First benefits of health strategy

One of the principal innovations announced as part of the National Health Strategy was a National Treatment Purchase Fund (NTPF…

One of the principal innovations announced as part of the National Health Strategy was a National Treatment Purchase Fund (NTPF).

Widely acknowledged to be the Progressive Democrats' major input into the Government's plans for reinvigorating the ailing health service, the fund is seen as offering the best opportunity of a quick-fix solution to the widespread problem of hospital waiting lists.

So what can patients and doctors expect when the National Treatment Purchase Fund team swings into action early next year?

The Irish Times has seen a copy of a briefing document - written in a question-and-answer format - which was prepared for the Minister for Health. With so many elements in the strategy document, many of these questions remained unasked at the ministerial press conference on Monday week.

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In terms of accountability, the brief clearly states that the new team will be an independent unit answerable to the Minister for Health. It will have its own budget - expected to be announced by Mr McCreevy today - and it will require amending legislation to the Health [Corporate Bodies] Act, 1961, to allow it to function.

What will the team do?

The eight-person team, made up of medical, nursing, finance, logistics, data management and contracts experts, will purchase treatment for public patients who have waited more than three months from their outpatient appointment.

"In the first instance, the concentration will be on those who have waited longest, consistent with clinical need," according to the briefing note.

Initially, the team will attempt to arrange treatment in the Republic, using either private hospitals or private beds in public hospitals. If this is not possible, the National Treatment Purchase Fund will be used to buy hospital treatment abroad.

The brief says "a minority of total treatments will be outside Ireland". It acknowledges that it will be more costly to be treated abroad when travel costs are taken into account.

Who will the patient contact under the scheme?

"Patients should contact their GP and/or consultant," say the Minister's notes.

The decision on whether they are treated by another consultant other than the one they have already seen in the public system will involve the patient, the GP, the consultant and the treatment purchase team.

This will be a particularly unwieldy arrangement well outside the usual rules of clinical independence.

The new team may find itself in conflict with both individual doctors and the medical representative organisations if the cryptic answer to a question on how the team will manage the level of demand under the initiative becomes an issue.

"The treatment purchase team will monitor the number of public patients each consultant will treat in private practice. If there is evidence of any otherwise unexplained increases from a consultant's present level of cases, the team will have to review the position."

It is clear that the new team aims to bring the standard of service offered to public patients to that expected by private patients.

Where a consultant is unable to arrange an appointment in reasonable time for the patient "and consistent with waiting times for existing private patients" the NTPF will have the mandate to seek treatment elsewhere.

When will the first patient benefit?

The end of April 2002 is the commitment contained in the briefing document, which acknowledges that meeting this target will require "goodwill and effective management". Any slippage on this date will clearly nullify whatever effect the NTPF may have on the way patients vote in the next election.

Like much of the rest of the Minister's Health Strategy, it will be three years before its impact is widely felt. And unlike many other innovations, the true measure of its success will be its own eventual redundancy.