Time to end the NTPF

[spidermom]

With harneys pronouncement today that the health service will face huge cutbacks next year it is now time to cut the NTPF.
Its budget for 2010 is 90 million. This is equal to the deficits being faced by 3/4 of the largest hospitals in the state, all of which have now closed beds to deal with the budgetary cutbacks introduced last year.
But here is why the NTPF should be cut.

NTPF treats fewer than 8,000....
The National Treatment Purchase Fund (NTPF) has arranged treatment for just 7,894 inpatients and first-time consultations for 3,000 out-patients in the five months to the end of May.
The Fund has claimed it will “facilitate approximately 31,000 patients in 2010” from its allocated budget. “The Fund is on schedule to meet this target,” an NTPF spokesperson said. It is understood the inpatient figure for 2010 includes radiology investigations.......

For comparison purposes Tallaght Hospital deals with 34,000 inpatients,78,000 A+E attendances and 228,000 outpatients for twice that budget...

There is also the thorny issue fo the "costs" charged for surgery under the NTPF..Wide variation in hip implant costs

I wish someone would explain this to me...because this is my clinical area and I DON'T understand it!!!

 

[nakatomi]

The thing about the NTPF is that the staff employed are not permanent and so there is no pension costs to be considered. Yes there may be increased short term costs but someone really needs to do a cost benefit analysis.

 

[rockofcashel]

Cause privitisation is good spidermom.. it's efficient.. get with the programme Commie

 

[johnfás]

The thing about the NTPF is that the staff employed are not permanent and so there is no pension costs to be considered. Yes there may be increased short term costs but someone really needs to do a cost benefit analysis.

The core frontline health service is now pretty much staffed by employees who are not permanent, let alone the NTPF. I am of an age where I know a hell of alot of nurses who are 2-3 years qualified. Every single one of them who remains in employment in Ireland, rather than London, is on a short term contract which is renewed again and again and again to avoid paying them a pension.

 

[LeDroit]

Cause privitisation is good spidermom.. it's efficient.. get with the programme Commie

+1

Finally!

 

[GDPR]

Cause privitisation is good spidermom.. it's efficient.. get with the programme Commie

The health system had years and all the money it wanted to sort out the waiting lists, it never could.
The bottom line is the NTPF works, the "system" didn't, not in that regard anyway.

 

[GDPR]

And I thought you were left-wing, tonic. I'm gutted.

Results over ideology, every time.

To a large extent the waiting lists are no more, be happy.

 

[spidermom]

It had very little to do with the NTPF (NTPF is less than 2% of public procedures) - the increase in the number of consultants in public hospitals was the main factor (thank you FF/PD for that at least) for the decline in inpatient waiting times - new technology and treatments which don't involve surgery also helped. But outpatient waiting lists haven't improved (if you get MS, you'll know all about it). The NTPF is expensive and will cost the exchequer a lot more in the long run. It also encourages over-investigation and over-treatment, which are the main causes of the costs getting so out of control in fee-per-item healthcare regions.

You really are unbelievable at spin, tonic. Is that, like, your job?

Another issus that remains hidden from the NTPF data is the numbers of patients who suffer post op complications and end up in Public hospitals. In particular infections...have had at least 2 patients weekly....forever!!
The hospital that performs the surgery should be the one to treat the patients...or there should be a mechanism for the public hospital to recoup the cost.Infection rate for my hospital do not take into account infections acquired elsewhere!!

 

[GDPR]

It had very little to do with the NTPF (NTPF is less than 2% of public procedures) - the increase in the number of consultants in public hospitals was the main factor (thank you FF/PD for that at least) for the decline in inpatient waiting times - new technology and treatments which don't involve surgery also helped. But outpatient waiting lists haven't improved (if you get MS, you'll know all about it). The NTPF is expensive and will cost the exchequer a lot more in the long run. It also encourages over-investigation and over-treatment, which are the main causes of the costs getting so out of control in fee-per-item healthcare regions.

As I remember it, the reduction in waiting lists, for which we have been paying forever, but began only in recent years (much like the NTPF) and preceded the increase in hospital consultants by some time.

You really are unbelievable at spin, tonic. Is that, like, your job?

No, it's not, like, my job, but you're not bad yourself the old spin. Respect.

 

[GDPR]

Things having been improving in the health service for some time (Euro Health Consumer Index agrees) - but there's a public relations problem because of the big three issues: inequality, high costs and ongoing issues with access for some services. The point isn't that the government hasn't made worthwhile efforts, it's that the PD wing is still committed to the market-based ideology that has paradoxically driven up costs - and is contrary to the extensive international literature on the subject. (e.g. Market-Based Failure — A Second Opinion on U.S. Health Care Costs. Robert Kuttner. N Engl J Med 2008; 358:549-551February 7, 2008).

I find it really frustrating when the government ignores good scientific evidence when formulating health and social policy.

