Before I make my opening statement, I thank the committee on behalf of the NTPF for its assistance over the years. By highlighting certain issues, it brings a focus to our work. At the end of the day, the health service is funded to serve the people, whether patients in hospitals or people in nursing homes.
The primary function of the National Treatment Purchase Fund is to facilitate the treatment of those who are longest on hospital waiting lists for surgery by acting as a resource to patients of the public hospital system. The NTPF was established as a targeted solution to a particular problem. From the start, it has stated that the number of patients waiting for operations is not the critical factor because the length of time they have to wait is more important when measuring progress in hospital care provision. In 2002, the year the NTPF commenced its duties, patients typically waited two to five years for their operations, whereas in December 2010 the national median wait time was 2.4 months. There are currently 16,060 patients on the patient treatment register awaiting surgery. Approximately 200,000 public patients have benefited from this initiative to date, including 33,000 in 2010. The NTPF is a resource for public patients which helps to shorten the length of time spent waiting for treatment.
The volume of patients to be referred under the auspices of the NTPF is agreed each year with public hospitals. This includes agreed levels of inpatients and outpatients. Most referrals to the NTPF are by the public hospital which places the patient on the patient treatment register but patients are also referred by their general practitioners or may contact the NTPF directly themselves. The NTPF's remit is to deal with those patients waiting longest in each individual hospital. Waiting times can vary in different hospitals. That is why, while patients are eligible to be considered under the NTPF initiative after waiting three months on inpatient waiting lists, there may be persons not yet treated who have waited longer on the same waiting lists. By virtue of the NTPF's remit the longest waiters are our priority.
The NTPF is mandated to refer no more than 10% of its cases to public hospitals. Among the reasons for this is to allow for surgery that is not suitable to be referred outside the public hospital system because of matters such as complexity of care required, instances where patients have other underlying medical conditions or lack of specialised paediatric capacity in private hospitals. This means that some surgery will be undertaken under the NTPF initiative in public hospitals on the basis that there is no alternative and that it does not interfere with the core activity of the hospitals. To do otherwise would deny patients quicker treatment. In 2010, 7% of NTPF activity occurred in public hospitals.
The following table sets out the volume of cases treated and expenditure:
|
2010
|
2009
|
2008
|
Inpatients
|
20,603
|
19,995
|
20,829
|
Outpatients
|
9,025
|
6,388
|
12,342
|
MRIs
|
3,515
|
2,513
|
3,098
|
Total Activity
|
33,143
|
28,758
|
36,269
|
Allocation
|
90 million
|
90 million
|
104 million
|
Administration Ratio
|
4.7%
|
5.3%
|
4.5%
|
The costs associated with the fair deal were incurred by the NTPF from 2009.
The NTPF works to maximise the number of patients that can be treated from its budget. If particular treatment prices offered to the NTPF by a private hospital are higher than the market rate, the fund will source an alternative supplier. We do not have to accept the prices offered by private hospitals. This means that when and where it makes sense to do so, NTPF patients are steered to quality providers that represent value for money.
The NTPF negotiates prices with each treating hospital in advance for the full episode of care. Prices are fully inclusive per procedure of all hospital and consultant costs, incorporating preadmission and post-discharge care. We do not enter into discussions with consultants or any other staff on fees. No payment is made to a hospital until the full episode of care is complete. In that way payment is made on an output basis and with this model it is known what each and every treatment per patient costs. Also, for a given input of funding to the NTPF there is a measurable output in patients treated.
The NTPF has provided some outpatient appointments on a limited basis since 2005. Currently this is one of the bottlenecks in the public hospital system. Access to outpatient consultant clinics is one of the big differences between public and private medicine at the present time. Our experience over the past five years has consistently been that it is necessary to call almost double the number of patients one wishes to treat. By the end of 2009, 82,144 patients had been contacted with an offer of an NTPF outpatient appointment, of whom over 50%, or 41,193, accepted. The number of patients contacted reached approximately 100,000 at the end of 2010. Just over one quarter of patients, or 20,989, were immediately removed from waiting lists as no longer wanting an appointment, 11%, or 9,354, declined the offer and chose to remain on the list and 13%, or 10,608, did not respond to the offer. Many of these cases were subsequently removed from lists. It is clear from the results of the pilot that a large proportion of patients currently recorded on outpatient lists do not belong on them. Approximately 50%, or 40,951, of the 82,144 patients contacted did not want to avail of an appointment, did not know they were on a waiting list or were removed from the waiting list due to validation by their hospitals. Furthermore, 11% of patients who have already been waiting a long time chose to turn down the option of faster assessment. It would be worth investigating why this is the case.
Not all patients on outpatient waiting lists require procedures. However, patients who require further treatments as a result of the initial outpatient appointment are facilitated by the NTPF, which means they do not go onto public hospital inpatient waiting lists. In any event, these patients have already waited a considerable period as outpatients.
The NTPF's annual involvement in the provision of outpatient consultations has thus far been on a small scale. Hospitals are invited to submit proposals on specific outpatient areas as part of the annual agreements on numbers to be treated. However, by applying our particular focus to specific specialties it is possible to validate and reduce waiting lists very quickly. For example, in 2009 waiting times for rheumatology in St. James's Hospital were reduced from 52 weeks to eight weeks and respiratory waiting times in St. Vincent's Hospital were reduced from two years to three months. With a wider focus, it is our belief that similar results could be achieved throughout the country.
The NTPF's function in the administration of fair deal costs approximately €250,000 per annum. This expenditure is constant as the negotiation of prices with the private and voluntary nursing homes is an ongoing process. In addition to the face-to-face negotiation meetings the process involves drawing up and controlling the dispatch and receipt of formal contract deals. The National Treatment Purchase Fund, NTPF, requires these deals to be formally signed by the nursing homes before notification of agreed prices is conveyed to the Health Service Executive. Under the scheme the function of the NTPF is to set the maximum prices which the State will pay in respect of long-term elderly care in private and voluntary nursing homes. There are 440 homes and, under competition law, the NTPF is obliged to conduct negotiations with each home separately. There are approximately 20,000 private beds in the system and a potential market worth €850 million annually. Therefore, it is important for the NTPF to maximise the outcome for the State as far as possible.
The NTPF achieved its targets in 2010 although some of the price negotiation discussions with hospitals and nursing homes were difficult. The NTPF managed to negotiate prices equivalent to a reduction of 8% with private hospitals in 2010 over 2009 prices. The NTPF will continue to arrange procedures for those public patients waiting longest while, at the same time, ensuring that treatment is provided to the highest standards. We will continue to seek further productivity increases for the expenditure allocated. Patient satisfaction levels remain high with access to faster treatment under this initiative. While 2011 will be challenging, our main priority will be to keep overall waiting times as low as possible. In total we expect to treat in excess of 32,000 public patients in the current year.