Alan Kelly (Tipperary, Labour)
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To refer to Deputy Durkan's comments and the information that the total claims are just under €2 billion, with €600 million paid to public hospitals and the balance, more or less, going to private hospitals, clinics etc., I had not intended speaking on this but it creates a discourse which the witnesses will understand is out there. It comes to us as public representatives and raises concerns. I refer to what Deputy Kelleher said earlier about cherry-picking. I include myself in this, rather than speaking for everyone, but there is probably a misconception of what the witnesses' organisation is or what it does. I know it is a representative body. As a result of this, I have a number of questions which I understand they cannot answer because they will have to try to find the information, if they even can find it. This leaves us with gaps regarding the collation of information from private hospitals. Mistakenly or not, we probably assumed - some of us, including me, did anyway - that they would have their hands on this information but they obviously do not. This is not a criticism. Perhaps we just did not understand or know about this but it does create a gap for us, which we will have to try to fill some other way in trying to find information on the work done in private hospitals.

I have a number of questions. I will try not to repeat the questions that have already been asked, although I may have some nuances to add to them. I have a bee in my bonnet about the issue of ICT and e-health. I understand and appreciate the answers already given regarding the difference between clinical and administrative ICT. I respect Mr. Fitzgerald's honesty in saying that in his current role, some of the ICT on the public side is actually better than the private side. I understand there is a huge cost involved but across private hospitals, is there a kind of coming together or economies gained regarding the type of investment they are putting into ICT across these two completely different areas, namely, the administrative and the clinical? If so, perhaps this could be shared with the public as well because it is all the one. Furthermore, where do the witnesses see the breakdowns regarding the transfer of information interoperability between public and private? I am absolutely convinced that huge efficiencies are possible in this area and I hope we will make reference to them in our final report. Do the witnesses believe and agree that we need to create one unique identification code for all patients in order that there is interoperability between public and private hospitals and across health care?

My next question relates to emergency departments, EDs, and medical assessment units, MAUs, and the 1,000 patients per week. As the committee will know, I have spoken publicly on this. It is quite immoral that we found out during the recent crisis in emergency departments, which is not over yet, that private hospitals were supposedly doing their job, in that they were advertising their EDs to patients while many people - hundreds of people - across the country were waiting on trolleys in public hospitals. How do the witnesses feel their hospitals can play a role in this regard? I believe in ideological debates. I would prefer to see these people treated in public hospitals. However, as an interim step, how do the witnesses believe they could play a better or bigger role in working on an interim solution in the next year or two while we sort out this absolutely chaotic situation? Is there anything in this regard to which they feel they can contribute?

Statistics have been given to us on elective procedures in private hospitals. Reference was made to 50%. Does that change when it comes to the NTPF? Can we break that figure down into types of procedures as opposed to accounting for everything in the one figure?

Regarding the lack of data available on the type or volume of activity in private hospitals, Mr. Fitzgerald talked about the HIPE. Obviously, it is something he feels his sector could work towards into the future. I knew about this, but it is still very concerning. Collectively, we need this information. Do the witnesses feel they are also at a loss because this has not advanced and has not been brought in across private hospitals? Following on from that, what are their views on the advancements of HIQA licensing across private hospitals, which is also proposed?

Mr. Fitzgerald spoke about the transfer of patients from public to private hospitals and from private to public hospitals. Regarding the latter, he spoke about the four different ways in which this might happen. I thank him for his honesty and brevity in this regard. Does this vary by hospital area? Specifically, given the geographical locations of the private hospitals, does it vary based on their locations because of the types of hospitals that may be near them, that is, whether they are tier 1 hospitals? Generally, they are tier 1 hospitals. Does it vary across the country?

The questions about recruitment and length of stay have been dealt with.

Do the witnesses have any idea or knowledge of the percentage of procedures in private hospitals provided for public patients but on behalf of the public health care system? I would appreciate if they would come back to Deputy O'Reilly's questions about support staff across all the private hospitals. That is very important information to some of us on the committee.

I have one final question. Obviously, the witnesses are advocates for the hospitals they represent, and in many ways private investment is important for the existence of their hospitals. They have shareholders. Obviously, because of this, they want profits, etc. Many of their hospitals have been created because of the way in which health care has been managed in this country, and gaps have been created in the market. This is more a question for Mr. Nugent than anyone else. Given the current health care environment in this country - and I hope the committee under this Chairman will change it and have a plan for the next number of decades and the next ten years in particular- do the witnesses envisage any way that they can see new private offerings, private hospitals, etc. being proposed or a need for them anywhere in this country?