National Treatment Purchase Fund

Dáil Éireann Debate, Tuesday - 18 October 2016

Tuesday, 18 October 2016

Questions (25)

Dessie Ellis

Question:

25. Deputy Dessie Ellis asked the Minister for Health the funding allocated to the National Treatment Purchase Fund, NTPF, in each of the years since its inception; the way the money was spent; the number of surgeries and services that were purchased in each of the years since its inception; the way the funding allocated in budget 2017 to the NTPF will be administered; the surgeries to be prioritised under the NTPF; and if he will make a statement on the matter. [30510/16]

Oral answers (6 contributions)

Deputy Louise O'Reilly

This question relates to the National Treatment Purchase Fund, NTPF. I seek a breakdown of the manner in which the money was spent, the specific services and procedures that were procured and how priorities will be decided for the future NTPF, particularly in light of the fact that we have just had a discussion on the manner in which waiting lists operate and the fact it is difficult to have sight of what is needed.

Deputy Simon Harris

The NTPF was established on a statutory basis in 2004. Since its establishment, the NTPF has carried out a range of functions, including arranging the provision of hospital treatment, maintaining and validating waiting list data, and making arrangements in respect of the price for long-term residential care services under the nursing homes support scheme. The NTPF's annual funding allocation was at its highest between 2004 and 2012 when it was involved in arranging the direct provision of hospital treatment to patients.

Since 2012, the NTPF's role has focused on the maintenance, audit and quality assurance of waiting lists, pricing under the nursing homes support scheme, and supporting the HSE in the delivery of a number of waiting list initiatives, most commonly initiatives regarding endoscopy. During this time, the NTPF has also directly delivered a number of smaller waiting list initiatives such as the endoscopy initiative in 2016. Its annual budget allocation has been aligned with these functions.

I propose to circulate with the Official Report a tabular statement setting out details of the annual budget of the NTPF and the number of patients treated per annum.

The Deputy asked for information on the procedures. I do not have that in my file but I will get the Deputy a detailed note of what was done in each of the years.

The 2017 budget provides for the treatment of the longest waiting patients. The budget allocates €20 million to the NTPF for 2017, rising to €55 million in 2018, giving a total of approximately €77 million for dedicated waiting list initiatives between 2017 and 2018. Planning of this initiative is at an advanced stage by the NTPF, my Department and the HSE. I expect to receive proposals from them very shortly. I will focus on the longest waiters. While the NTPF was very effective in getting treatments done, it did not always focus on the longest waiters. There cannot be self-selection. We must focus on those waiting the longest. We must also focus on particular specialties where there are specific delays, such as orthopaedics and scoliosis which were identified in the winter initiative. We also have waiting problems in ear, nose and throat, ENT, and some general surgery. I have asked for the longest waiting, the areas of acuity and the areas in which we have particular difficulty and I will have plans for it very shortly.

Additional information not given on the floor of the House

Tabular statement setting out details of the annual budget of the NTPF

Year	Total Patient Numbers	NTPF Care Expenditure (€m)	Revenue Grant from Department of Health (€m)
2016 (Forecast)	3,000	2.0	5.1
2015	1,092	1.0	5.1
2014	1,002	0.5	5.1
2013	1,950	4.8	17.4
2012	2,012	41.9	40.6
2011	19,217	57	85.6
2010	33,639	84	90.1
2009	28,758	90	90.4
2008	36,269	94	104.6
2007	32,638	95	91.7
2006	24,411	75	78.6
2005	18,994	60	64.0
2004	13,627	42	44.0

Deputy Louise O'Reilly

The Minister outlined that the NTPF performs a range of functions. It might, but not one of those addresses in any meaningful or long-term way our hospital waiting lists. I would not ask the Minister to take my word for it. Dr. Sara Burke confirmed it to the Oireachtas Committee on the Future of Healthcare when she addressed us. It is counter-intuitive to suggest pumping money into the private sector will magically have an impact on the public sector in any long-term or meaningful way. The Minister said he would target the longest waits and specific procedures. I struggle to understand how it will be done, given the conversation we have just had on the number of unknown individuals on our waiting list and the fact that we do not necessarily have clear sight of who is waiting for what procedures. If the Minister could give us some details on it, I would appreciate it.

Deputy Simon Harris

I tend to agree that if a waiting list initiative is a flash in the pan or a one year thing it does not have a major impact. It just drives down some waiting lists for some time, after which they pop back up. This is why, in my budget discussions with the Department of Public Expenditure and Reform, my Department and I were very eager to get continuity of funding for the NTPF. This is why we are announcing not only an allocation for this year but also for next year, which allows the NTPF to gear back up. It also provides a degree of certainty for people working in the system and, most important, for patients. While we can have this ideological debate about people waiting, people are waiting too long and there is some spare capacity in parts of the public hospitals and private hospitals which we must use to try to drive down waiting lists. The Deputy is correct that we do not know everything about waiting lists. There is much we do not know, and we need more data. However, through the HSE liaising with our acute hospitals, we know there are particular difficulties. As a public representative, the Deputy knows it through her clinics that there are difficulties in orthopaedics, scoliosis and ENT cases. We will go with what we know, but we could do with better data.

Deputy Louise O'Reilly

We do not know enough for the Minister to say with any confidence that the NTPF will have anything other than a very short-term effect of temporarily massaging the figures. I do not think it will have any real impact. I do not think the Minister does either. Regarding the follow-up that goes with the NTPF and the purchase of private health care, we are having an ideological debate here and I am not shy about saying it. The Minister is wedded to the notion of privatising our health service and I have been elected to try to stop it. When a person is treated in the private sector under the NTPF, the Department pays for the treatment, after which the patient is discharged and goes home. If the patient needs any follow-up care, such as physiotherapy - there is precious little of that and the patient may go onto another waiting list for it, God help them - how is it done? There is no joined-up thinking between the outsourcing and the public service. Will the Minister address it?

Deputy Simon Harris

I have no doubt we are having an ideological debate. I am just saying patients would not thank us for having one, given that they just want to know when they will get their operations. I, too, despite the Deputy's best efforts to paint it otherwise, am a major supporter of the public health service. This is why I have just delivered the largest ever budget it has received in the history of the State. However, I am not shy about saying that when there is capacity in other areas to try to help patients who are waiting too long, we will use the capacity. Follow-up care is part of the discussions between the NTPF, the HSE and my Department. We are discussing exactly what happens after a patient has a procedure and whether it will be in the private hospital or in a public hospital and who does what. It is not all about outsourcing. Some of it is about insourcing. There is spare capacity in parts of our public hospitals. I have seen it as I have visited hospitals. This will be detailed when we publish the NTPF plan shortly.

I believe it will make a difference. However, it must make an appropriate difference and it cannot be used to cherry-pick people. It must be used for acuity and certain specialties where we have a shortage in the public health service, which we will address but cannot address overnight. It must also be used to target those waiting the longest time. There must be a fairness about it.