I note with interest that you don't have any answers to the difficult challenges that I outlined around tendering for services that are inherently unpredictable in nature. Perhaps you'd like to go back and review these questions again and educate us all on the possible solutions instead of coming up with catch (yet meaningless) cliches.
Very very simple. If you dont look after these cases well, then you dont get paid and you dont get the lucrative contract when it is up for renewal.
You neglect to point out that the HSE currently has a terrible track record in dealing with these cases, yet there is no remedy. There doesnt appear to be any incentive for HSE hospitals to do a good job - they dont get paid any more if they do. What incentive do HSE paid staff have to go the extra mile with a difficult case?