National Treatment Purchase Fund: An investigation of the National Treatment Purchase Fund (NTPF) has found huge variations in the amount it pays different hospitals for the same procedures.
It has, for example, agreed to pay one hospital 87 per cent more than another for cataract operations on inpatients and in another instance it pays 217 per cent more to one hospital than another for removing skin lesions on day-case patients. Gall-bladder operations are costing the fund up to 215 per cent more in one hospital than another.
The investigation, by the Comptroller and Auditor General (C&AG), has also found that many public hospitals referring patients to the NTPF for private treatment last year ended up treating the patients privately themselves.
The NTPF was set up in 2002 to buy private treatment, mainly in private hospitals, for people waiting long periods on public hospital waiting lists.
The C&AG looked at the eight procedures most commonly arranged for patients by the NTPF in 2004. These included cataracts, varicose veins, hip replacements, skin lesions, coronary angiograms, knee replacements, grommets and gall-bladder removal. Some 3,809 of these were carried out last year, and 44 per cent were in public hospitals.
Furthermore, 36 per cent were carried out in the same public hospital from which the referral had been made.
"It was also established that the documentation maintained by the NTPF did not systematically record information relating to the referring consultant and the consultant carrying out the surgical procedure to enable the NTPF to guard against the risk of excessive self-referral," the C&AG's report states.
C&AG John Purcell said that given the extent of same-hospital referral of waiting-list patients he asked the Department of Health to explain how it was possible "for each of these hospitals to have a waiting-list problem for the procedures in question and, at the same time, a capacity to undertake a substantial number of additional treatments requested by the NTPF".
The department said it had agreed to 30 per cent of public hospital facilities being used for NTPF work "once public core service planned activity was not compromised". It had now been decided, however, that just 10 per cent of public capacity should be used for NTPF work in future. The department also said public hospitals sometimes carried out private NTPF work in the evenings and at weekends.
On the subject of the prices paid by the NTPF to individual hospitals for treating patients, Mr Purcell says he has acceded to a request from the department not to publish the prices paid "on the basis that the publication of commercially sensitive information would affect NTPF's negotiating position and as a result its capacity to deliver a value for money service". The NTPF negotiates prices with each hospital individually.
Labour health spokeswoman Liz McManus last night called for a full review of the NTPF, saying it now appeared consultants were being paid twice for treating the same patients.