Mr. John Horan:

I thank members for their comments and questions. Senator Burke asked about the review of the system for setting nursing homes prices, the first part of which is to be completed in June 2017. There are two elements to it. A group comprising representatives of the NTPF, the Department of Health and the Department of Public Expenditure and Reform is working on one element. A broader group involving the Department of the Taoiseach, the Revenue Commissioners and many others is working on another element. We are well advanced in the work to be completed by June 2017. The terms of reference are to continue to ensure value for money and the economy with the lowest possible administrative cost for clients and the State and the lowest possible administrative burden for providers, to increase the transparency of the pricing mechanism in order that existing and potential investors can make as informed decisions as possible, and to ensure the adequacy of residential capacity for residents who require higher level or more complex care. That is the section on which the NTPF is leading . Work is well advanced in this regard.

I am conscious that when we were asked to carry out the review, the Minister of State at the time, Kathleen Lynch, referred to the review carried out in 2015 about the financing of the scheme and concluded that the NTPF had done an effective job in introducing and managing a pricing system for long-term residential care facilities. She said it accounts for a very substantial amount of State funding, and the way the scheme is priced has critical relevance not only for the Exchequer but also in securing the long-term adequacy of residential bed capacity for older people. It is acknowledged that we did a good job. When the Nursing Homes Support Scheme Act was passed in 2009, we were given a greenfield site and asked to get on with it. Very quickly, we had contracted more than 400 nursing homes to provide the service. This was done by negotiation and agreement, not with a group of them or a body but with each individual nursing home, and the process has continued to date. That is not to say that a system that we think is working well cannot be improved. That is what the review is about and we are working on it.

The question of complexity of care was mentioned. That is one aspect that is being looked at because, as residents are in nursing homes for longer periods, their needs become greater. We need to consider how that is dealt with and it forms part of what we are doing.

The appeals mechanism was mentioned. There are currently a number of stages in the appeals process. If a nursing home does not agree with the price negotiated with it, it can appeal. The case is referred to a new account manager, for a peer review, as it were, who takes a fresh look at everything and decides whether an adequate price has been offered. If the nursing home is still dissatisfied with the outcome of that, it can appeal to the finance director of the NTPF who will take a further fresh look at the case. If it is still not satisfied, it can further appeal to the chief executive officer of the NTPF. There is an argument for an independent appeals mechanism but there would be a legislative difficulty with that as the NTPF is the body set up by legislation to negotiate and agree prices with nursing homes. To allow a third party to conduct appeals might require a change of legislation. That is not necessarily a bad thing but, as things stand, it could not happen without a change in the legislation. We have made significant progress in the review and are working with the Department of Health and the Department of Public Expenditure and Reform and will soon be coming back to the broader steering group involving the Department of the Taoiseach, the Revenue Commissioners and others.

Gynaecological waiting lists in Cork were mentioned. That is a specific issue. The Minister for Health, Deputy Harris, acknowledged it is an issue. Members might recall that I mentioned there is €15 million for patient treatment at our current funding levels. That has been divided into three tranches.

The first is €5 million which we have now begun to spend. That is being spent on day cases, all in private hospitals. The second €5 million comes to Deputy O'Reilly's point. It is to do with insourcing, that is, spending money in public hospitals. We have dealt with private hospitals and are now dealing with public hospitals. Within that, a specific element is being committed to the gynaecological problem to which Senator Burke referred.

There is a slight concern that people generally have regarding insourcing. If there is a problem in a public hospital system with waiting lists and we are giving more money to it through the National Treatment Purchase Fund, people will ask whether we are paying on the double for something. If we spend €5 million, which we will, in the public hospital system, we have to be sure it is not going into a black hole. Rather, it must be identified for specific items and people, as is the case in private hospitals. For every €1 we spend we can relate that back to a patient. Similarly, in terms of the vast bulk of the €5 million going back into the public system, we will, due to the way things are being conducted, be able to ensure the same level of traceability in public hospitals.

I am going on the notes I have made. Deputy O'Reilly referred to her serious ideological difficulties with private versus public hospitals. I fully understand her thinking on that. She asked me for my thinking. My answer is that it is a case of whatever works. People are on waiting lists. There are individuals who have families around them. They are all suffering and do not want to be on waiting lists. If we can end their suffering, improve their situation and help them to get on with their lives through buying treatment in a private hospital, we will do that. If we can do so in a public hospital, let us do it that way. Let us do things in the most efficient way possible. I do not have any hang-ups about public or private hospitals. My phrase is "whatever works".