Billy Kelleher (Cork North Central, Fianna Fail)
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Question 4: To ask the Minister for Health when the special delivery unit will be established and operational; the process by which it will begin receiving referrals of patients; the timeline for this process; the date on which the National Treatment Purchase Fund will no longer receive referrals; the functions the NTPF will have following the establishment of the SDU; and if he will make a statement on the matter. [18080/11]

James Reilly (Dublin North, Fine Gael)
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I announced the establishment of the special delivery unit, SDU, on 1 June. This has been one of my key priorities since becoming Minister for Health because I am determined to tackle the delays in access to hospital services whether that is for emergency or elective care. The SDU is also a critical building block in the Government's plans to reform radically the health system in Ireland, with the ultimate goal of introducing a system of hospital trusts and access to services based on universal health insurance. Access to such a system will be determined by need rather than what someone can afford to pay. As part of this, free general practitioner, GP, care at the point of delivery will be put in place.

I have appointed Dr. Martin Connor as head of the SDU and to the interim board of the HSE. Dr. Connor is an international expert, with a proven track record in health service transformation. He has extensive experience in the NHS and led a similar initiative in Northern Ireland with considerable success. His principal task will be to build up the SDU and to prepare proposals for me on how best it can be placed on a permanent footing within the next six months.

Dr. Connor has already begun to work with the hospital system in order to put in place new arrangements to reduce waiting times in emergency departments and to improve access to elective inpatient and day-case services. This work includes a detailed baseline analysis of the emergency and elective access system. Part of Dr. Connor's remit is to advise me on the governance arrangements which will best ensure there is real accountability and responsibility for performance across all public hospitals.

For now, the National Treatment Purchase Fund, NTPF, will continue to operate as normal, accepting applications from persons who have been waiting for over three months for treatment. However, the establishment of the SDU will require a change in the current role of the NTPF. This is an issue I will be considering over the coming months.

An immediate priority for the SDU will be to ensure waiting lists for inpatient services are managed properly and that hospitals take responsibility for managing patient flows. I cannot accept a position where some hospitals allow small numbers of patients to wait more than a year for their procedures. I will expect this matter to be tackled quickly.

Billy Kelleher (Cork North Central, Fianna Fail)
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Most people accept that the National Treatment Purchase Fund has proven to be a very effective mechanism in the context of dealing with delays and reducing waiting lists. Some €30 million has now been taken out of its budget. Will the Minister confirm that this money will be spent by the special delivery unit on ensuring the capacity the National Treatment Purchase Fund would otherwise have had if there had been no reduction in its budget will be used to reduce the waiting lists relating to elective and emergency surgeries, MRI scans etc.? I am concerned the National Treatment Purchase Fund should continue to be in a position to refer people on to private hospitals in respect of having procedures carried out. The major issue that arises here is that the special delivery unit might use up most of the €30 million to which I refer in covering administration costs rather than in disbursing it in the form of direct funding to patients.

I wish to comment on the position relating to hospital trusts, particularly in the context of Roscommon County Hospital. Prior to the general election the Minister stated:

We will establish Roscommon County Hospital as a stand alone hospital. It will continue to be owned by the State, but will be governed and managed by a Local Hospital Board...

If that is the case, will legislation be required to establish the hospital as a stand-alone facility? Will the hospital be used by the special delivery unit in the context of the provision of elective surgery or will it be in a position to operate independently of the unit?

James Reilly (Dublin North, Fine Gael)
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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.