logo
National Treatment Purchase Fund seeks assurances from all hospitals that rules of waiting-list schemes being followed

National Treatment Purchase Fund seeks assurances from all hospitals that rules of waiting-list schemes being followed

Irish Times3 days ago

The
National Treatment Purchase Fund
(NTPF) is seeking assurances from all hospitals that rules governing the operation of waiting-list initiatives that it funds are being followed.
The move follows concerns raised about special out-patient clinics run on Saturdays in the children's hospital group,
Children's Health Ireland
(CHI).
On Tuesday, the NTPF suspended funding to CHI pending inquiries into issues raised in an internal report, which was originally drawn up in 2021 but never published or circulated to senior figures elsewhere in the health service.
The NTPF said on Tuesday: 'Following serious concerns raised over the 2021 CHI report, the NTPF immediately placed a temporary pause on all insourcing work with CHI. It has initiated a comprehensive review of all insourcing work with CHI to gather the necessary assurances regarding compliance, value for money and appropriate use of NTPF funding mechanisms.'
READ MORE
Minister for Health
Jennifer Carroll MacNeill
suggested on Wednesday that this NTPF pause on funding would continue for a week or 10 days as it sought assurances on the operation of waiting list initiatives at the group.
It is understood that the NTPF has now sought assurances from all hospitals. The current pause on funding, however, applies only to CHI.
The NTPF will this year receive about €230 million from the exchequer to buy treatment in both the public and private systems for patients on waiting lists.
The NTPF, as part of its work, pays for treatment for those waiting longest to be provided outside core working hours in public hospitals by staff working in their own time.
Hospitals and staff are paid additional sums for taking part in such initiatives. This process is known as 'insourcing'.
Insourcing programmes are targeted at the longest waiting public patients.
The internal CHI report said there were 'significant concerns about prudent and beneficial management of NTPF funding and a lack of oversight in relation to access schemes that were not in keeping with the memorandum of understanding'.
The report highlighted 179 children seen at five special outpatient clinics operated by a consultant at CHI over five Saturdays. The report questioned whether such clinics were needed and whether there was capacity elsewhere in the public system for the children in question to be seen.
The consultant concerned received €35,800 in additional funding from the NTPF.
In the Dáil on Thursday, Labour Justice spokesman Alan Kelly said CHI should be subsumed into the HSE. This is 'about the only outcome that is in any way possible' and 'it needs action quick'.
He said: 'we need to have confidence in governance and the day-to-day running, because the culture in CHI seems to be absolutely atrocious.'
He also called for the NTPF to be closed down in an orderly manner with a full audit of its operations and who benefited. 'I don't believe that the NTPF is or should be in place in a country where the healthcare system is working,' he said, adding 'we should be in a situation where those who need treatment the most are prioritised based on need.
'It shouldn't be a case of: we can't deal within the public system, so we'll actually pay off others to do the work.'

Orange background

Try Our AI Features

Explore what Daily8 AI can do for you:

Comments

No comments yet...

Related Articles

Oireachtas should slam down gavel on judges' planned 16.7% injury awards hike
Oireachtas should slam down gavel on judges' planned 16.7% injury awards hike

