Stephen Donnelly (Wicklow, Fianna Fail)
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In relation to the queries raised, about the number of physiotherapists catering to the needs of public patients and whether waiting lists are maintained to measure the extent to which demand is being met by the existing throughput of caseload of these practitioners, as these are service matters, I have asked the Health Service Executive to respond to the Deputy directly, as soon as possible.

As the Deputy may be aware, management and administrative grade staff in the Fórsa union in the HSE commenced industrial action on Friday 6th October 2023. As a consequence of this industrial action, members in these grades are not engaging with political forums or processes. As a result, the question asked by the Deputy may be delayed in receiving a response directly from the HSE.

As regards extending the role of the National Treatment Purchase Fund (NTPF). The NTPF was established under the Health (Corporate Bodies) Act 1961, with the function of providing hospital treatment for citizens and the collection and validation of information in relation to waiting lists. Its role was extended in 2009 (via the Nursing Home Support Scheme Act, 2009) to provide for negotiations with private nursing homes in the context of fees payable for Fair Deal clients.

Notwithstanding the fact that Primary Legislation would be required to expand the NTPF’s role there are other core factors that may militate against a role for the NTPF in the areas identified by the Deputy in the short to medium term.

Firstly, there is the nature of private capacity in the context of hospitals versus community services. Currently, NTPF treatments are purchased from hospitals (institutions) through panel agreements with the relevant providers; community services are predominately provided via individual practitioners.

People using HSE primary care therapies are likely to have more complex needs and, therefore, require several services at the same time, provided through a multidisciplinary team. In essence, they have a longer-term relationship with health services rather than an episodic relationship such as that provided in a hospital, and as such it would be necessary to cost and profile ‘bundles’ of work that would be required to address service user needs and pathway requirements, as distinct from the once-off episodic treatment arrangements with hospitals.

In addition, careful consideration would need to be given to the impact of the purchasing of private capacity on long-term expansion of public capacity within primary care, and ensuring appropriate skill mix to meet the needs of people including children with more complex needs.

Any changes would need to be widely consulted upon, analysed, and planned prior to enactment. The NTPF could potentially play a role in the future. However, there are foundational issues as outlined above that need systematic reform and development to enable an NTPF style approach.