The members have it in writing and can refer to the hard copy if they wish.
I am pleased to be in a position to report that since its inception the National Treatment Purchase Fund has carried out some great work in delivering faster treatment to hundreds of thousands of patients in the public healthcare system. While not wishing to delve too much into the history of the organisation it is worth noting that in its first decade as an independent agency, the NTPF succeeded in reducing inpatient waiting times for public patients from their original levels of two to five years - depending on the category - down to an average waiting time of 2.5 months. This was achieved through the direct commissioning of patient-level treatment for public patients by the NTPF - mostly in private hospitals.
In 2012 the Government assigned additional responsibilities to the NTPF and effectively signalled the end of the organisation’s direct patient treatment commissioning role. It also reflected a major resulting change in the operational framework of the NTPF, as this commissioning work had represented a significant part of the activity of the NTPF since its inception, as we have seen in the presentation by the Comptroller and Auditor General. The result was that the organisation re-focused its efforts on areas such as data and analytics, audit and quality assurance and its role in respect of the nursing home support scheme, which was referred to earlier. Through these, the organisation continued to provide valuable support services to the broader healthcare system at a time when it was undergoing significant change and reform.
In 2014 a new NTPF board was appointed, one of the first selected under the Public Appointments Service process. This board has a wide range of skills covering areas such as medical, legal, accounting, IT, procurement, personnel and general management. While continuing to oversee the ongoing operations of the organisation, at that time this board applied itself particularly to the task of preparing the organisation through the development of a detailed strategy and action plan, all aimed at supporting performance improvement for the faster treatment of patients. The outcome of this work meant that the NTPF was well placed to support the commitments contained in A Programme for a Partnership Government of 2016 in the specific funding allocated to the organisation to reduce waiting lists in 2017 and 2018.
On foot of the decision of the then Minister for Health in 2016 to re-establish the individual patient-level commissioning role of the NTPF and, importantly, with the allocation of the enabling funding, the organisation is particularly well placed now to make an increased positive and valuable contribution again towards shorter waiting times for patients. I say this with confidence based on the organisation's proven track record of having done so in the past. It is also based on what has been achieved more recently - in the past 12 months. The outline of the organisation's objectives is contained in my written statement, which has been provided to the committee.
In order to deliver on the requirements placed on the organisation under the programme for Government 2016 the NTPF budget was increased to €20 million last year, with a further €55 million committed for the current year. I am pleased to report that we have successfully resumed commissioning of patient treatment and that detailed arrangements are in place with private hospitals for this work. An in-sourcing initiative was also undertaken to treat patients in public hospitals for specific procedures and treatments. Through this process - and using €5 million of the €15 million allocated to us for patient treatment work in 2017 - day-case patients were brought into the system and more were then placed on treatment pathways in private hospitals. A further tranche of funding was then committed to an in-sourcing initiative under which up to €5 million was provided for treating patients in public hospitals. In the second half of 2017 a third phase of spending was decided upon based on our experience with the first two private and public elements.
A specific target was that the active inpatient and day-case waiting list numbers would be less than 9,153. At the end of October the number was down to 7,282. We aimed to remove 7,000 patients from this list through acceptance of offers of treatment funded by the NTPF and a total of 8,192 people were removed from the list. It was proposed that 700 of the longest-waiting patients would be treated from the gastrointestinal scope waiting list and as a result of our initiative, 1,382 patients were removed. These are just figures but in human terms each one of these patients, and their families, have had their pain and suffering dealt with at an earlier date and have been enabled to get on with their lives.
Importantly, from the perspective of the Committee of Public Accounts, the NTPF can identify each patient and the precise treatment that he or she received. We can assure this committee that value for money was achieved and that despite the funding allocation being small in the context of the overall spend on health, a real impact was made. Our decisions on the specific uses for the current year's funding allocation of €50 million for patient treatment were informed by our experiences with last year's approach. By the end of this year, the organisation will have arranged treatment for a further 20,000 inpatient and day-case patients. NTPF-funded treatment is being provided in private hospitals or in public hospitals where there is available capacity. The focus will be on those waiting longest, for around 50 different procedures.
To date, in 2018, the NTPF has made arrangements for almost 9,000 inpatient and day-case patients and this has contributed to the number on the inpatient and day-case waiting list, reducing by a further 3,000 in the first five months of 2018, despite the challenges posed earlier in the year by Storm Emma. The number on this waiting list is currently 7,500 lower than at its peak ten months ago, a reduction of 9% on the list.
Earlier, I mentioned the nursing home support scheme - the fair deal scheme - which was established in 2009. The NTPF was given a specific key role on the pricing of long-term residential care. Given the significant sums of public moneys, of the order of €1 billion, being allocated to this scheme, this matter will be of particular interest to the members of this committee. While the NTPF’s role is very precisely defined and quite limited, through the Nursing Homes Support Scheme Act the organisation was given a vitally important task for the users of the system and for national finances. Specifically, the NTPF is mandated by statute to negotiate with nursing home proprietors for the purposes of reaching an agreement as to the maximum amount that will be charged for the provision of specified long-term residential care services. I am happy to be able to record that the NTPF has delivered consistently on this mandate over the past eight years. The organisation has done this by setting up the system of agreeing prices, which had not existed previously, by successfully negotiating and agreeing prices with approximately 430 nursing homes and by renegotiating and updating these prices on a fully negotiated basis with each nursing home over the years of the operation of the scheme. By the end of April 2018, more than 430 nursing homes had pricing contracts with the NTPF and the average price of long-term residential care paid to these nursing homes amounted to €955 per resident per week.
Another key figure is that these nursing homes are providing care to 17,500 fair deal residents. On behalf of the organisation, I assure members of this committee that the NTPF will continue its work to ensure that value is achieved for the taxpayer and that the substantial funds being made available to the fair deal scheme are maximised for the benefit of those assessed as being in need of long-term residential care.
The review of the nursing home support scheme has been discussed with the other group. Any proposals to amend a successful system benefitting the 17,500 residents and involving State expenditure of close to €900 million should be very carefully scrutinised and considered. The NTPF is currently working in the first instance with the Departments of Health and Public Expenditure and Reform in a review to ensure that viable and effective systems continue to be provided for both providers and users of long-term residential care nationwide. I assure the committee that the NTPF has undertaken this task with all the due diligence that would be expected of us. Our overriding concern throughout the process has been to provide the best possible inputs to the steering group, which includes the Departments of Health and Public Expenditure and Reform. This group will, in turn, bring its proposals to a broader working group that will include officials from the Department of the Taoiseach and the Revenue Commissioners.
When the review was initiated by the Department of Health, it was recognised by it that the NTPF would require professional and independent costing and other technical and relevant expertise to inform our review of pricing. We have been working with Deloitte on this and it has consulted a wide range of stakeholders and interested parties. Their work is close to completion and these matters will be considered by the steering group in the near future.
The remainder of my written statement contains information on the NTPF annual accounts, which are a matter of record and I am sure we can get into in more detail on those later. As the chairman of the NTPF board, I wish to reassure members that our objective is to ensure the National Treatment Purchase Fund continues to be well directed and managed in accordance with all appropriate governance requirements. We have a cohort of skilled board members, a committed executive team and employees giving us a base of significant experience and skills. Our aim is to ensure that all of the functions allocated to us by Government are carried out effectively and efficiently and that we will continue to be in a position to demonstrate that all funding voted to the organisation is being spent as intended to reduce waiting times for patients in the public healthcare system. I thank the Acting Chairman and members of the committee. The members of the executive and I will gladly take any questions members may have.
