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Unravelling expenditure on private ambulances

In 2016, HSE National Ambulance Service (NAS) Director Mr Damien McCallion attended a National Performance Oversight Group (NPOG) meeting.

An action log from the January meeting noted that “National Director [Damien McCallion] to ascertain if the money allocated to hospitals for private ambulance provision has actually been used for this purpose.”

According to comments from the same log, the NAS National Director reported that private ambulance expenditure, excluding voluntary hospitals, was at €6 million.

It added: “Top hospitals for spending are as follows: Letterkenny, Portlaoise, Portiuncula and Limerick. €340k spend on ICV [intermediate care vehicles] (vehicles not included). Area managers in NAS are currently working with hospitals to see where services could have service and cost benefit. Private ambulance contract is very restrictive at present and being reviewed with tender to go out in the first quarter of 2016.”

The log, released following a Freedom of Information (FoI) request, pointed to concern within the HSE around the issue of finance allocated towards private ambulance expenditure.

Demand

Patient transport by private ambulance is regularly required within the HSE, as the NAS does not have capacity to undertake all routine patient transfers between hospitals.

The NAS deals with up to 280,000 emergency calls annually and struggles to meet with this level of demand as well as providing some inter-hospital transfers.

More than €19 million has been spent on private ambulances in the four-year period from 2012 to 2015, according to data released under FoI.

Figures reveal that €6.3 million was spent in 2015 compared to €4.4 million in 2014 – a jump of 42 per cent. Around €4.5 million was spent in 2013, while €3.8 million was expended in 2012. The figure for 2016 was unavailable, stated the HSE.

The FoI data listed separate costs from “known ambulance vendors” for each of the years 2012 to 2015 and is the “best record available”, according to the HSE.

The HSE said “there is a significant requirement for transfer of (mostly non-urgent) public patients for various clinical reasons and private ambulance providers are used to provide additional capacity to handle such patient transfers. Examples include transfers between hospitals, between residential and acute settings and transfers for diagnostic tests at another hospital.”

Taxis are used in cases where ambulances are not required, the HSE added.

SLA

Lifeline, Beaumont Private Ambulance, Medicall and James Murray/Murray Ambulances are the four companies included in a HSE framework contract and service level agreement (SLA) relating to patient transport to and from HSE hospitals.

The major part of public patient transport to and from HSE acute hospitals is carried out under the SLA, the HSE added.

“Hospitals are permitted to seek patient transport services from other providers included in the Pre-Hospital Emergency Care Council list of recognised institutions, where those included in the agreement are not in a position to provide the service required,” the HSE stated.

“In the broader context of health services, patient transport forms one thread in a complex canvas, which also includes issues of patient safety, effective delivery of services, efficient use of resources and geographical challenges (particularly for sites outside the major urban centres).”

The data reveals much about the costs incurred by HSE hospitals and services, but also raises many questions – such as why the HSE’s stated spend on private ambulances increased so dramatically by 42 per cent between 2014 and 2015, compared to much smaller increases in previous years.

‘Null’

It is also unclear why the second highest spender of private ambulance services in 2015, racking up a cost of over €1.2 million, is not identifiable and referenced as “null”.

The HSE said its ICT system could not identify the HSE service responsible for this expenditure for “technical reasons”.

In 2014, ‘null’ spent €860,000 on private ambulances and €1.2 million in 2013. In 2012, ‘null’ was the highest spender of private ambulance services nationwide running up costs of €1.1 million. This amounts to over €4 million in taxpayers’ money in four years.

In addition, several HSE-run hospitals and local health offices are absent from the data provided.

The hospitals absent from the data include Roscommon University Hospital, University Hospital Galway and Mayo University Hospital – which all regularly use private ambulances for patient transfers.

It should be noted that costs for private ambulance transfers from voluntary hospitals are not included in the data provided by the HSE.

In 2015, figures provided by the Saolta University Health Care Group to current Minister for Communications, Climate Action and Environment Denis Naughten showed that over €1.5 million had been spent on private ambulances transporting patients to Mayo University Hospital between 2013 and the first six months of 2015.

During the same time period, Portiuncula University Hospital incurred charges of €366,000, with €112,000 spent on transfers to Roscommon University Hospital.

However, neither Roscommon University Hospital nor Mayo University Hospital were listed in the data provided to the Medical Independent (MI). Other absent hospitals include Cavan General Hospital and Monaghan General Hospital.

In a response to questions, a HSE spokesperson said the information sought is not available due to the manner in which it is collated by HSE Health Business Services onto the system.

It is understood that all invoices are put onto a HSE IT system and every invoice would have to be pulled from an archive and examined in order to answer questions arising from the data.

It is not known if such an examination has taken place following concerns by NAS Director Mr McCallion about private ambulance expenditure.

Portiuncula

In 2015, documents show that Portiuncula University Hospital spent more than €1.3 million on private ambulances – the highest of any hospital in the country.

The second highest spend that year was €1.2 million but, as noted, the HSE said its ICT system could not identify the HSE service responsible.

Over €835,000 was spent by Letterkenny University Hospital in 2015, while more than €636,000 was expended by Sligo University Hospital.

Midland Regional Hospital, Tullamore, spent over €312,000, while University Hospital Limerick and Cork University Hospital paid out €306,000 and €290,000 respectively.

In 2014, Portiuncula University Hospital topped the list once again, with a spend of over €1 million. In 2013, it spent €1.3 million and in 2012 more than €1 million.

The hospital data refers to the transport of public patients only, as insurers pay for the transport of private patients.

In April last year, the HSE launched an internal and external market review and consultation process with potential bidders in preparation for a tender competition for inter-hospital transfer services.

“The HSE invites submissions from economic operators for the purpose of research into market capacities for the provision of Inter Hospital Ambulance Transfer Services,” the HSE states in a briefing note attached to the request for information.

The closing date for submissions fell in May 2016 but a tender competition for inter-hospital ambulance transfers has yet to be launched.

The HSE had yet to respond on a possible tender competition for inter-hospital ambulance transfers or its investigation of monies allocated to hospitals for private ambulances at the time of going to press.

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