National Treatment Purchase Fund

Dáil Éireann Debate, Thursday - 19 April 2018

Thursday, 19 April 2018

Ceisteanna (5)

Róisín Shortall

Ceist:

5. Deputy Róisín Shortall asked the Minister for Health his views on whether the recently announced funding for the National Treatment Purchase Fund, NTPF, to procure medical procedures in private hospitals represents best value for money; if a cost-benefit analysis on this €50 million investment has been carried out; his further views on whether this policy could represent a perverse incentive in the public system and is delaying reform; and if he will make a statement on the matter. [17264/18]

Freagraí ó Béal (6 píosaí cainte)

Deputy Róisín Shortall

The Minister's Government, along with Fianna Fáil, has resurrected the NTPF. We know that is only a stopgap measure, and we know it has been problematic in the past. Can he assure us that he has carried out a cost-benefit analysis before committing to the very substantial figure of €50 million? What kind of assurance can he give us that we are actually going to get value for money for that spend?

Deputy Simon Harris

I thank Deputy Shortall for the question. As the Deputy knows, the programme for Government commits to reducing waiting times for procedures in hospitals and to increase funding for the National Treatment Purchase Fund to deliver on this commitment. In the budget and Estimates for 2018, funding for the NTPF to treat public patients was increased to €50 million.

The inpatient and day case action plan is a joint initiative between the HSE, the NTPF and my Department and sets the projected activity and impact that will be delivered in 2018 from within the allocated funding.  As outlined in the action plan, a projected 1.16 million inpatient and day case procedures will take place in 2018, with NTPF activity accounting for 20,000 procedures and HSE activity accounting for 1.14 million procedures. 

The NTPF procures capacity for each of the procedures identified in the action plan in both private hospitals or public hospitals. That is the difference between the NTPF now and in the past. We are spending resources also within the public health service. In 2018, the NTPF projects that 4,000 of its treatments will be delivered in the public health service.

No formal cost-benefit analysis was carried out on activity funded through the NTPF, nor indeed in respect of activity funded through the HSE.  However, the action plan strikes the appropriate balance between maximising the number of patients treated in both public and private capacity, as appropriate, and ensuring the best return for the taxpayer.

The overall number of patients waiting for an inpatient or day case procedure is projected to fall to below 70,000 by the end of the year, from a peak of 86,100 in July 2017. My ambition is to build on this progress and to further reduce waiting times for patients.

Parallel to improving access for patients this year, I am committed to reforming and investing in our public health system. However, we know that with the trolley situation, elective procedures are regularly cancelled in our public health service. I cannot expect those patients to wait while the capacity is being built in the public health service. I am, therefore, implementing a commitment in the programme for Government and in the confidence and supply agreement to utilise the NTPF to find capacity wherever it may be, both in the public sector and in the private sector. I want to spend all of the investment that we spend in health on our public health service, but I think it is widely acknowledged in this House that it will take time to build that capacity.

Deputy Róisín Shortall

Those figures are fine. They are very aspirational. However, the Minister has not answered the question. How do we know that we are going to get value for money for that €50 million? We know that the NTPF has been problematic in the past. There is a major structural problem within the health service in that we do not know relative costs for different procedures.

Would the Minister not be much better off concentrating on why it is that progress is so slow on working through the waiting lists? We do not know anything about the activity in hospitals in terms of waiting lists. Theoretically at least, we could have a situation where consultants are being paid on the double, when they are already being paid to do public elective work but we do not know about that activity. We know there are certainly the problems that were highlighted in the "RTÉ Investigates" programme, so it is slow progress. Is this not a perverse incentive if the State pays separately and on the double for that work to be done in either other public hospitals or the private sector? What guarantee is there that we are getting value for money for this substantial spend?

Deputy Simon Harris

I have outlined to the Deputy how we are using the capacity that is available in the private hospital sector while building up the capacity in the public health sector. I would much rather be able to have adequate capacity in the public health service but it is not possible to bring all of that capacity onstream overnight.

I agree with the Deputy in regard to wanting to remove private practice from our public hospitals. As she knows, in line with the Sláintecare report I have set up the de Buitléir group chaired by Dr. Donal de Buitléir and it is to bring its report back by the end of the year. It is a significant statement for a Minister for Health to say they wish to see private practice removed from public hospitals and how we do that is something the de Buitléir group needs to make a reality. I want to make it clear that is the purpose of the de Buitléir group - to show me the roadmap as to how to do that, rather than to decide whether it is a good or bad idea. I accept it is a good idea.

The programme for Government committed me to utilising the NTPF to provide additional capacity. The approach will support HSE activity and performance management, with additionality being provided by the NTPF. The NTPF has a statutory responsibility in terms of how it procures and uses tendering. It will undertake a number of insourcing arrangements, for example, cataract surgery in the Royal Victoria Eye and Ear Hospital. It will use Nenagh General Hospital and will treat lesions in Roscommon General Hospital, and orthopaedic surgeries will take place at Cappagh hospital. Further insourcing arrangements will be put in place and a significant further insourcing arrangement will be the funding of a brand new cataract theatre in Nenagh General Hospital. This is not the old NTPF of the past, where it was all about money for the private health sector. We are looking at using all capacity, including available capacity in the public hospital system.

Deputy Róisín Shortall

I am sure the Minister is aware that, in regard to the NTPF, in the past funding went into public hospitals but it was found by the Comptroller and Auditor General that this just went into the general budget of each of those hospitals and there was no ring-fencing. Again, the reality is that we do not know how much a cataract operation or hip replacement operation costs. Unless we have that kind of detailed analysis of costing within the health service, there is no way of knowing whether we are getting value for money or not. That is my concern, namely, this will go into the general pot and we will not see actual improvements. For example, did the NTPF engage in open tendering for this money? How can the Minister assure us we are getting value for money? Would he not be better off concentrating on introducing the kind of fundamental reforms that are required in terms of activity-based funding and establishing elective-only hospitals? Would that not make a much more substantial difference to the waiting lists?

Deputy Simon Harris

I believe elective-only hospitals are the way to go and could have a real impact, as I know the Deputy does. We have seen this used in Scotland with very significant success. Scotland had very long waiting times and managed to reduce that substantially by purchasing what, ironically, was a former private hospital and turning it into an elective-only hospital. I have funding to deliver elective-only hospitals and that is a priority. I will keep the House updated in that regard.

The funding that is used by the NTPF to insource is ring-fenced. The NTPF has to satisfy itself that the HSE and the individual hospitals are going to spend that on providing the additionality in terms of procedures that they have agreed to, and the waiting list plan I published last week has outlined that.

The Deputy has rightly highlighted on a number of occasions the question of how we monitor and oversee hospital consultants' contracts, an issue on which we engaged here and at the Oireachtas health committee. My Department is working closely with the HSE to find a solution to ensure compliance is monitored more effectively. The engagement commenced last July. On 11 January of this year the Secretary General reinforced the point to the HSE that a key requirement is for a governance framework and a reporting and monitoring arrangement. The HSE responded on 12 February, outlining the arrangements it proposed to meet the Secretary General's requirements. These include monthly monitoring at hospital level of performance at individual consultant level, with appropriate actions to be taken where required. At a meeting with my Department on 23 March the HSE confirmed it would incorporate within the framework a map allocating additional responsibilities at each local hospital group hospital and at national level. I believe the Comptroller and Auditor General has also announced his intention to do some work in this regard, which I welcome.