Mr. Don Gallagher:

I thank the Chair and the Committee of Public Accounts for today's invitation to discuss the role of the National Treatment Fund as part of Ireland's public health system. I was first appointed to the NTPF board in March 2021 and became chair in July of that year. I was reappointed as chair last March for a second term. I am an experienced chief executive who most recently managed the Health Insurance Authority before retiring and have served on the boards of State organisations and international insurance companies.

I am joined by the NTPF’s CEO, Ms Fiona Brady, who was appointed to the role in July 2023. Ms Brady was previously CEO of Our Lady of Lourdes Hospital Drogheda and Louth County Hospital for five years and has first-hand knowledge of the workings of the acute hospital system relating to scheduled and unscheduled care.

As the committee will be aware, and as already mentioned, the NTPF has three key responsibilities: commissioning inpatient and day-case procedures, outpatient appointments, gastrointestinal scopes and diagnostics for the longest waiting public patients; collecting, collating and validating public hospital waiting lists; and negotiating the maximum price of long-term residential care under the fair deal scheme. The third is a vitally important task, in terms of nursing home residents and for national finances. The NTPF concluded 300 negotiations with individual nursing homes last year.

For the purpose of today’s meeting, I will focus on the NTPF’s commissioning role as part of the multiagency strategic approach to improve health outcomes for patients, explaining our approach and impact. I will also address the actions the NTPF has taken in recent weeks following allegations of misuse by public hospitals of funding provided for approved insourcing initiatives.

On the commissioning front, the NTPF ensures public patients get faster access to timely care through insourcing arrangements with public hospitals and outsourcing arrangements with private hospitals. Outsourcing arrangements involve the NTPF procuring treatments and care for public patients in private hospitals. Every year private hospitals tender to offer care across a wide range of specialties. We select the hospitals with available capacity and suitability of location, giving the NTPF options to offer treatment and care across almost all specialties, from cataracts and hip replacements to scopes and first-time consultations.

We review hospital waiting lists regularly, enabling us to identify the longest waiting patients for certain specialties. Working with the referring public hospital, we offer patients the option of treatment or care in a private hospital. The welfare of the patients is always of the utmost importance, with only patients confirmed as clinically suitable for outsourcing by their hospital offered treatment.

Patients must also agree to the treatment. If a patient declines an offer, we will call them to see if there is anything we can do that would make the treatment offer a possibility for them. The patient will always receive a full episode of care. For example, if they have a knee replacement, we will also arrange a full programme of follow-up physiotherapy and consultant reviews at the same hospital. Only when the patient is fully discharged is payment made to the private hospital. It is important to note that the NTPF pays the treating hospital, not the consultant.

Outsourcing with private hospitals accounts for approximately 70% of our commissioning work. The remaining 30% is focused on insourcing initiatives, which have been at the centre of recent media discussion. Insourcing is where the NTPF provides funding directly to public hospitals for treatment or outpatient consultations seen outside core activity, that is, additional to the activity funded by the HSE. Insourcing means we can maximise the existing resources in the public hospital system.

The process involves senior management in public hospitals applying to the NTPF to secure funding, outlining their opportunity to get long waiting patients treated faster and providing a specific treatment plan and solution. The application is reviewed by our commissioning team and then forwarded to NTPF senior management for approval.

The NTPF has strong financial oversight procedures and processes in place to administer insourcing funds. It only makes payment in respect of specific, named patients who have been on a public hospital waiting list, and then only on receipt of detailed invoices from the public hospital confirming that care is fully complete and the specific named patient has been discharged. Payments are made only to the hospital and never to any individual consultant or staff member. Internal governance on the management of the insourcing work remains with the referring public hospital, with the agreement under the NTPF’s memorandum of understanding that the funding is used as specified and agreed.

On the impact on patients, the NTPF’s approach to commissioning front-line care has been overwhelmingly successful in ensuring public patients get access to quicker treatment over the past number of years. Since 2019, the NTPF has arranged surgery or care for almost 1 million public patients, helping the system move closer to Sláintecare waiting times targets. Over the last two years, almost 500,000 public patients received their surgery, consultant appointment, scope or diagnostic scan faster because of the NTPF.

Last year, the NTPF exceeded its patient treatment targets set out in the 2024 waiting list action plan by over 10%. This year, it is again ahead of its set treatment and care targets for 2025. Last year, NTPF activity between commissioning and validation accounted for the removal of over 317,000 public patients from the scheduled care waiting lists.

Turning to the allegations of the misuse of funds, the NTPF and its board have been deeply concerned by recent allegations of breaches of its processes by public hospitals concerning insourcing initiatives. The NTPF first learned of the internal CHI report outlining the misuse of NTPF money in CHI through the media. We immediately placed a temporary pause on all insourcing work with CHI and initiated a review of this work. Both parties worked closely together, and on receipt of the appropriate assurances by CHI management confirming its ongoing compliance with existing NTPF procedures, we recommenced insourcing work. The engagement of the CHI senior management and CEO, Ms Lucy Nugent, greatly expedited the process, thereby minimising the impact on patients.

On learning of potential issues in regard to NTPF-funded insourcing work at Beaumont Hospital, the NTPF immediately suspended all insourcing work and payments at Beaumont and informed the Department of Health and HSE of its concerns. The HSE's internal audit is currently carrying out a detailed review in Beaumont. We are ready and willing to recommence insourcing once we receive the necessary assurance regarding the appropriate use of NTPF funds. We are working closely with the HSE regional executive office on this matter.

The public must have full confidence and trust in the insourcing process. We are working alongside the Department of Health and HSE to increase governance and oversight across our insourcing work with public hospitals. As part of this process, the NTPF CEO has written to all hospitals which participate in insourcing initiatives funded by the NTPF to seek assurances of full compliance with our memorandum of understanding. We are now assessing the responses received and will provide a comprehensive report to the Department of Health and HSE.

Looking to the future, the board and executive of the NTPF take their responsibilities to the public taxpayer very seriously. We will take whatever actions are necessary to ensure our spend is fully protected for the benefit of public patients and taxpayers. While waiting lists remain a challenge for the general hospital system, our priority for the remainder of the year is to continue to work with the Department of Health and the HSE to get long-waiting public patients access to treatment and care and keep overall waiting times as low as possible as we continue to work to achieve our Sláintecare targets. I thank the committee.