Mr. Seamus McCarthy:

I will be very brief. The National Treatment Purchase Fund, often referred to as the NTPF, was established in April 2004. The NTPF board is an independent body operating under the aegis of the Department of Health. The board's financial statements before the committee in this session relate to the financial year 2016. The audit of the board's 2017 financial statements is scheduled to commence in July of this year.

The role and focus of the NTPF has evolved over time, reflecting changes in policy and available funding. The original remit of the NTPF required it to make arrangements for the provision of hospital treatment, either within or outside the State, for patients on long-term waiting lists and to collect and validate information about patients waiting for public hospital treatment.

In 2009, the NTPF acquired responsibility for negotiating and agreeing payment rates with private and voluntary nursing homes for the provision of residential home care for older people being supported under the fair deal scheme. Responsibility for the administration of the fair deal scheme rests with the HSE.

In 2012, the NTPF moved away substantially from the direct commissioning of patient treatment and put more focus on data and analytics, pricing, and audit and quality assurance. The board reduced its staffing levels to reflect its changing role and the reduction in annual budgets. In 2015 and 2016, the NTPF provided administrative support to the HSE by disbursing payments to private hospitals providing patient treatment for the longest-waiting public patients.

In 2016, the NTPF received funding of almost €29 million to pay for patient care and €5.1 million for its other activities. The NTPF reported an operating deficit of around €320,000 for the year.

The graph now being shown to members profiles the changes in the National Treatment Purchase Fund's spend over the years 2012 to 2016. Patient care expenditure accounted for around 89% of the NTPF's expenditure in 2016. The balance, 11%, related to administration expenses.

The primary focus of the patient care expenditure in 2016 related to the provision of treatment in orthopaedic cases, at around 43%; ear, nose and throat cases, 14%; and general surgery cases, 12%. The balance, 31%, covered a range of treatments.

I issued a clear audit opinion in respect of the NTPF's financial statements for 2016. The report draws attention, however, to the NTPF's accounting treatment of staff pension benefits. The legislation establishing the NTPF gives the Minister for Health the authority to set the accounting framework for the board. In doing so, the Minister directed that pension benefits should be accounted for as they are paid, rather than as liabilities accrue, which is what generally accepted accounting practice requires. As I have explained previously to the committee, this accounting treatment for pensions is common to a number of health bodies.