Mr. Tony O'Brien:

I thank the Deputy for the thoughtful and informed question. The practice of treating patients elsewhere, other than in the primary hospital, is often generally referred to as outsourcing. We tend to use that term only for transfer into the private sector but I know that, locally, they think of outsourcing even if patients go to another public hospital. I think the figures used by the Deputy encompass both.

Where we have capacity to meet an unmet need in one hospital in another hospital, we regard it as good practice to utilise the resources of the second hospital. For example, recently there would have been a significant shift of provision of service in orthopaedics from Waterford to Cappagh in order to deal with a long-term waiting list issue and, more recently again, in the cardiac area, Cork University Hospital has been addressing the needs of some long waiters as well. That is clearly an increasingly efficient use of the public resource and is always beneficial both to the patients and to the system.

Where there is what we essentially regard as outsourcing, which is to the private sector, that is always done on the basis of an appropriately procured service and best value for money is obtained. Most importantly, the driver is to ensure that patients who are in need of outpatient assessment, and-or inpatient or day-case treatment they would not otherwise get in a timely way, do get it. Therefore, overall, we regard that as offering value for money.