately be necessary to reduce surgical activity commensurate with the funding provided. Orthopaedic surgery is costly and the only lever the hospital has to reduce costs is a reduction in medical and surgical spend, as the majority of other costs are fixed.”
Surgeons at the meeting noted that “this is very regretful and that the position has been communicated to the HSE on a number of occasions”. The EMT also heard that activity levels were ahead of 2025, with inpatient activity running 11 per cent ahead and day-case activity 4 per cent ahead at the end of quarter one compared to the same period in 2025.
A NOHC board meeting in February had heard that the 2026 draft service arrangement had been received from the HSE. It had set out “a significant increase in the 2026 inpatient targets without any additional funding”.
A spokesperson for the NOHC told the Medical Independent: “The hospital is working closely with the HSE to maximise surgical activity within the funding available.”
The hospital did not provide details of its HSE funding allocation for 2026. In 2024, HSE revenue grants amounted to €60,061,000, compared to €54,551,000 in 2023.
According to the NOHC’s 2024 annual report, the successful implementation of the HSE Waiting List Action Plan resulted in positive reductions of 29 per cent in outpatient and 9 per cent in surgical waiting lists.
Hospital-wide activity remained strong, with a notable 9 per cent increase in hip and knee replacement and revision surgeries, 10 per cent increase in spinal surgeries, and 29 per cent increase in upper limb surgeries.
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