Ms Fiona Brady:

I thank the committee for the invitation to appear before it today to discuss the role of the National Treatment Purchase Fund within Ireland's public healthcare system. I acknowledge my NTPF colleagues in attendance today.

By way of background, I was appointed chief executive of the NTPF in July 2023, following five years as chief executive of Our Lady of Lourdes Hospital, Drogheda, and Louth County Hospital. Prior to that, I was chief operations officer and director of unscheduled care. I also worked with the national clinical programmes on a project for the emergency medicine programme. I began my career in clinical practice, having trained as a nurse and midwife.

The NTPF carries out three core responsibilities within the public health system. The first is commissioning treatment and care. This includes inpatient and day case procedures, outpatient procedures and endoscopies for patients experiencing the longest waiting times. Second, we facilitate the management of hospital waiting lists by collecting, collating, validating and publishing national waiting list data. Third, we negotiate nursing home rates by setting the maximum prices for long-term residential care in private or voluntary nursing homes under the nursing home support scheme, NHSS, a function that is critical both for protecting residents and safeguarding public finances. In 2024 alone, the NTPF concluded more than 300 negotiations with individual private and voluntary nursing homes.

Today, I will focus primarily on the NTPF's commissioning role, outlining our approach and our impact on patients. I will also provide an update on the actions we have taken in recent months in response to concerns regarding the misuse of NTPF funding for approved insourcing initiatives within public hospitals.

The NTPF enables public patients to access timely care through two commissioning pathways. Insourcing is where funding is provided directly to public hospitals to deliver additional treatment or outpatient consultations beyond their core HSE-funded activity. Second is outscourcing, where the NTPF procures treatment and care for public patients in private hospitals. Currently, outsourcing represents approximately 70% of all NTPF commissioning expenditure, while the remaining 30% is insourcing expenditure.

Robust governance and oversight arrangements are in place for all commissioning activity. Outsourcing agreements are governed by legally binding contracts between the NTPF and the treating private hospitals. Similarly, public hospitals undertaking insourcing initiatives are required to adhere to the principles of a formal memorandum of understanding, MoU, setting out their obligations in relation to NTPF-funded work.

Since 2019, the NTPF has arranged treatment and care for more than 1 million public patients, supporting the health system in progressing towards the waiting time targets set out under Sláintecare. In 2023 and 2024 alone, over 500,000 public patients accessed surgery, consultant appointments, endoscopies or diagnostic scans sooner as a direct result of NTPF commissioning.

As previously communicated to this committee, following allegations of non-compliance with NTPF insourcing processes, the NTPF conducted a comprehensive insourcing assurance review during May and June 2025. This review covered 38 public hospitals that had applied for and received approval to undertake NTPF-funded insourcing initiatives. Each hospital was formally requested to confirm that all NTPF-funded insourcing activity had been delivered in accordance with the signed MoU and the NTPF’s governance procedures. All 38 hospitals responded and the NTPF was satisfied with the responses of 35 out of 38 hospitals that they had delivered their insourcing initiatives in full compliance with their MoUs. There were three hospitals that breached the principles of the MoU but there are no ongoing concerns from an NTPF perspective in these cases.

Beaumont Hospital was excluded from the insourcing assurance review as all of its NTPF-funded insourcing initiatives had already been suspended on 11 April 2025 following reported concerns regarding compliance. The NTPF acknowledges that it continued to fund insourcing initiatives at Beaumont Hospital in the absence of the hospital returning a signed MoU. This action was taken as the previously signed MoU was still in place, the terms had not changed and in the interest of ensuring long-waiting patients received their much-needed care. The National Treatment Purchase Fund and Beaumont Hospital continue to work collaboratively to improve waiting times for patients. While insourcing has been temporarily paused, the NTPF remains actively engaged with Beaumont Hospital to provide outsourcing solutions for long-waiting patients. In addition, the NTPF undertakes administrative validation of waiting lists to ensure their accuracy and Beaumont Hospital remains fully engaged in the NTPF audit process. The NTPF is fully committed to maintaining this collaborative relationship and is pleased to continue working with the management team at Beaumont Hospital to support the effective management of patients and waiting lists.

The NTPF is continuing to strengthen its insourcing processes with the aim of improving access to care for patients. As part of this, the NTPF is introducing enhanced monthly tracking and monitoring of all insourcing activity in relation to waiting list volumes and wait times. This will support a more targeted approach, helping to ensure that patients are seen more quickly and that overall efficiency leads to shorter waiting times for treatment.

The NTPF welcomes the Minister and HSE’s commitment to driving greater productivity across our health service especially in light of the new public-only consultant contract. The executive and staff of the NTPF are ready and committed to working closely with the Department of Health and the new regional structures to deliver a more focused and collaborative approach to managing waiting lists, fully aligned with the ambitions and targets set out in Sláintecare.