The National Treatment Purchase Fund has its critics and champions, writes Eithne Donnellan
There's little doubt but that the National Treatment Purchase Fund has had a significant impact on the lives of more than 5,000 Irish adults and children who were on waiting lists for years with little hope of receiving treatment in the short-term.
The fund, the brainchild of the Progressive Democrats, was set up just over a year ago to tackle the unacceptably long waiting times for treatment for ailments such as varicose veins, hip problems and hernias. Some patients had been waiting up to eight years and the fund was meant to remove these "long waiters" from the system.
In that, it has been successful. By year's end, the 8,305 "long waiters" initially earmarked for treatment by the National Treatment Purchase Fund (NTPF) team will have been dealt with. By and large, those treated seem to be pleased with the service provided. This is not surprising given that most of them, having waited for years, were treated within two months of being referred to the fund.
The fund pays for these patients to be taken off public-hospital waiting lists and treated in private hospitals in the Republic, the North and Britain. Even patients' transport costs are covered, as are the costs of a travelling companion where patients are sent abroad.
But the fund has also had its fair share of critics. Some have asked why should public monies be pumped into private hospitals when beds in public ones are closing. To date this year, an estimated 500 beds have closed in public hospitals due to funding difficulties.
Dr Hugh Bredin, a consultant urologist at Galway's University College Hospital (UCHG), is "outraged" at the diversion into the private system of money he feels should be spent in public hospitals. "I feel what is really happening is we are robbing Peter to pay Paul," he said yesterday.
The money, he said, would be better used, for example, to open closed urology beds at UCHG, where patients could then be treated in the public system.
"I'm worried that it's a more costly system than processing patients through the public hospital and therefore not cost effective," he added.
Furthermore, he feels it results in non-urgent cases being taken off waiting lists and being treated while more urgent ones are being postponed. He has, he said, "very great difficulty" admitting patients with prostrate obstruction and urinary retention problems in Galway, and he would consider these men's cases more urgent and more serious than the varicose-vein cases, for example, being treated under the fund.
These men with prostate problems are the "hidden serious cases" whose treatment, like that of little Róisín Ruddle, are being postponed while less serious cases are treated under the fund.
He believes the fund was set up for political, not medical, reasons.
The director of the fund, Ms Maureen Lynott, defends its work. She says she understands the concerns about the fund's money not being channelled into public hospitals, but she stresses that both in good times and bad, the patients the fund is treating have been left waiting and something had to be done about it. Their ailments may not have been the most serious in the system, she admits, but they were enough to cause the patients to miss school, in the case of children who needed their tonsils out, and enough to cause severe discomfort, in the case of those who needed hip replacement operations or cataracts removed.
Furthermore, she says, not all its work is "minor". It has seen to 47 circumcisions, but it is also now seeing to patients in need of open-heart surgery.
"This is an innovative approach to a very specific intractable problem that existed in the health services here for a very long time. There was significant public disquiet about it," she says.
Furthermore, she points to the fund's budget as being small in the overall scheme of things. "The funding for the NTPF is €31 million out of a health budget of over €8 billion. So in scale it is a very, very tiny part of the health budget, again to deal with a specific problem," she adds.
True, but a doctor at Our Lady's Hospital for Sick Children in Crumlin, yesterday questioned why it was necessary to spend so much sending patients abroad when, as he put it, "if the same money was properly invested in the health service here" it could prevent surgery having to be postponed.
He also referred to the extensive improvements which could be carried out at the hospital if it had the fund's budget of €31 million.
Maureen Lynott stressed that Róisín Ruddle, the two-year-old Limerick girl who died within hours of her heart surgery being postponed by Crumlin Hospital just over two weeks ago, wasn't referred to the fund, and if she were she would have been treated.
However, she noted that the child was scheduled to have her operation in Crumlin, which meant there would have been no need for her to be referred to the fund.
Furthermore, up to now a child must have been waiting more than six months for treatment before becoming eligible for treatment under the fund. From initial reports, it appears the little Limerick girl may have been waiting a shorter period for surgery, which would have ruled her ineligible for treatment under the NTPF.
Dr Paul Oslizlok, a consultant in Crumlin, said she had been waiting for two to three months for surgery, though he indicated this was a month more than was ideal.
Labour's health spokeswoman, Ms Liz McManus, stressed yesterday the fact that more than 5,000 people had been treated under the fund so far should not detract from the fact that there are still over 29,000 patients on hospital waiting lists across the State.
She also questioned the diversion of "millions" to the fund to buy private healthcare for non-acute patients. "This is unconscionable. A treatment fund only makes sense when the health service is operating at full capacity. In the current critical state of our hospital service, it is siphoning off desperately needed funds to less acute care."
"Hospital wards are now being closed and staff vacancies are not being filled because of Government cutbacks in health spending. That, rather than purchasing care for patients in private hospitals, should be the principal focus of Government health policy," she said.
The work of the fund looks set to continue. As an indication of his confidence in it and its director, the Minister for Health, Mr Martin, recently announced he was extending its remit to managing all acute hospital waiting lists in the State.
Certainly the NTPF has been successful in weeding out of waiting lists all those patients who had died, had already had treatment or were on waiting lists in several places. Its validation work to date has resulted in more than 4,500 patients being removed from waiting lists. Any agency which makes waiting lists look good is hardly likely to be scrapped by Government.