Irish Times

time6 hours ago

  • Irish Times

Oireachtas should slam down gavel on judges' planned 16.7% injury awards hike

The introduction in April 2021 of judicial guidelines on personal injury awards had an immediate and sharp effect – with the median value of compensation awarded by the Injuries Resolution Board (IRB) falling 46 per cent to €10,000 in the eight months that followed. The guidelines were also aimed at creating more consistency in awards, regardless of whether they were resolved directly with an insurer, the IRB, or through the courts. The problem is, there is no comprehensive data available from the courts on awards – not helped by a dearth of written judgments at District and Circuit Court levels – for anyone to make such an assessment. Either way, an all-too-high number of claimants – encouraged, no doubt, by their lawyers – continue to think they can fare better going down the legal route than settling through the IRB. Figures published by the board last month show that while the motor crash claimants consenting to being assessed by the IRB in the first instance rose from 62 per cent to 78 per cent between 2020 and last year, the acceptance rate of awards from the board fell marginally, to 47 per cent. [ Judges expected to support draft guidelines for 16.7% rise in personal injuries awards Opens in new window ] The board of the judicial council, required by law to review the guidelines every three years, proposed in December that payouts increase by 16.7 per cent. This was adopted by the council of the State's judges in late January and passed over to the Minister for Justice Jim O'Callaghan, who must put the amendments before Houses of the Oireachtas for approval. READ MORE There is an expectation that the minister will bring the proposal before the Oireachtas before the summer recess. The planned blanket hike has been met with resistance from insurers and business lobby groups, who know that the increase will be passed directly on to consumers and companies. Motorists, who had seen insurance premiums fall by 25 per cent between 2017 and 2022, have already stomached rate increases in more recent years as car parts and labour inflation have driven up damage costs. The guidelines review was a crude exercise, with the committee of judges that carried it out applying the general Irish inflation rate to existing awards guidelines. The judicial council even said at the time that the committee 'did not find it possible to carry out any meaningful analysis of the quantum of court awards given under the guidelines that might inform this review'. Nor does there appear to have been any regard given to what's going on elsewhere. The going rate under the existing guidelines for minor neck injuries, where recovery is made within six months, is up to €3,000, 5½ times higher than that in the UK – where awards are among the highest in Europe. [ Is going to court worth it for personal injuries claimants? A lawyer and insurer go head to head on the issue Opens in new window ] 'The large disparity is before the 16.7 per cent increase proposed by the judicial council, which, if introduced, will make the gap even larger,' Aviva Insurance Ireland said in submission last month to the Department of Finance, which is weighing further insurance reforms. 'Comparing Aviva's claims in the UK and Ireland, attritional claims like whiplash represent 30 per cent of the cost of motor insurance premium in Ireland compared to 10 per cent of premium in the UK in 2024 and lower still in Europe.' TDs and senators should reject the planned amendments and push it back to the judiciary to go back to the drawing board. Their key role was inadvertently copper-fastened by a Waterford woman, Bridget Delaney, who mounted a challenge three years ago against the constitutionality of the guidelines. The Supreme Court ruled in April last year that it had been, indeed, unconstitutional to give the judicial council the power to set personal injury guidelines. However, the fact that the initial guidelines were subsequently independently approved by legislators gave them legal effect. The unsophisticated way that the judiciary has gone about reviewing the guidelines suggests they need some help. The IRB argued in its submission to the Department of Finance consultation said that judicial council be required to liaise with it on any future amendments. 'The board's expertise, practical experience, and annual assessment of nearly 10,000 cases annually would meaningfully contribute to the continued relevance, fairness, and effectiveness of the guidelines,' it said. Various submissions called for future guidelines to be benchmarked against European countries. 'Legal expenses and award levels for lower-value claims remain disproportionately high and are not aligned with those observed in the UK and other European jurisdictions,' said German insurance giant Allianz's Irish unit. A number, including the Alliance for Insurance Reform, a lobby group for business and civic organisations, and the IRB said the current requirement that the guidelines be reviewed very three years does not allow them to be embedded. 'Under the current guidelines model, there could be several versions of the guidelines in use dependent on whether a claim has already been assessed or if legal proceedings have been initiated,' said the IRB, which reckons it should be extended to every five years. 'A situation cannot exist whereby the same injury, the same claim, that has been rejected within the Injuries Resolution Board goes into the court system and a different set of guidelines is used to value compensation.' While the setting up of the IRB back in 2004 (then known as the Personal Injuries Assessment Board) was meant to do away with the need for solicitors, 95 per cent of claimants that end up before it are represented by lawyers. The board suggests legal fees now need to be brought into cases its handles. 'The board is aware that in some cases the issue of legal fees becomes an impediment to the acceptance of an IRB award,' it said. There's disquiet in Government, too, about the judges' review process. Minister for Finance Paschal Donohoe is known to have expressed concern to the Minister for Justice about the knock-on effect of such a large hike to businesses and households. Colm Brophy, Minister of State at the Department of Justice, told the Seanad last month that his boss is looking at what legislative amendments 'can be made to make further reviews of the personal injuries guidelines more inclusive and transparent'. This may include 'making changes to the mechanism and the timing of future reviews of the guidelines', he said. This will not go down well with the judiciary. But it has only itself to blame.

