Mr. John Horan:

I thank the Deputies for their questions. In response to Deputy Durkan's question about lack of capacity, I am aware that the programme for Government does contain a commitment to undertake a bed capacity review to feed into the Government's mid-term review of its capital plans. I understand that review will have a wider scope than previous reviews and will extend across hospitals, primary care and social care. The Department of Health is leading that review under the direction of a steering group which includes officials from the Departments of Health, the Taoiseach, and Public Expenditure and Reform, the HSE and experts with clinical and academic backgrounds. It is fairly wide-ranging and involves an independent peer group of international health experts who will review the methodology and findings and so on. We are not directly involved in that, but we are available to support it and look forward to seeing its findings which will come out later this year.

There are two factors that caused the lack of capacity, one is the well-known financial crisis when there were cutbacks here and there, resulting in ward closures, reductions in staff, nursing and consultants, all the shortages that are well-rehearsed. The other element is on the demand side which is increasing dramatically. Last year, 60,000 more inpatients were treated than in the previous year. I am not apologising for a system that I am not responsible for but I do feel its pain to an extent.

In response to the point about the long-stay beds in public hospitals, I take it the Deputy is talking about the old town hospitals. I was a great supporter of those and have personal experience of them through my extended family. Some fell victim to what one person might call improving standards while another might call them increasing standards, which found them unsuited to their purpose and they fell out of the system. That added to the lack of capacity. A total of €15 million of the €50 million available this year is available to the NTPF, the rest goes to the normal hospital system. We have been out of commissioning patient treatment care for a few years but we are back into it. We started by getting expressions of interest from private hospitals, drawing up contract documentation, analysing the specific treatments we would target. We identified the top 25 and went out to tender on those. We got the tenders and we have started to give out that work. We will soon have close to 2,000 patients in the system with case authorisation notices, CANs, purchase orders in layman's terms. More individuals will come into the system very quickly. That accounts for the first €5 million of our €15 million. The second €5 million goes to the public hospitals, the third €5 million might be a combination of the two. Next year, we will have €50 million available and what we do with that will be informed very much by what we have learned in the current year.

As to why nursing homes are not used, I am very familiar with their situation and receive regular calls telling me they have beds available and so on but it is not the NTPF's decision. That is not our role but I would not be against using them.

In addition to the cross-Border fund, there is a European system and it is not as fully utilised as it might be. It is advertised to an extent on the Department of Health or HSE websites. It could be used more. We do send some work to the North of Ireland but the bulk of it is within the State. I would be worried about the impact of Brexit and I know this committee has had discussions with the Department of Health and the HSE about the impact of Brexit. While it does not have an immediate impact on the NTPF we do need to be very conscious of it to make sure it does not affect us adversely.

In respect of the new CEO, before we moved back into commissioning we had been operating with a reduced staff because we had a reduced budget and were not going to spend money we did not need to spend. We moved from having a full-time CEO when we were doing treatment of commissioning to having several part-time CEOs, working one day a week, for the past four or five years. When we saw we were getting back into patient treatment commissioning we realised we needed to beef up the systems again. Some of our staff had gone on secondment to other areas of the health care service and we want some of them back. Some have settled in where they are but we will need to replenish our staff, not quite to the level it was at before. We will see how we get on. We are in that process. As part of that we decided we needed a new full-time chief executive late last year, when we saw the budget had allocated us the money for that. We advertised in November through the Public Appointments Service to make it an open and transparent competition but that takes time. Big systems move slowly. We then selected a very well qualified chief executive, Liam Sloyan. It was clear, however, he was wanted where he was. In a previous existence he was chief executive of the Health Insurance Authority, HIA, and since 2013, when the national lottery was sold off and the office of the regulator of the national lottery was set up, he was appointed to that role and has been there ever since. He joined us four weeks ago. He got his feet under the table quickly and working with the board and the executive team, he is gearing up for our move back into patient treatment commissioning. The cost had to be approved by the Departments of Health and Public Expenditure and Reform and is in line with the chief executive levels for a body of our size, a grade 3 body.