Mr. Brian Fitzgerald:

I am happy to give some examples if I may. Reference was made to the number of inpatients, which I believe is in the region of 250,000. There were specific comments about the emergency departments, procedures, hip operations, average length of stay and the National Treatment Purchase Fund.

On the issue of emergency departments and patients being transferred from a private to a public hospital, it was reflected in commentary from all the Deputies that perhaps this was in the context of perverse incentives. I can use examples in both systems because I have worked in both. There are basically four types of patients who are transferred. First, there are patients who go by ambulance. Clearly, private hospitals are not funded to take ambulance transfers, which is a choice. If the Government wishes to fund private hospitals so they are open 24-7 and can take ambulance transfers, we would certainly look at it. Second, there are patients who require significant intervention, for example, a patient with a brain tumour. These are small volume numbers of patients. It is not in the interests of the State to have lots of providers treating small numbers of patients, and in fact there would not be the specialists to do it. The private system will not do that because it is not funded to do it and it would not make the best use of resources as one would not find the surgeons.

Third, on occasion a patient might arrive at our emergency departments who might need, for example, an ear nose and throat, ENT, consultant and at that moment, although we have ENT consultants, we would not have one available. This happens all the time in the public system also. In that context we encourage the patient to go where he or she can, if we deem it to be urgent, whether that is to a public emergency department or one of our sister private hospitals. The fourth type of transfer is probably the one that comes up a lot. It is when patients come to the emergency department of a private hospital and there are no beds. This is not dissimilar to a public hospital. In that case, we offer the opportunity to the patients to remain in the hospital under medical supervision, we probably give them a light lunch if they can have food, we will try to admit them later in the day or if they are well enough, they can go home and come back the next day. The bottom line is that we are genuinely only interested in looking after the patient. We want to make sure patients get the best treatment they need and if they are really sick they are treated quickly. If they are really sick, they may choose to go to a public emergency department because they feel they will get the care they need in that setting. That was reflective of a number of queries.

I will now turn to some of the specifics on procedures. Some 40% of patients typically in private hospitals are classed as medical patients with respiratory or gastroenterology problems and about 60% are elective patients for general surgery. We are seeing a huge demand, particularly through our emergency departments, from more medical patients. Last week, we had over 60 medical patients out of, I believe, 143 patients on one day. That is a significant number for us. The elective patients cover areas such as orthopaedics, cardiology, which are the bigger of the general surgery types, vascular surgery and cancer. They are the big elective areas one will find in the private system.

The average length of stay for a medical patient is typically about four days. My comparison with that, and we watch this every month with our board, is the published public figure of seven days, but in my experience in my previous career I have seen stays of over ten days. Reference was made to the NTPF and volumes, which are actually quite low. Last year, it would have been in the order of perhaps 2.5% to 3% of our overall revenue. Just over 90% of our revenue comes from insurance companies and the rest comes from self-pay, the NTPF or patients who come from abroad seeking treatment in the State.

There is a full range of diagnostic tests. In all the private hospitals, there are full laboratory capability, full radiology capability and full endoscopy capability, which is the main diagnostic test that patients seek.

In fact, there are specialist areas in our hospital that are not provided in the public system for which public patients come in by way of service level agreements with the HSE.

MRI costs is an interesting area. MRI is the only area, under legislation, in the public system for which the public system can charge. For all the diagnostic tests that private patients receive in the public system, MRI is the only one for which there can be a charge.

Cost was referred to but I refer to price in my current life because I have to negotiate price with our funders. We have different prices with different funders, and that is a commercial discussion. We have different prices for self-pay patients. Our patients pay less for self-pay MRI and other diagnostics than we would receive from the insurers. That is a commercial conversation.

We have faced the same recruitment challenges the public system faced. We have just over 300 nurses but when I joined my current employer we had more than 30 vacancies, which is 10% of our nurses. We went abroad to the Middle East and anywhere we could and we practically filled all those vacancies in the last 12 months. The last time I looked we had five vacancies. Interestingly, I have noticed a trend in the last few months of a lot more CVs coming in from nurses who want to take up roles in the private system.

I need to mention doctors. I know there is a view about salaries, history and contracts. I talk to young surgeons in Australia, North America and the UK predominantly who want to come back. In fact, I lecture in Trinity College and UCD on health care management, and I lecture doctors who want to look at a career. Doctors want to come back, but it is not just about the salary. There is a mixture of issues, such as training and career advancement. Having said that, I have noticed in the last six months that we are having some success. There are more doctors coming to us now who want a salary in the private system, and will offer their services to the public system. I am seeing that trend. It is starting to happen.