James Reilly (Dublin North, Fine Gael)

People know my view on the National Treatment Purchase Fund. I must seriously contest the Deputy's contention that it provides value for money and works very well. The fund has delivered a certain level of relief to the system. However, we must consider the fact that €300 million was spent by the National Treatment Purchase Fund over three years. Last year it spent a total of €90 million and 28,000 patients were seen. If I recall correctly, inpatient procedures were required in respect of 20,000 of these individuals. Let us compare that with the position in Northern Ireland, where the special delivery unit approach is used. In 18 months, and at a cost of £36 million - as opposed to €300 million - 57,000 people were treated.

There are ways of doing things a great deal better. I cannot suddenly turn off the tap in respect of the hospitals and patients that continue to use the fund. However, we are reducing the number of people in respect of whom the fund will purchase operations. We want to use the funding that will be saved as a result of this in more innovative ways. I refer, for example, to circumstances where the addition of a theatre nurse could double the output of a surgical unit. There are a host of other examples which could be offered in this regard in respect of accident and emergency departments, medical departments and various other procedural areas. The addition of staff - even half-time whole equivalents, etc. - can make a huge difference in the context of output in these areas. The prime example I might offer relates to Our Lady's Children's Hospital, Crumlin, where the addition of 0.4 of a whole-time equivalent of a nurse could double the number of scoliosis patients treated.

We are concerned with doing things in a different way. The special delivery unit will also be the agent of change, which is extremely important. I am not just referring to changes in clinical programmes and the way in which services are delivered, I am also referring to the unit being the agent of change in the context of how information and communications technology is used.

It is deeply disturbing that there is a major training hospital in this country to which no non-consultant hospital doctor, NCHD, wants to go as a result of the way in which they are treated. Protocols will be put in place to inform people how they should deal with their peers, with junior staff and with patients. Those who stand outside of this will be brought to book.

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