David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I think we all need second and third opportunities because there is so much we could talk about and so many questions we would ask the witnesses. I thank them for their presence. Earlier, Mr. O'Brien rightly said that he could not be expected to be across the detail of what is happening in every hospital and I would not expect him to be. Luckily for me, I do know the detail concerning University Hospital Waterford.

I put down parliamentary questions almost every week to keep myself acquainted with what is happening there. I want to use the examples of what is happening in Waterford, because I am familiar with them, in order to frame questions which have a national implication. I will start with the outsourcing of patients, whereby patients who are on waiting lists in certain hospitals are outsourced to other hospitals because capacity simply is not there in the original hospitals. One of the responses I got back to a parliamentary question on outsourcing in University Hospital Waterford was that, in 2013, the total number of patients who were outsourced - this refers to OPD patients - was 3,085. That had increased to 6,203 by 2015 and, in fact, has gone up again in 2016. That is a 100% increase in the number of patients who are being outsourced.

First, has the HSE done an analysis of whether it costs more to outsource patients in the first instance? There would certainly be a cost that is not being taken into account by the patient who will have to travel and incur costs, but is there a greater cost to the organisation? Second, when patients are outsourced, how is that paid for? Is it paid for by the hospital that refers the patient or by the hospital that provides the treatment? Let us bear in mind that many of these patients are outsourced to private facilities in different parts of the State, including the Mater Private in Cork, St. Francis Private Hospital, Beacon Hospital in Sandyford, Barringtons Hospital, Aut Even Hospital and Whitfield Clinic. Most of the outsourcing, including of many patients in my area, has been done to private hospitals so my question is obvious. Has the HSE done any analysis of its cost effectiveness?