Frustration in Government over continual revelations from CHI
Frustration in Government over continual revelations from CHI

Irish Times

time17 hours ago

  • Irish Times

Frustration in Government over continual revelations from CHI

For weeks the Government had been bracing for more trouble at Children's Health Ireland (CHI), the embattled group that runs paediatric hospital services in Dublin . There has been frustration over waiting times for children who need orthopaedic surgery and a scandal over the implantation of unauthorised springs into three children. By mid-May another significant controversy was brewing; a review indicated that up to 60 per cent of a type of hip operations carried out at Temple Street Hospital were not necessary. However, just days after the hip report, real trouble came out of left field, with questions raised over the use of special waiting list clinics. The Sunday Times highlighted an internal CHI report that alleged potential irregularities in the State's initiative to tackle waiting lists. The Department of Health has said it had never seen or heard of the unpublished report, which dates back to 2021/22. Health Service Executive (HSE) chief Bernard Gloster also said he was unaware. But in recent days CHI told Minister for Health Jennifer Carroll MacNeill that its content had been 'discussed' at performance management meetings with a senior HSE executive. READ MORE The report said a doctor, identified only as Consultant D, had been paid €35,800 for seeing patients at special clinics paid for by the National Treatment Purchase Fund (NTPF). The report questioned whether the special NTPF clinics were needed and suggested the children could have been treated using other capacity in the public system. [ Audit of CHI waiting lists ordered to ensure productivity in public hospitals, Minister for Health says Opens in new window ] The report was devastating on several levels. Taoiseach Micheál Martin is a champion of the NTPF, which forms part of Government initiatives that have seen €1.6 billion spent in recent years trying to curb hospital waiting times. Any suggestion of irregularity could undermine the wider system. Senior management across the Department of Health, the HSE and the NTPF maintain they were completely blindsided. Senior figures have acknowledged it is possible there were 'miscommunications' but insist that CHI never flagged any serious issues. Oireachtas committees will, undoubtedly, seek to pursue what the HSE was told about the CHI report in 2021 or 2022. Gloster, in a pre-arranged interview with RTÉ's 'This Week' programme on May 25th, described the CHI report as 'absolutely shocking'. 'I assure you if anything connected with, or near connected with alleged people ingratiating themselves financially in the public health system, the first step I'll be taking is to refer that matter to the gardaí,' he said. Gloster demanded to see the report from CHI the next day, and the HSE passed it to Carroll MacNeill. The report caused consternation, with worrying findings made about the NTPF clinics. More importantly, the report raised issues about patient safety. In the Department of Health there was concern that architecture put in place in the health service to deal with issues regarding the safety of patients had apparently not been utilised. [ Hip surgery audit: Almost 70% of operations in two children's hospitals 'unnecessary' Opens in new window ] The HSE is understood to have pressed CHI to refer the report to the Medical Council, the regulatory body for doctors. It warned that it would make the referral itself if the CHI did not. Last Thursday the HSE said it would bring the issues to the Medical Council, as well as to gardaí. The NTPF suspended funding to CHI pending an investigation. The report also deals with rows between staff in a particular unit. The findings are stark: 'CHI has a broken culture, created by dysfunctional relationships and challenging behaviour, negatively impacting service delivery, department dynamics and staff experiences and has the potential to put patients at risk.' The new controversy arriving after issues of hip surgery and spinal implants adds to the governance problems at CHI, which is preparing to take on operation of the new €2 billion national children's hospital. On May 27th the Minister confirmed three members of the CHI board had resigned. Another had stepped down the previous week. The Taoiseach told the Dáil it was clear the environment was 'not optimal for safety'. He said it was absolutely critical that there should be fundamental reform at CHI. Separately, the Minister for Health said 'toxic behaviours' developed over time within CHI as individuals had not got along with its board and executive. The report found there were 'significant concerns' about the prudent and beneficial management of NTPF funding and a lack of oversight of access initiatives, which are ultimately not in keeping with the memorandum of understanding between CHI and the NTPF. Carroll MacNeill sought answers from CHI about the report. Sources said CHI appeared to view the report as identifying internal human resource management issues that were addressed internally. 