Dr. Laura Durcan:

In rheumatology, some centres have outsourced to the NTPF for basic, first-time assessments. In those cases, patients have gone to a private hospital for their first-time visit and if they are diagnosed with something or require further follow-up, they then go to the original unit as a return patient. That is dreadful for the person. The consultant in charge of that unit has not met the person who is now a return patient to the service with a rheumatological diagnosis. The same happens in many different places. It is something to be avoided for medical outpatients with conditions that need chronic care because it is a disaster.

I see many patients with joint replacements who have gone north of the Border or to other places to get their hips or knees done. It works really well for a young, healthy person who does really well with a hip or a knee and comes back saying it was fabulous and a great experience. Unfortunately, it becomes very difficult when somebody has a poor experience or does not necessarily do well with it. That person is then back in the public system with the complications of an operation that were done by somebody else.