Mr. Liam Woods:

That is a critical point and informed consent is vital. The patient must knowingly declare that he or she wishes to negate the public entitlement. That is required in law and we are very clear about that. If anything else is happening, that is a concern. It is something we looked at before and a concern was raised with us by the Department of Health some years ago that there should be no undue pressure put on patients in public hospitals to declare themselves private because they have insurance. We do not want that and we do not seek it. It is something we must keep on top of.

Deputy Margaret Murphy O'Mahony asked why it took an RTÉ programme to bring this matter to a head. The HSE is well aware of the problem of long waiting times. We worked with RTÉ for up to two years on the provision of information and we are very aware of the kind of information being made available to the programme. The Deputy's underlying point regards the awareness that a significant number of people are waiting longer than we would like for procedures.

We are aware of it. The NTPF data which come from the HSE systems and are published monthly show that is the case. Our response in the current year and as we move into 2018 is to seek to grow further. I will come to the Deputy's point about the NTPF, but the specialties of ophthalmology and orthopaedics were referenced. They are two of four or five specialties in which there is a significant number of patients who have been waiting a long time. We will seek to grow capacity in these specialties in 2018. To support this work, we are considering some specific proposals in the mid-west. For example, in Nenagh proposals have been put forward regarding cataract procedures, as others were elsewhere in the country which we are considering. Our response is to seek to provide the service, as well as an additional service because it is the true constriction.

As regards the robust measures mentioned by Deputy Bernard J. Durkan, I get the sense that members believe, as I do, that consultants who are outliers in terms of contract compliance need to be actively managed under the contract to be brought back into line with ratios that are appropriate at a local level and that the processes at hospital level, with the clinical director and hospital management, therefore need to be robust enough to know that we are dealing with the outliers. The point was made by Deputy Louise O'Reilly and those involved in the programme at the start that the vast majority of consultants complied with and potentially exceeded their contractual obligations. Therefore, there is a strong duty on us to ensure that where there is non-compliance, it is reviewed and amended and that there will be processes in place to achieve this. I assure the committee that we are fully aware of our duties in that regard.

As regards temporary contract locum posts, it is the clear preference of hospitals and hospital groups to have permanently appointed consultants. The key point in terms of the temporary posts, an issue that has previously been discussed at the committee, concerns post holders on the specialist register whom we are not developing such that they will be declared competent to work in the specialty in which they are operating. We are working to review consultants in posts but not on the register. That is a matter we have addressed here previously and on which we would happily bring back further information. It is not unique to the acute system.

Deputy Margaret Murphy-O'Mahony asked whether there was a conflict between NTPF funding and consultants' public contract. If I understand the question correctly, it concerns whether work we contract or which the NTPF buys in another environment for patients in public hospitals who have been waiting a long time is at odds with the consultants' public contract. The NTPF has a rule that when it contracts care in a private facility, it does not contract with the consultant on whose list the patient has been waiting. The NTPF's role relates directly to private hospitals in the country. Where feasible, we have worked with it to do additional work within the public system this year and that is within the current incentive set. We are providing more support and capacity to allow additional work to be done. The work the NTPF contracts directly is done in private hospitals. It tenders and contracts for that work as a separate organisation and does not------