You might like this piece by Jeffrey Sachs The Social Welfare State, beyond Ideology: Scientific American

"The Nordic states have also worked to keep social expenditures compatible with an open, competitive, market-based economic system. Tax rates on capital are relatively low. Labor market policies pay low-skilled and otherwise difficult-to-employ individuals to work in the service sector, in key quality-of-life areas such as child care, health, and support for the elderly and disabled."

I don't like the sound of that, whatever does he mean by "pay low-skilled and otherwise difficult-to-employ individuals to work in the service sector, in key quality-of-life areas"



Anyway, back to business.

In the French health system, much beloved by those who think everything in this country is the worst in the world, 25% of treatments are completed in private hospitals, the government pay only the first 80% of costs with the patient paying the balance either through private insurance or out of pocket. All this while the French pay much higher social/medical taxes than we do and their health system is still over 50 billion in debt.

I think you've got to have some private element in health care, otherwise you have no yardstick for efficiency, the P/S unions are just too strong and if not reined in will destroy what services we have through soaking up all increase health spend in wages.

Say what you will, but without the NTPF we would still have the same waiting lists with the same blame/counter blame and excuses that we had for years, which at the end of the day is damn all use to those who need the service and need it now.

The NTPF got the job done and I don't think there is an argument strong enough to counter that fact.

 

[gombeennation]

The NTPF is Harney's gift to the private hospitals to keep them from going bankrupt. It's one of the greatest scams on the planet.

isnt the fat ladys husband involved in the private health industry?

 

[boo-boo]

Ntpf

Results over ideology, every time.

To a large extent the waiting lists are no more, be happy.

That is an untrue statement. Waiting lists are increasing again but unlike before were we had some measure of the numbers awaiting across the different specialities - the NTPF done away with publishing any waiting list figures! There were multiple problems with the accuracy of figures in the first place and there was alway's a disparity between those allegedly on the list and those who were available to take up treatment. The question that was never answered however, was how many of these patients on the list came off the list because they died waiting for treatment, how many chose to self-fund private treatment because the public system was failing to respond to their needs within a defined time period?

The NTPF was part and parcel of the privatization agenda and theoretically it was suppose to tackle the long-waiters and get them timely access to treatment. It hasnt! According to the Health Strategy 2001 no patient was suppose to wait more than three months for treatment and this waiting time is supposed to be fully achieved by 2011....I think we can all accept now that's highly unlikely given the current health cut-backs that are coming down the line.

And the total perverse thing about the NTPF was that the consultants and the hospitals, who are the very same one's who have the long-waiting lists in the public system, are being given private case-work from the NTPF and the same patients, so that they see the public patients as private case-mixes and sometimes even in the public hospital.. So some would say that lenghty waiting lists actually benefited both the public hospital and the consultant!

Other ongoing problems that seemingly still exist today in 2010 is that many consultant's still refuse to transfer patients to the scheme. But maybe the question that needs to be asked is why?

I know one consultant who is a head of a national based speciality. The problem he has in his hospital, is that he has very few beds designated beds and those low numbers seriously impinge on his ability to carry out inpatient activity within the public system. Of course, he could refer to the NTPF but ironically he's the only specialist for this condition in Ireland....so who does he refer them to?

Early on, he told me that the NTPF's great solution was to ship his patients up to the north, but while it seemed ok on the face of it, the consultant in the private hospital up north was a sole operator in that he didnt operate as part of a multi-disciplinary team, which was a fundamental to the configuration of rehab in the unit down south. So if patients were to go through the NTPF up north, they are disadvantaged!

 

[obfp2010]

anyone know the cost per patient in Public V Private?
Are the private patients happier than public ones?
could the private sector run the public hospitals better?

 

[spidermom]

That is an untrue statement. Waiting lists are increasing again but unlike before were we had some measure of the numbers awaiting across the different specialities - the NTPF done away with publishing any waiting list figures! There were multiple problems with the accuracy of figures in the first place and there was alway's a disparity between those allegedly on the list and those who were available to take up treatment. The question that was never answered however, was how many of these patients on the list came off the list because they died waiting for treatment, how many chose to self-fund private treatment because the public system was failing to respond to their needs within a defined time period?

The NTPF was the privatization agenda that was suppose to tackle long-waiters and get them access to treatment. It hasnt. According to the Health Strategy 2001 no patient was suppose to wait more than three months for treatment and this waiting time is supposed to be fully achieved by 2011....I think we can all accept that's unlikely given current cut-backs coming down the line.

And the total perverse thing about the NTPF was that the consultants and hospitals, who were the very same one's who had thee most long-waiting lists, were now being given private case-work from the NTPF for the same patients they were suppose to treat through the public system. So some would say it benefited both the hospital and the consultant to have waiting lists didnt it.

Other ongoing problems that seemingly still exist today is that many consultant's still refuse to transfer patients to the scheme. But maybe the question needs to be asked what are their reasons?

I know one consultant who is a head of a national based speciality. The problem he has in his hospital is with the low number's of designated beds which seriously impinge his ability to carry out inpatient activity in the public system. Of course, he could refer to the NTPF but ironically he's the only specialist for this condition in Ireland.

