Mr. Paul Gordon:

I will take the questions of Deputy O'Reilly and Deputy Harty first. I agree with many of the points Deputy O'Reilly made on the National Treatment Purchase Fund, NTPF. The Irish Cancer Society has done a good deal of work around waiting times for colonoscopy procedures. We have found that the use of the NTPF is effective in the short term. However, it is expensive and I am unsure how sustainable it is. Probably, it asserts the primacy of the private system over the public system in terms of access to diagnostics. At present, it is a useful tool in reducing waiting times. However, there are ways to improve the system, for example, through better linkages within hospital groups. Certain hospitals have huge colonoscopy suites and only five or ten people on their waiting lists, while other hospitals in the same group might have large waiting lists and large numbers of people waiting over three months. There does not appear to be joined-up thinking. This has improved in recent months, with a clinical lead appointed to head the national endoscope working group. We hope that will improve matters. On the whole, there are other ways of improving access to diagnostics.

This links to Deputy Harty's point. There have been improvements in colonoscopy services but up to 46% of people are currently waiting over three months. The HSE guideline is that 100% of people should be seen within three months. That is significant. The NTPF initiative has worked, but only for a period of one or two months. There must be sustained investment and I am unsure whether it is affordable.

The question on primary and community care is apposite, especially in the context of the work of this committee. We are facing into a chronic disease crisis and a cancer crisis - I am not being flippant in saying as much. Cancer incidence will increase by 50% over the figure for 2010. Chronic disease accounts for approximately 78% of all deaths or mortality in the country. We know that 80% of chronic diseases are preventable and that 40% of cancers are preventable.

Certain measures help, such as investment in programmes like Healthy Ireland and other health promotion initiatives. Often, these measures require targeted intervention in disadvantaged communities, where the rate of chronic disease is far higher than in the rest of the population. I hope I have covered those points.