Irish patients sent abroad because we cannot provide care here
Ireland's public mental health system has quietly ceded ground to private providers over nearly a decade, with the HSE now spending €93 million annually on outsourced care — nearly double what it spent in 2018. The most human measure of this drift is the €13 million now used to send Irish patients, including children, across the Irish Sea for treatment their own country cannot provide. Labour's Marie Sherlock has named this not as a stopgap but as a structural failure — one in which public money trains clinicians who leave for better-paid private work, and the state then pays those same private firms to deliver the care it abdicated. The question Ireland now faces is whether it will continue financing someone else's solution, or invest in rebuilding its own.
- Ireland's HSE is spending €93 million a year on private mental health care — a bill that has nearly doubled in eight years and shows no sign of slowing.
- Children and adults with complex needs are being sent to UK facilities, separated from families and support networks, because Ireland's public system lacks secure settings, eating disorder units, and specialist care.
- The system is caught in a damaging loop: it trains clinicians who migrate to better-paid private providers, then pays those providers — using its own staff — to deliver the care it can no longer offer.
- Frontline managers are losing experienced staff to the private sector, leaving public services understaffed and waiting lists growing, with families in crisis finding fewer and fewer options.
- Labour is demanding an urgent reset — redirecting the €93 million toward hiring staff, opening beds, and building domestic capacity rather than deepening dependency on private contracts.
Ireland's health service has developed an expensive habit. Each year, the HSE writes larger cheques to private mental health providers, outsourcing care that should exist within the public system. Last year, that bill reached nearly €93 million — a figure that has nearly doubled in eight years, climbing from €46 million in 2018.
The most striking shift has been the export of patients. In 2018 and 2019, the HSE spent nothing on mental health care in the United Kingdom. By 2024, that figure had reached almost €13 million annually. Irish patients — many of them children — are being sent across the Irish Sea for treatment, separated from their families and support networks. The HSE has acknowledged why: the public system cannot provide secure settings for children, cannot treat complex multi-axial disorders, cannot deliver specialist eating disorder care. These are not edge cases. They are fundamental gaps.
Labour's health spokeswoman Marie Sherlock has made the numbers public and is demanding a reckoning. The arithmetic is damning. Every euro spent on private care is a euro not spent on hiring clinicians, opening beds, or building capacity. The perverse cycle runs deeper still: the HSE trains nurses and doctors, watches them migrate to private providers offering better pay, then pays those same companies to deliver care using the staff it trained.
Sherlock's argument is not that emergency outsourcing has no place — it does, in acute crisis. But building long-term reliance on private providers is a strategic failure of planning, investment, and leadership. The solution is to redirect that €93 million toward what should have been done years ago: more staff, more beds, local care, and conditions that might convince clinicians to stay in the public system. Until that happens, Irish patients will continue to be sent abroad, and the public system will continue to shrink.
Ireland's health service has developed an expensive habit. Each year, the HSE writes larger checks to private mental health providers, outsourcing care that should exist within the public system. Last year, that bill reached nearly €93 million—a figure that has nearly doubled in just eight years, climbing from €46 million in 2018. The trajectory tells a story of a system in retreat, unable to meet its own obligations.
The most striking shift has been the export of patients. In 2018 and 2019, the HSE spent nothing on mental health care in the United Kingdom. By 2024, that figure had exploded to almost €13 million annually—double what was spent the year before. Irish patients, many of them children, are now being sent across the Irish Sea for treatment, separated from their families, their support networks, their homes. The HSE itself has acknowledged why: the public system cannot provide secure settings for children, cannot adequately treat people with complex multi-axial disorders, cannot deliver specialist care for severe eating disorders. These are not edge cases. These are fundamental gaps in a public health infrastructure.
Labour's health spokeswoman Marie Sherlock has made the numbers public and is demanding a reckoning. The arithmetic is straightforward and damning. That €93 million is not solving the problem—it is financing someone else's solution while the public system atrophies. Every euro spent on private care is a euro not spent on hiring clinicians, opening beds, training staff, building capacity. The perverse cycle runs deeper still: the HSE trains nurses and doctors in its own system, only to watch them migrate to private providers where pay and conditions are better. Then the HSE turns around and pays those same private companies to deliver care using the staff it trained. It is wasteful, it is circular, and it is unsustainable.
Frontline staff are feeling the pressure acutely. Managers report losing experienced clinicians to the private sector, leaving public mental health services understaffed and overwhelmed. The families navigating waiting lists, the young people in crisis, the parents searching for help—they encounter a system that has outsourced its way into dependency rather than built its way toward capacity. For those who cannot afford private care and cannot wait months for public treatment, the choice narrows to nothing.
Sherlock's argument is not that emergency outsourcing has no place—it does, when someone is in acute crisis and the public system cannot respond immediately. But building a long-term reliance on private providers is a strategic failure. It is a failure of planning, of investment, of leadership. The solution is not to spend more money on private contracts. It is to redirect that €93 million toward what should have been done years ago: hiring more staff, opening more beds, delivering care locally, and treating the clinicians who work in the public system with the pay and conditions that might convince them to stay. Until that happens, Irish patients will continue to be sent abroad, and the public system will continue to shrink.
Notable Quotes
It is a serious mistake to build up a long-term reliance on the private sector and on sending people abroad— Marie Sherlock, Labour health spokeswoman
The HSE has confirmed this outsourcing is driven by an inability to meet patient needs within our own services— HSE statement
The Hearth Conversation Another angle on the story
Why does the HSE keep turning to private providers if it costs so much?
Because the public system has structural gaps it can't fill quickly. Secure child units, eating disorder specialists, complex psychiatric care—these require infrastructure and staff the HSE doesn't have. Private providers can fill the gap immediately, even if it's expensive.
But doesn't that just make the problem worse?
Exactly. Every time the HSE outsources, it's admitting defeat on building its own capacity. And it's spending money that could hire permanent staff on temporary contracts with private companies. It's treating the symptom, not the disease.
What about the patients being sent to the UK?
They're separated from family, from their support networks, from everything familiar. A teenager in crisis doesn't want to be in a hospital in England. But if there's no secure unit in Dublin, that's where they go. The HSE has no choice—or rather, it made choices years ago that left it with no choice now.
Is there a way out of this cycle?
Yes, but it requires the HSE to stop outsourcing and start investing. Take that €93 million and hire clinicians, open beds, build units. It takes longer than writing a check to a private provider, but it actually solves the problem instead of hiding it.
Why haven't they done that already?
Political will, budget constraints, the difficulty of building public infrastructure. It's easier to outsource than to commit to long-term public investment. But easier isn't working.