Martin Daly (Roscommon-Galway, Fianna Fail) | Oireachtas source

I thank Mr. Gloster and his team for coming. I reiterate his tribute to the public health workers in hospitals, the community and various settings throughout the country. The vast majority carry out their roles with distinction but there are questions, some of which he identified. He touched upon the one that is possibly the most sensitive to this committee, namely, the moral hazard of the NTPF, especially where services are being provided at public sites by people, some of whom are already employed in the public sector in their day jobs. That is not simply my reflection on it. It is not simply about doctors. I am not here to defend anyone. If there is wrongdoing there is wrongdoing, but it seems a system-wide issue because I do not think people understand that hospitals also gain by providing a NTPF service. It becomes a form of revenue, which creates that moral hazard and perverse incentive.

Unfortunately, we have had allegations regarding CHI. I will not dwell on that perverse incentive, as it has been well aired, but there is an allegation of a different level of productivity compared with the five-day week, if someone is doing a private clinic, with maybe not all the resources, on a Saturday morning. That is a question the public are asking. They are sophisticated and can see through this. We need to make sure that the NTPF, which was set up to deal with long waiting lists and to provide services to patients when the public system was at full capacity, is not used for any other reason, including as a revenue generator for public hospitals that should be carrying out this work. The Minister was here last week. She suggested there was significant investment in our hospital sector and a very inconsistent response in certain hospitals. There was a different level of performance. There was very significant investment for some hospitals, but a lack of proportionate response and activity. That might point to some of the issues we are trying to deal with here.

On the insourcing issue, and the NTPF will speak for itself, it has been pointed out that governance lies with the hospital providing the service. Is there no overarching audit system between the NTPF, the HSE and voluntary hospitals on how to regulate that? It seems there is a gap in governance. We are relying on hospitals that are looking for revenue to police themselves. With the best will in the world, when those sort of incentives are created, people tend to go through the easiest gate and the one that is open.

What is the governance around NTPF insourcing and the governance of former and current employees who are providing such services? As was pointed out, it is not illegal to be the director of a company, but there must be robust governance of activity that might reward individuals and institutions. Who are the voluntary hospitals, such as CHI group and other voluntary hospitals, answerable to? Are they answerable to their board, to the regional CEO of the HSE or to the Minister? Will Mr. Gloster reflect on the performance of the public sector versus the private sector, which seems to stand out in respect of that particular allegation around the 2021 report into CHI where the clinics were carried out on Saturday mornings? There appeared to be much greater performance on Saturday mornings than there was during the week.