Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

Some of the issues I would like to raise have been touched on but I would like a little more detail on them. The funding this year for the National Treatment Purchase Fund is €20 million. From what I can gather, that will increase to €55 million next year. In the context of the assessment of who should be treated through the fund and the contracts that will be entered into with the private health care providers providing treatment, what size contracts will be awarded financially, procedurally or otherwise? What is the cost of providing the same treatment in a public facility by comparison with that of providing it in a private facility? We are trying to compare how much it costs to provide certain surgeries or procedures publicly and privately. There are varying views, including that the private sector can provide treatment more efficiently. Others argue that the public system can do so more efficiently. If we do not have any detail on it, how can we adjudicate on which is more efficient? Ultimately, public money is being spent. Where unused capacity in public hospitals funded by the National Treatment Purchase Fund is concerned, is what is occurring not just shifting money by way of an accounting exercise as opposed to increasing genuine capacity in the public health system?

On the section 39s, which have been referred to already, a considerable issue arises in terms of pay awards to employees across the broader health system. They are also awarded to section 39s. No provision is being made, however, in the bloc grants from the HSE to the organisations concerned. I refer to very large ones of which I have reasonable knowledge, such as COPE in Cork and St. Joseph's Foundation in Charleville. There are many across the country that do amazing work for the amount of money they are being given. There was a cost-benefit analysis of the varying section 39s. They were asked to find savings and they did. Many made substantial savings but there seems to be no acceptance that they cannot keep cutting services to fund public pay increases. What the HSE is effectively asking people to do is to cut services to fund public sector pay increases that they are not party to, as such. HIQA is now investigating these same organisations saying that they are providing substandard care in some cases, yet there is no provision by the HSE to fund the increased number of staff required to comply with HIQA regulations. Could I have Mr. O'Brien's observations on those issues?