Early on, I heard that the NTPF's solution was to ship his patients up north but while it seemed ok on the face of it, while the hospital up north was private, the consultant was a sole operator in that he didnt operate as part of a multi-disciplinary team which was necessary for rehabilitation and recovery. So if patients were to go through the NTPF they are in this instance disadvantaged.

PLUS....NTPF places are divided up between hospitals...for example 100 to James...100 to CUH....100 to UHG...etc. Its not how long an individual hospitals waiting list is...or that the NTPF is targeted in areas of most need. So if "your" hospital has used up its NTPF allocation...tough...you remain on the list.Its a con job...one of the more expensive kinds!!!

 

[EvotingMachine0197]

What's the problem with the NTPF? Out of the HSE 14.7 Billion budget, just over 1 Billion is spent on real clinical stuff as far as I can see.

Then a further 2 Billion on Pharmaceuticals.

The 90 Million on NTPF seems like a bargain - what would the investment be for the HSE to kit up for these NTPF types of services ?

 

[ManOfReason]

NTPF treats fewer than 8,000....
The National Treatment Purchase Fund (NTPF) has arranged treatment for just 7,894 inpatients and first-time consultations for 3,000 out-patients in the five months to the end of May.
The Fund has claimed it will “facilitate approximately 31,000 patients in 2010” from its allocated budget. “The Fund is on schedule to meet this target,” an NTPF spokesperson said. It is understood the inpatient figure for 2010 includes radiology investigations.......

For comparison purposes Tallaght Hospital deals with 34,000 inpatients,78,000 A+E attendances and 228,000 outpatients for twice that budget...

If you know anything about health care you must know that comparing 'numbers treated compared to total euros spent' is meaningless. You can't even compare the cost of the 'same' operation on two different patients, e.g a hip operation on a 55 year old and a 85 five year old may be completely different, or on a 25 year old with a chronic joint disease.

Yet you choose to do so.

The problem with the Irish health system is not public vs private, but the interests of health interests vs patients. Put patients first and health care will improve dramatically.

 

[boo-boo]

Ntpf

PLUS....NTPF places are divided up between hospitals...for example 100 to James...100 to CUH....100 to UHG...etc. Its not how long an individual hospitals waiting list is...or that the NTPF is targeted in areas of most need. So if "your" hospital has used up its NTPF allocation...tough...you remain on the list.Its a con job...one of the more expensive kinds!!!

I totally agree. I've no time for them either...

A couple of years ago I done a master's diss on pain management. When I delved into stats, I looked at the waiting list figures that were available. At this particular hospital this speciality had significant number's waiting 3 years or more. I looked at the NTPF and the qualifying times for treatment. They had published a chart detailing the different qualifying waiting times for eligibility to the NTPF across all the specialities. For some odd reason, the waiting times for targeted specialities were less, whereas pain management services had a six month qualification criteria. However, patients needing diagnostic procedures/blocks could not be done under the NTPF at that time. So I wrote to the NTPF to get some answer's on the scheme and how the system was being applied to pain management compared to other targeted specialities. I was then put onto their communications PR people who at that time were Gibney Communications. I asked all the right probing questions but obviously they didnt like what I was actually asking them - so needless to say in typical health service mode of lack of openness and transparency, I didnt get a reply from Gibney or the NTPF.

When the NTPF actually started to pull the publication of waiting list numbers and the times they were waiting...that's when I realised....we were in trouble...they had another agenda....and the welfare of the patient was so far from reality!

 

[GDPR]

Most people who I see objecting to the NTPF do so from an anti privatisation perspective, trying to look after their own bailiwick rather than looking at outcomes for the patient. There should only be one focus for the health system and so far as I would be concerned left/right opinions/agendas have no place at that table.

These are the facts as I know them.

We had waiting lists, some years long, more or less forever.

We got the NTPF and the waiting lists came down, dramatically and consistently. For the first time we got on top of most of the lists, with totally unacceptable waiting times a thing of the past and this was achieved in a relatively short time after donkeys years of trying everything and anything else.

I'm really not interested in protecting the interests of those who make their living from the health service. I am interested in anything that looks after the interests of patients and I don't care whether that's a idea that's acceptable to those on the right wing, left wing or any other wing.

 

[boo-boo]

Ok, the private market can do things efficiently, but if its chronic and more complex, they dont touch them by and large. In Ireland, our dichotomy are policies that are are driven by the ideologies of privatisation and marketisation. As far as I see, for profit medicine is not concerned about patient outcomes - their primary concern is profit first and last. That's the nature of the market....and health is no different.

And there are over 30,000 persons currently on waiting lists - so there's not much inroads on that particular score.

 

[On_The_Far_Right]

Wow Spidermom, thats some article and a crazy cost variation in operations!!!

But look: In 2008, a source quoted US$7–9,000 in India at an internationally accredited hospital; in a county in Florida, USA, from $41,597–56,258... Hip replacement - Wikipedia, the free encyclopedia