Mr. Seamus McCarthy:

The National Treatment Purchase Fund board has responsibility for the management of a range of activities within the healthcare system. Its main activity comprises identification of and payment for treatment or assessments to assist in reducing inpatient and outpatient waiting lists in public hospitals. The board also has an important function in assessing and approving the scope and level of charges for long-term care in private nursing homes for people availing of the Health Service Executive's fair deal scheme.

The board's financial statements for 2023 record an effective break-even situation with total income and total expenditure of slightly more than €190 million. Almost all of the board's income comes from Vote 38 - health. The board's income and expenditure have both grown rapidly in recent years. To illustrate this, the board's expenditure in 2023 was almost three times the expenditure of €64.8 million incurred in 2019. The board secures treatment and assessments for waiting list patients in private hospitals and in public hospitals which offer space capacity to provide required patient care. In 2023, payments made to private hospitals amounted to €107 million, while payments to public hospitals amounted to €72 million. This represents a reliance of 60% on private healthcare providers and 40% on public healthcare providers in 2023. Note 3(b) to the financial statements analyses the payments by medical specialty, indicating the range of areas in which care is purchased. Payments to individual hospitals are not shown in the financial statements. The board's payroll costs and other administrative expenditure amounted to €11 million in 2023. Included in this are costs of slightly more than €1 million in respect of the board's price negotiation function with private nursing homes.

I issued a qualified audit opinion in respect of the agency's financial statements for 2023, but only in respect of the accounting treatment of retirement benefit liabilities for the board's staff. This is not in line with standard accounting practice, but does comply with the accounting directions of the Minister for Health, which are common to a number of health sector bodies I audit. The 2023 financial statements were certified on 30 September 2024. Members may wish to note that I certified the financial statements for 2024 last week. I understand the process for presenting those financial statements is in train with the Department.

I outlined the key financial results for the 2023 year of account when the representatives of Children's Health Ireland, CHI, were last before the committee on 22 May and I do not propose to repeat that presentation this morning. Since the meeting of 22 May, details of an internal examination undertaken by CHI in 2021-22 have come to public attention. As I have previously explained to the committee, my office was not provided with a copy of that report at the time it was finalised or when the audit of the hospital's financial statements for 2021 was being undertaken. My office has in recent weeks received a copy of the report. While the main focus of the internal report is personnel management concerns in a clinical department in part of the hospital, it also raises some concerns around a number of financial risks, including controls over claims in respect of care paid for by the National Treatment Purchase Fund. Due to the report's findings with regard to those financial risks, the hospital should have brought the report to the attention of the audit team in the course of the audit of the 2021 financial statements. The control implications of the report's findings will now be considered as part of the audit of the hospital's 2024 financial statements, which is currently ongoing.