Dáil Éireann Debate, Tuesday - 23 October 2018
72. Deputy John Curran asked the Minister for Health the additional procedures to be carried out in 2019 under the National Treatment Purchase Fund, NTPF, resulting from the increase in funding from €55 million in 2018 to €75 million in 2019; and if he will make a statement on the matter. [43168/18]
View answerAn increase in funding to €75 million for the National Treatment Purchase Fund was announced in budget 2019. What additional procedures and treatments will be provided in 2019 as a result of that additional funding?
I thank the Deputy for his important question. Reducing waiting time for patients for hospital operations and procedures remains a key priority. As the Deputy correctly stated, in budget 2019 we further increased investment in this area, with funding to the National Treatment Purchase Fund to increase from €55 million in 2018 to €75 million in 2019, an overall increase of 150 % since the Government came into office and entered into the confidence and supply agreement.
In 2019, the NTPF plans to deliver 25,000 inpatient day case treatments, an increase of 5,000 from the 20,000 procedures committed to in the waiting list action plan this year. In addition, provision of 5,000 gastrointestinal scopes will be arranged by the NTPF, an increase of 1,000 from its target for this year. Furthermore, 40,000 first outpatient appointments will be arranged. This is a very important point. As has been acknowledged by Fianna Fáil, we have made significant progress. There has been a very significant reduction in the inpatient day case list, from approximately 86,000 people waiting for hospital operations or procedures at its peak to the low 70,000s. The number waiting is projected to continue to drop month on month. We know the investment is making a difference in that area. We now need to target outpatient lists, which is why I will be putting a particular focus on those 40,000 first outpatient appointments in terms of the resourcing of the NTPF.
There have been ongoing improvements in the number of patients waiting for inpatient and day case procedures this year, with the number now at 72,700, down from a peak of 86,100. That is a 16% reduction and the number awaiting treatment will continue to fall. The number of patients waiting for over nine months has reduced from over 28,000 to under 19,000 in the same period, a 32% reduction. It is expected that through the combination of HSE and NTPF activity this trend will continue. It is projected that the overall number of patients on the inpatient day case waiting list will reduce to approximately 70,000 by the end of this year and to under 59,000 by the end of 2019.
NTPF activity next year will cover approximately 50 high to medium-volume procedures and will be through a combination of treating patients in outsourced facilities and public in-sourced facilities. I will publish a waiting list plan with the NTPF detailing that but about 50 high to medium-volume procedures will be targeted in 2019.
I thank the Minister for the reply. In the opening part of the reply, he mentioned that spending has gone up by 150% from what it was a number of years ago. Yes, it has because it came off the back of a very low base. I am glad to see the Minister acknowledge and identify the procedures that are being carried out.
I do not want to play politics with it but I want to be very serious. A decade ago, we were spending more than €75 million on the NTPF at a time when the total health budget was considerably less than the €17 billion it is today. The Minister quite rightly identified the various procedures, including 40,000 people on the outpatient list who can be targeted this year. I am concerned that he is not ambitious enough in respect of the NTPF. Over the past number of years, these lists across outpatients and so forth have grown very significantly. There is an opportunity to be more ambitious. I would have hoped that the budget for the NTPF this year would have been more like €100 million rather than €75 million and that we would have a really ambitious programme. I say that on the day when the Taoiseach stood where the Minister now stands and said that if anybody had any suggestions for the extra €1 billion in health, they should tell him. I am suggesting that a small portion of it could be directed at the NTPF with very specific targets.
I do not want to play politics with this either because I accept Deputy Curran's bona fides on this. I would just make the point that the confidence and supply agreement did commit to €15 million so in fairness to Deputy Curran's party and the Government, I think we are doing more than we said we would do together through confidence and supply. I would make the point, which the Deputy would recognise, that the funding for the NTPF is not the totality of funding on waiting list initiatives. In fact, it is still very much at the margins. As the Deputy rightly says, the HSE has a budget of over €17 billion. I would make the point, particularly when Deputy O'Reilly is here, that it is not all for outsourcing either. An awful lot of it can and should be used on in-sourcing. I have met all the hospital groups in recent days and weeks and have asked them to put forward their proposals for in-sourcing. For example, we have opened a cataract theatre in Nenagh as a result of that. I must also make the point that outpatient waiting lists were not published until a few years so people who say the lists are at a record high are not comparing like with like. The previous figures were never published.
We have seen a lot of progress, for example, with regard to cataracts. At the end of July 2017, there were 10,024 people on the waiting list. This figure has dropped to 6,626 at the end of September so we have an awful lot more to do with regard to this. I am always happy to allocate more funding in this regard. We will work our way through this in the service plan.
I know some Members of this House have an ideological viewpoint that is opposed to the NTPF. I look at it from a pragmatic point of view. It delivers a service for people who are currently waiting on lists. I think the Minister should consider being more ambitious in terms of what is available and that we need to consider extending the services offered under it. For example, we could look at the role it could play in terms of providing services for children. By that, I mean children who require diagnosis, be it in terms of occupational therapy or speech and language therapy and some initial treatments. Some of those waiting lists for young children are unacceptably long. I believe a targeted approach from the NTPF could have a role to play here and should be examined.
Like Deputy Curran, I do not approach this from an ideological viewpoint. I very much see the NTPF as an agency that should be seen as an access fund and a way of making sure we can have ring-fenced budgets to ensure our patients can get more timely access to treatment, be it inpatient or outpatient. I am ambitious when it comes to seeing the NTPF extend its remit to outpatients. We need to do this in a careful way and that we make sure that if it is outsourced, they look after the entire episode of care so that someone is not just seen on an outpatient list and then referred back to a public hospital list for an inpatient procedure.
I agree with the Deputy with regard to the assessment of needs issue. As the Deputy is aware, we have funding in budget 2019 that the Minister of State, Deputy Finian McGrath, will reflect in the service plan for 100 additional therapist posts. I certainly do not rule out looking at other ways of using the NTPF if it can be helpful.
