I propose to take Questions Nos. 120, 137, 143, 151, 201 and 206 together.
The national treatment purchase fund, NTPF, was established as one of the key actions for dealing with public hospital waiting lists arising from the 2001 health strategy. The strategy envisaged that the NTPF might make use of any capacity within public hospitals to arrange treatment for public patients. It was recognised that during the start-up phase of the fund, the use of public capacity could account for 30% of total NTPF activity, once public core service planned activity was not compromised. The Department has recently advised NTPF that use by the fund of public facilities should be limited to 10% of its total referrals for treatment. The allocation available to the fund in 2005 is €64 million.
The majority of elective orthopaedic surgery, including hip replacements, takes place in public elective orthopaedic facilities which do not provide accident and emergency services. As elective activity in these hospitals does not take place 24 hours per day and seven days a week, using theatres and beds outside of normal working hours is one way of creating extra elective capacity in the public system. Allowing public hospitals to undertake work under the NTPF initiative also incentivises hospitals to perform extra work and to treat more patients over and above core funded activity. This activity is carried out often by staff working overtime, who come in at weekends or who extend theatre time on occasions.
Other situations that compelled the use of public or "in-house" capacity were cases where, for reasons of clinical or patient complexity, it was clearly best practice to have certain patients treated by their own consultant in the hospital where they were on the waiting list. Not to have used this facility would have effectively barred this cohort of patients from accessing the NTPF scheme.
With regard to the transport of patients, the policy of the NTPF is to provide transport for patients where it is deemed medically necessary or where there are people with special needs, for example, the elderly or the infirm. The number of patients that require transport is small. In the case of a patient going abroad for treatment the travel costs are paid for by the NTPF. The authorisation of transport is considered on an individual basis, particularly in circumstances where lack of transport would present a barrier to a patient being treated. Otherwise patients are responsible for their own transport to hospital for treatment.
In the context of his examination of my Department's appropriations account for 2004, the Comptroller and Auditor General carried out a review of the operation of the NTPF in 2004. During his review the Comptroller and Auditor General received the full and comprehensive co-operation of the fund and of my Department. The responses from the fund and my Department to the issues raised in the Comptroller and Auditor General's report have been fully recorded in the text of the report and are a matter of public record. As a statutory body funded by the Exchequer, the annual accounts of the national treatment purchase fund will be audited by the Comptroller and Auditor General. The fund's accounts for 2004 are currently being audited by the Comptroller and Auditor General. It is a matter for the Comptroller and Auditor General to decide which State organisations or State funded programmes are to be the subject of value for money audits.