'They don't seem to understand there is an issue,' one senior figure told The Irish Times. The Opposition demanded publication of the report but the Attorney General advised the Minister that such a move was up to CHI. However, over last weekend this argument became rather moot. On Monday The Irish Times reported details directly from the report . It found a 'negative and toxic' work culture at a CHI hospital, with multiple staff complaining of 'unprofessional and disruptive behaviour from consultants'. It said this contributed to the undermining of care and treatment for sick children. Challenging behaviours regarding one particular part of the organisation 'appear to be the norm', the report stated. It revealed one that consultant had taken a defamation action against another and stated that it was reasonable to assume this could only arise as a result of fraught relationships within this particular unit. In a statement issued at about 9.30pm on Bank Holiday Monday, CHI said the issues raised in the report had been addressed 'and the team in question are working well'. Effectively congratulating itself, the group said: 'This is an example of taking action when issues are identified in line with good HR practice.' [ Doctors say they warned CHI of toxic behaviour by several senior medics Opens in new window ] On Wednesday The Irish Times revealed that the consultant at the centre of the review for allegedly referring patients to the NTPF-funded clinic did not fulfil his on-call hours for more than three years due to 'health issues'. He had run five weekend clinics for which he was paid an additional €35,800. The consultant was seeing twice the number of patients in the weekend clinic than during his regular weekday equivalent. CHI had brought in a locum to cover the consultant's on-call hours, at a cost of around €450,000. 'It needs to be explored how one consultant can undertake a series of NTPF-funded clinics over numerous Saturdays and during these clinics see a much greater number of patients than they are able to see in their routine public clinics, working at a very fast pace with significant throughput – a substantial undertaking of additional work – yet is unfit for any on-call duties for the past three years,' the report stated. [ CHI consultant at centre of review did not fulfil on-call hours for three years due to 'health issues' Opens in new window ] In the meantime the Minister and the Department of Health were going through answers provided by CHI, particularly on whether the report's recommendations had been implemented. CHI told the department that monthly meetings had taken place, with actions tracked and the majority 'closed out'. Separately the HSE chief executive commissioned an audit of governance and equity in patient access and waiting-list management at CHI. This aimed to look at the balance between public and private patients' access to care. A pre-scheduled meeting of the Cabinet subcommittee on health discussed the CHI issue on Wednesday . Ministers were told the HSE had referred the CHI report to gardaí who will determine what steps to take. In the meantime the service level agreement between the HSE and CHI, which underpins funding, is to be strengthened. Under new HSE structures, regional executive officers have greater responsibilities for running services in their areas. The regional chief executive for Dublin and the Midlands will have a greater involvement in working with management in CHI. But the key issue for the Government is whether it believes CHI is the body that should be given responsibility for the new children's hospital. The Minister expressed confidence in current CHI management, and some in Government believe it may be too late to implement radical change before commissioning of the hospital begins. [ CHI unable to move in to national children's hospital due to continued delays Opens in new window ] Still, frustrations remain in Government at the succession of crises involving the children's hospital group. And a further report on spinal surgery is awaited.

