HSE's Decision to End Insourcing Could Increase Patient Waiting Lists by 4,000 Monthly

London, United Kingdom Jul 22, 2026 ALN: The Health Service Executive (HSE) of Ireland has recently made a controversial decision to end its insourcing initiative, a move that could significantly impact patient care across the country. According to an internal report from the HSE, this decision could lead to an increase of up to 4,000 additional patients per month being placed on waiting lists to see a consultant. This alarming prediction comes at a time when the healthcare system is already grappling with long-standing issues related to patient access and waiting times.

Insourcing is a practice where private companies are contracted to utilize HSE staff and equipment outside of regular hours to conduct special clinics aimed at treating patients who are on waiting lists. The initiative was introduced to enhance access to healthcare services and improve the timeliness of care delivery, particularly for those waiting to see specialists. However, the Minister for Health and the HSE announced the termination of this initiative effective from July, citing concerns regarding governance, value for money, and potential perverse incentives that could arise from such arrangements.

Tony Canavan, the regional executive officer for HSE West and North West, which encompasses six acute hospitals in Galway, Mayo, Sligo, and Donegal, has expressed the need for alternatives to the abrupt cessation of the insourcing agreements. In a report addressed to HSE chief executive Anne O’Connor and director of access Sheila McGuinness, Canavan highlighted the significant risks posed to patient care due to the sudden removal of the insourcing initiative. The report noted that insourcing had become a "critical enabler" for service delivery in the region, accounting for 13% and 11% of new outpatient activity for the years 2024 and 2025, respectively, and 20% of endoscopy capacity for 2025 and 2026.

The implications of this decision are profound. The report emphasizes that third-party insourcing has facilitated rapid scaling of healthcare activities without necessitating capital investments, thereby playing a crucial role in managing waiting lists and striving to meet waiting list targets. It has become increasingly clear to senior management within the HSE that restricting insourcing would likely lead to reduced access to care for a substantial number of patients. Initial estimates suggested that about 4% of patients receiving treatment through insourcing would be adversely affected. However, the internal report's more dire warnings indicate that ending the initiative altogether could result in a rapid increase in waiting lists, impacting thousands of patients.

The report also pointed out that insourcing is no longer viewed as supplementary but has instead become embedded in the standard care delivery model across various specialties, including endoscopies and breast assessments. The abrupt cessation of this initiative without a suitable replacement could not only exacerbate waiting lists but also lead to a loss of momentum in efforts to improve patient care.

In light of these concerns, the report highlights that there was a national pause on insourcing from May to October 2025 while the HSE head office reviewed the associated concerns. During this hiatus, the region experienced an increase in waiting list volumes, further underscoring the potential negative consequences of abruptly ending the program. The report estimates that the cessation of the insourcing scheme could lead to an outpatient waiting list increase of between 2,000 and 4,000 patients each month, exacerbating an already critical situation.

The outpatient waiting list represents patients who have been referred by their General Practitioners (GPs) to see hospital consultants, and the increase in this list could have significant ramifications for patient health outcomes. The report warns that the decision to end insourcing poses a "significant risk of unintended harm to patients," as prolonged waiting times can lead to deteriorating health conditions and increased morbidity.

Moreover, the report raises alarms about the possibility of a "significant increase in the numbers of patients breaching urgent colonoscopy and breast targets," which could widen existing disparities in access to care, particularly for patients in rural and peripheral areas. The implications of these waiting list increases are not just logistical; they could have serious health consequences for patients who are already vulnerable.

To mitigate the risks associated with the cessation of insourcing, the report proposed a "regionally tailored approach" that would involve a careful and planned withdrawal from the initiative, rather than an abrupt termination. It outlined five potential options to address the challenges posed by the end of the insourcing scheme: permitting the continued use of third-party insourcing, introducing regional flexibility, maintaining insourcing for high-demand specialties and patients with long wait times, implementing a phased withdrawal, and conducting a planned review after cessation to reinstate the initiative if demand exceeds available capacity.

A spokesperson for the HSE acknowledged the concerns raised in the report and stated that a range of measures were being implemented to support regions in managing the fallout from the end of insourcing. These measures include service developments, capacity enhancements, planned overtime, and appropriate outsourcing arrangements. However, the spokesperson emphasized that all third-party insourcing activities have ceased, and a short, managed close-out period was implemented in early July to complete appointments that had already been scheduled for patients. They clarified that this decision was made solely to ensure continuity of care and that no new insourcing initiatives or extensions would be pursued.

In response to the internal report's findings, the HSE West and North West region contended that the report did not adequately consider alternatives for managing waiting lists and expressed a commitment to putting in place alternative processes for patient care. This response reflects the ongoing tension within the HSE regarding how best to balance resource allocation, patient access, and overall healthcare quality.

The decision to end insourcing raises critical questions about the future of healthcare delivery in Ireland. As the healthcare system continues to face challenges related to waiting lists and patient access, the implications of this decision will need to be carefully monitored. Stakeholders, including healthcare professionals, policymakers, and patient advocacy groups, will undoubtedly be watching closely to assess the impact of this decision on patient outcomes and the overall effectiveness of the healthcare system.