Mr. Jim Breslin:

Deputy Kelleher asked about the process under the National Treatment Purchase Fund for securing value. There are two aspects to it. The first relates to the arrangements whereby private hospitals are procured. Private hospitals are invited to express interest in the work. They submit the basis on which they carry out the work. The submission is then assessed by the NTPF and drawdown contracts are put in place. The reason for the drawdown approach is that where the patient goes is determined by the specialty of procedure required and, to some extent, by the location of the patient. Depending on where the patient is to be dealt with and the condition that needs to be addressed, the patient will be funnelled to relevant private hospitals. This happens against a properly procured price arrangement.

As the Minister has said before, we can determine the precise amount of activity delivered by the NTPF in return for the funding. The reason is that the funding flows on a per-patient basis. Private hospitals only get paid if they treat the patient in line with the arrangements in place. The Minister has said that between 17,000 and 18,000 additional procedures will be performed as a result of the funding put in place for the NTPF next year - that is why we can say that.

The activity taking place funded by the NTPF in any public hospital is additional activity and it has to sit firmly additional and above what is already in place. Particularly relevant arrangements are those for the Royal Victoria Eye and Ear Hospital and Cappagh National Orthopaedic Hospital. The funding made available has allowed these hospitals to increase their capacity. Had they not got the funding, they would have been unable to carry out the additional activity.

The question of whether this complicates funding flows was asked. It does complicate funding flows somewhat. Again, it gives transparency to the fact that those hospitals have to carry out additional activity. If they do not carry out the additional activity, then they will not get the funding.

Overall, we are moving towards a place within the total acute hospital system where the budgets for hospitals will be far more related to the activity they undertake. However, that is a gradual process and we do not have full activity-based funding in our public hospital system. This is a means of incentivising hospitals to undertake additional activity.

One recommendation in the Sláintecare report related to trying to look at greater separation of elective and emergency workloads. It is quite possible that a hospital will come under pressure from emergency demand and will see its elective activity reduce. This is one way in which we can try to maintain a separation of elective activity, especially in hospitals such at Cappagh, the Eye and Ear and Our Lady's Hospital, Navan, which are unaffected by emergency pressures to the same extent, and reward them for doing more emergency activity.

It is more difficult in the large general hospitals, where the two pressures feed in to each other. That will be one of the things to address in the implementation of the Sláintecare report. The question is whether we can get capacity within our public system that is firmly dedicated to elective activity and waiting lists and does not get buffeted by seasonal and other pressures to do with emergency workloads. Some of the experience in the NTPF is of use to us in doing that and developing our total system of hospital funding.