The Irish economy grew by 22% over the past year. Yes, you read that right
The Irish economy grew by 22% over the past year. Yes, you read that right

Irish Times

time20 hours ago

  • Irish Times

The Irish economy grew by 22% over the past year. Yes, you read that right

Ireland's economic data was always going to be a bit special at the start of this year. But Thursday's figures were mind-bending. It is impossible to overstate the extent to which we now stand out in international comparisons. And this is not just a curiosity – it matters. The economy, as measured by gross domestic product (GDP) , was 22 per cent larger in the first quarter of 2025 than one year earlier, according to the latest estimates from the Central Statistics Office . Think about it. The figures suggest that for every €1 of activity last year, there was €1.22 in 2025. Even comparing GDP in the first quarter of this year with the last quarter of 2024, there is a rise of close to 10 per cent – this is roughly the extent of growth across the euro zone over the past decade. Of course this bonkers data is not real, in the sense that it does not reflect what is happening in the underlying economy in which we all live. How could it? As has been long discussed the headline economic data is entirely distorted by the activities and tax planning of a small number of very big US tech and pharma companies. From time to time, this has created huge distortions in the figures. A decade ago, top US economist Paul Krugman famously described a 26 per cent GDP growth rate reported for the Irish economy (later revised up to over 30 per cent) as 'leprechaun' economics . At the time the figures were distorted by massive tax-driven investments by the companies concerned, including Apple, essentially a manoeuvre by the companies involved to try to keep their tax bills down as international rules changed. READ MORE Now, as one observer put it, we are seeing another 'Krugman' moment. This time the reasons are different. Big pharma companies have been rushing product over to the US to try to get drugs and key ingredients into the market before Donald Trump announces tariffs on the sector. This has led to a surge in exports, feeding into the GDP data. Many of these are manufactured here – and some are made elsewhere but organised by Irish subsidiaries and so also show up in our figures. And so we see a massive surge in Irish GDP in the first quarter of this year. A big – temporary – decline in pharma exports in GDP will follow at some stage, as the firms involved must now have massive stocks jammed into every free warehouse in the US. Much will depend on how the tariffs story plays out. [ Welcome (back) to the era of Leprechaun economics Opens in new window ] Whether Krugman renews his leprechaun offensive or not, let's not pretend this won't be noticed. Ireland's GDP data is not some irrelevance in a quirky economic corner. The amounts of money being moved through Ireland are now enormous. Daniel Kral, chief economist at Oxford Economics , calculates that Ireland – which accounts for 4 per cent of the euro zone economy – accounted for half its total growth over the past year. Analysts have taken to looking at the figures 'excluding Ireland'. How do we pull back from all of this to judge the underlying health of the economy? Total demand in the domestic economy – adjusted by the CSO to remove the multinational factors - rose just 1 per cent over the year. But we need to look under the surface here, too. Consumer spending, a good measure of how we feel, was up by a decent 2.5 per cent. But the overall figure was dragged down by a fall in business investment, presumably reflecting the international uncertainty. So households continued to spend in the first part of the year, but businesses are taking a wait-and-see approach to big capital spending. This is likely to be reflected in the jobs market as the year goes on – and here AI is also changing the game in many sectors. Consumers may get more cautious too. Uncertainty is starting to slow the economy and this is a trend we need to watch as the year goes on. The piece of data that seemed a bit out of line this week was a 30 per cent fall in corporation tax in May compared with the same month last year. This was affected by the comparison with a strong May last year – which the Department of Finance suggests was boosted by once-off factors. Two of our biggest taxpayers, Pfizer and Microsoft – pay significant amounts of tax that month. But the key early indicator for most of the big companies is June – and what happens here will give a good pointer for the year as a whole. The figures do underline one point. It is our huge reliance on the opaque affairs of four or five massive companies – and our exposure to the sectors they operate in, their own performance and complex decisions on how their tax structures are set up. Our latest bout of data exceptionalism again puts Ireland in the spotlight, when it would have been better to keep the head down. It underlines the outsize take Ireland is getting from pharma and tech activity in the EU – both contentious points in the White House. Notably, the US added Ireland to an economic watch list this week, based on the size of our trade surplus. We are very much on the radar in Washington. Our corporate tax take and manufacturing base are looked on enviously not only from the US , but from elsewhere in Europe. [ 'No long-term commitments to anything' – Ireland's economy is experiencing a silent slowdown Opens in new window ] The advance shipping of products again focuses attention on the scale of activity and tax planning in Ireland by big pharma companies. And this causes a rollercoaster of cyclical activity. But what really counts is longer-term, structural issues. Will these pharma giants decide over time – and it would take years – to relocate some of their production to the US? Will their profits and thus tax payments here be hit by Trump's policies? Or will they – or some of the tech giants – alter their corporate structures so that they pay significantly less tax here? It comes down to whether Trump's policies change the way the economic and corporate world operates fundamentally, a fair bit or not much at all. As Ireland benefits from the current system so much, the more it changes, the more risks there are for us. The coming months will tell a lot.

DOWNLOAD THE APP

Get Started Now: Download the App

Ready to dive into the world of global news and events? Download our app today from your preferred app store and start exploring.
app-storeplay-store