Mr. Martin Varley:

We have moved from funding the NTPF for procedures to, more recently, outsourcing outpatient appointments. Set, contained procedures can work but our view is that we should mainly be using this funding to fund the capacity in public hospitals. Moving to outsourcing outpatient appointments, as we have heard from the two consultants present, is not really effective because the same patients come back in and need treatment in public hospitals.

Unfortunately, they will, in all likelihood, go back in at the end of the queue. It is a very cynical exercise, which does not deliver value for money.

I was speaking to a nephrologist in Tullamore, one of our main hospitals, earlier today. Normally that hospital has two nephrologists, but the second person took a post in another hospital. One nephrologist has been carrying the work of two for the past five years in Tullamore. The post has been advertised three times but there are no eligible candidates. The waiting list for an outpatient appointment is two and a half years, whereas the ideal is for patients to be seen within three to four months in order that urgent cases can be diagnosed. This type of scenario plays out all across the country; I am merely giving the committee a few vignettes to illustrate the problems. The situation is causing difficulties for patients, GPs and community services. Until we sort it out, the problems will spiral into greater problems throughout the whole health service.