Fewer than 10 per cent of people listed as waiting longest for elective treatment in hospital are available for treatment under the National Treatment Purchase Fund (NTPF) scheme, the C&AG report said.
The report says it is, consequently, “difficult to see how the NTPF can discharge its functions in relation to those waiting longest for treatment”.
Overall, however, the C&AG found procedures purchased from private hospitals by the NTPF generally cost less than those carried out in the publicly funded hospital system.
The auditors examined procedures in place to validate patient waiting lists and the arrangements for the cost-effective procurement of treatments by the NTPF.
The most common reason for unavailability for NTPF treatment (37 per cent to 46 per cent of cases) arose from the failure of hospital administration to follow up patients who had not responded to a previous contact e.g. the offer of a hospital admission date.
In November 2008 three hospitals accounted for almost half of the numbers in this category – Letterkenny General (340), AMNCH Tallaght (228) and Sligo General (200).
Some 29 per cent or over 1,000 cases were removed from the active Patient Treatment Register as a result of the November 2008 NTPF validation process.
Reasons included patients being unavailable for medical or social reasons who should have been removed to a ‘suspended’ list, as well as patients already scheduled for treatment. The largest number of removals were in Letterkenny General (100) and Sligo General (70).
A review of the 13,193 cases awaiting surgical procedures for over three months at April 2009 showed that 66 per cent of that number was accounted for in 11 hospitals, each of which had in excess of 500 patients on its waiting list.
In terms of total patients on the register (where more than 300 people were waiting for between six and 12 months, and more than 60 were waiting for greater than 12 months), Galway (UCH) had the highest number on the register as at April 2009, at 1,466.
It was followed by the Mater in Dublin with 1,293. Our Lady’s Hospital Crumlin had 841 patients waiting for treatment, followed by St James’s with 808. AMNCH Tallaght had 783, the Mid-West Regional Hospital in Dooradoyle, Co Limerick had 731, Letterkenny General had 574, Temple St (CUH) had 541 and the Midland Regional in Tullamore 531.
Overall, the C&AG found procedures purchased from private hospitals by the NTPF cost less than those carried out in the publicly funded hospital system.
But it says the extensive removal of longer-waiting patients from hospital waiting lists as a result of reviews by NTPF staff had left less than 10 per cent of those previously listed now available for treatment under the NTPF scheme.
The C&AG said there may be a need for an in-depth review of a sample of cases removed from the patient treatment register (PTR) following NTPF validation in order to determine the factors that give rise to those removals, and why the delay in removing them from the register arose in the first place.
“That type of analysis may uncover opportunities for more proactive waiting list management.”
The C&AG also said it was clear the volume of procedures purchased by the NTPF from private hospitals represents only a small proportion of the overall annual publicly funded hospital throughput of elective treatments – of the order of 3 per cent of total elective treatments or about eight days work of the overall system.
It said it would be worth exploring whether, and to what extent, an increase in public hospital capacity (due to the recent agreement of an extra four-hour time commitment from consultants under the new 2008 contract) or the elimination of any spare capacity already existing could be used to reduce or eliminate the waiting list.
It would also be worth exploring whether the “throughput norms” for specific procedures can be set for each publicly funded hospital so as to manage demand effectively.
The C&AG also concluded it might be worth exploring whether there might be a need to broker exchanges between the public hospitals so as to achieve more cost-effective waiting list clearance, and also how hospitals might be incentivised to maintain more accurate waiting list information.
In a statement, the NTPF said it noted the C&AG's conclusion that prices negotiated by the fund from private hospitals generally cost less than those carried out in the public hospital system and that most treatments purchased cost less than the adjusted benchmark cost, which is used by the HSE and internationally recognised.
"This has been achieved through a sustained policy of ensuring value for taxpayers’ money. In particular the NTPF has negotiated discounted volume arrangements and has leveraged the increased supply of private hospital facilities over the past few years. During 2009 the trend identified by the C&AG has continued and accentuated. We continue to work with those private hospitals that can deliver quality patient care at maximum value."
The NTPF said that since its establishment in 2002 it had arranged faster treatment for over 150,000 public patients.
"In this time, the average length of time patients wait for elective surgery has reduced from two to five years, to an average of 2.8 months today. In recent years, the NTPF has consistently highlighted areas of the country where too many people were waiting an exceptionally long time, more than 12 months, for surgery and has applied a particular focus to reducing these numbers."
In addition, the volume of longest waiters nationally was reduced by 65 per cent in the year under review.
"In relation to the small number of longest waiters listed as unavailable for NTPF treatment, the Fund has encouraged hospitals to ensure these patients still require treatment and that this is provided as quickly as possible. The NTPF also notes the proposal by the Public Accounts Committee in November 2008 that “the NTPF be given a stronger mandate in dealing with public hospitals so as to ensure that patients do not have to wait longer than 12 months for treatment."
NTPF was set up on an administrative basis in 2002, and on a statutory basis in 2004. Each of 44 public hospitals, excluding maternity and psychiatric hospitals, provide the NTPF with details of patients on its waiting list.
Torlach Denihan, director of the Independent Hospitals Association of Ireland, welcomed the findings that procedures purchased from the private hospitals by the NTPF generally cost less than those in publicly funded hospitals.
“The private hospital sector in Ireland is generally efficiently run and well managed and we believe it makes sense, both from a clinical and a cost perspective, to use the private hospital system to alleviate waiting lists in the public hospital system and ensure that patients have their surgeries under NTPF within as short a timeframe as possible.”