Bernard Durkan (Kildare North, Fine Gael) | Oireachtas source

I welcome Mr. Horan for appearing before the committee and for his introductory remarks. Unlike my colleague, I believe that both the public and the private health sectors should be cost-effective, efficient and responsive.

There is no harm in having competition between the two in respective areas. I favour the public health sector and I want to see it develop and grow. When comparisons are made, it should not be possible for the private sector to make a profit and deliver the service more effectively, more efficiently and more cost-effectively. That should not be the case. Questions need to be asked about that or we would seem to be bolstering something that is not efficient and effective at all.

From Mr. Horan's own observations, where does he think the incapacity has occurred in the public sector, which in turn causes the overflow to go into the private sector and in particular circumstances that cause the National Treatment Purchase Fund to be called in? For example, as the Chairman pointed out, members have been looking at these issues as they have been sitting on the Committee on the Future of Healthcare for quite a long time now. Incapacity in certain areas seems to be a key issue. What happens next will be determined by others who are outside but who have looked at this. In Mr. Horan's direct experience - in dealing with both sides on the ground, over quite a period of time and in the good times and bad times - why does he think the logjam is caused? Is it a lack of theatre facilities? Is it a lack of nursing staff or a lack of consultants or GPs? Is it a lack of theatre availability? What is it? There must be something causing the problems.

I welcome the move to have the purchase fund in both the public and private sector. That will be a good thing and will sharpen both sides and maybe the patient will become the issue everybody focuses on. That is the way it should be. Long waiting times are not good for the public or the private sector, they are certainly not good for the health sector in general in its public appeal and they are certainly not good for the patient. Waiting times of four or five years, which we have had many times in the past, are appalling. We should never be in such a situation. The questions that arise following on from that relate to particular areas. I know that hip replacement operations is one area that has caused problems in the past. Are there other treatments that show up more regularly than others and which require National Treatment Purchase Fund intervention?

With regard to competition, has Mr. Horan seen evidence of competition between the two sectors in responding to the demands made of them? I know the old argument about people jumping the queue, and Deputy O'Reilly already referred to this. It is one of the questions that comes up from time to time. As public representatives, we ask parliamentary questions about when particular patients will receive treatment, having suffered on a waiting list for two, three, four, five years or sometimes much longer. The general answer is that the clinicians will make that decision. My answer to that is "let them decide quickly". It is as good to do it quickly as it is slowly over a long period of time. Why do we not have a more dramatic response? It goes back to capacity and to staffing levels.

Mr. Horan referred to the fluctuating staffing levels in the NTPF organisation during the downturn in the economy. There was a lack of funding in the public sector in general. To what extent did the NTPF find that demand had fluctuated along with the staffing levels? How did the demand move on the graph and what sort of cases were referred? We all have anecdotal experiences but I can tell the committee of someone who has been waiting quite a long time. The person was on the point of going to the NTPF only in the past couple of months, but there was a breakthrough, for some very good reason, and they suddenly got the treatment. It was challenging treatment but they were able to get it through the public health system. We all must be challenged from time to time so we can do our job well. What were the most common causes that Mr. Horan observed in the creation of the backlogs under the various headings and categories?

I am not a great supporter of the fair deal scheme, for obvious reasons. It has a tendency to be insatiable in terms of how much it costs the patient. People start off life, they may be newly married couples, and they try to raise a mortgage and raise families. By the time they have that barely finished, somebody else has come along and the costs of nursing home care could visit them for a long time in certain cases. The costs could leave them and their immediate families penniless for quite a long time also so I am not a great supporter of that system. I know this system replaced an older one that was a throwback from the workhouses system, and which none of us would ever want to hear of again, but there were long-stay beds in public nursing homes in the fairly recent past. They were efficient, maybe not by today's standards but they gave a very high quality of service when it was available nowhere else. Patients who were in need of the service received the service. It did not cost a fortune. It was only when the times and legislation changed to the effect that people should not receive the service in public hospitals - because there was no legislation to back it up - that as a result we arrived at the system we are in now. The number of public long-stay beds has dramatically reduced in the intervening period. The shifting of that burden has gone from the public sector to the patient albeit in the private sector.