Up to 4,000 additional patients per month could be placed on regional waiting lists after the Health Service Executive scrapped a key initiative aimed at improving access to healthcare, an internal HSE report has warned.
Insourcing - where private companies are paid to use HSE staff and equipment after hours to hold special clinics for patients on waiting lists - was abolished from July 2026 due to concerns around governance, value for money and perverse incentives.
The Warning
Tony Canavan, regional executive officer of HSE West and North West (covering six acute hospitals in Galway, Mayo, Sligo and Donegal), sought approval for alternatives in a report sent to chief executive Anne O'Connor and HSE director of access Sheila McGuinness on 20 April 2026.
The report warned that the abrupt ending would create a "significant risk of unintended harm to patients."
The Numbers
Insourcing accounted for 13% of new outpatient activity in 2024 and 11% in 2025
20% of endoscopy capacity for 2025-2026
Estimated increase in outpatient waiting list: 2,000 to 4,000 patients per month
Risk of "rapid growth" in waiting lists
Risk of "significant increase" in patients breaching urgent colonoscopy and breast targets
The report stated insourcing had "become embedded in baseline care delivery" and was no longer supplementary - covering endoscopies, breast triple assessment and various specialities.
"Without replacement capacity, this reduction cannot be absorbed within existing core hours," it warned.
Previous Impact
A national pause on insourcing between May and October 2025 resulted in increased waiting list volumes in the region. The report highlighted risks of:
Loss of momentum
Increased reliance on outsourcing "at potentially higher costs"
"Widening existing inequities in access, particularly in rural and peripheral areas"
Proposed Alternatives
The report advanced five mitigation options:
Permit continued use of third-party insourcing
Introduce regional flexibility
Maintain insourcing for high-demand specialities and long waiters
Phased and supported withdrawal
Planned review after cessation - reinstate if capacity falls short
HSE Response
A HSE spokeswoman confirmed all third-party insourcing has now ceased. She said a range of measures were progressed including service developments, capacity measures, planned overtime and appropriate outsourcing. A "short, managed close-out" in early July completed already-scheduled appointments in the West and North West.
"No new third-party insourcing initiatives, extensions or additional arrangements are in place or will be progressed," she said.
The HSE West and North West region said the report "did not take into account alternatives" and that the region is "now putting in place alternative processes for patients."