Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I will revisit a few points that have already been made. First and foremost, policy must set the template for the direction the health services will take. In that context, I assume that if we are to produce a workforce planning model in the years ahead, we need a definitive view as to where we are going with our health services. That would mean that we would have to assess whether primary care would become the bulwark of the delivery of health care in our communities. On top of that, we also have an issue that is not compatible with other countries that we looked at, such as Australia, New Zealand, the Netherlands, Scotland and Wales. This issue is a national health system. We have a national health system but half our population has private health insurance. How can we assess the delivery of health care in the private sector vis-à-vis efficiencies there versus the public sector because if we are to amalgamate or move to a stage where it should all be done through public health, clearly, we must assess it very stringently to see whether different efficiency levels, etc., exist? Did Dr. Kinsella look at that part of health care delivery in this country in terms of his views on assessing performance, etc.?

This leads to how one assesses efficiencies in a workforce planning model and how one extrapolates from quantitative and quantitative data in terms of efficiencies for future workforce planning. It goes back to Dr. Kinsella's original point about dialysis nurses not only in that context, which is just changing technologies, but in terms of assessing efficiencies such as how many people are required to carry out a certain task and whether there can be changes because of technological advances, IT, changing work practices and inherent ability to get more efficiencies out of individuals and the system.

When we speak about skill sets, I have always noticed that when one meets groups of people to address the problems in our health service, while they come with the best of intentions, they also come as captives of their own profession. Dr. Kinsella said earlier that management, the Department of Health, the HSE and others, by and large, forecast honestly. I suppose they do forecast honestly but not all forecasts are correct so it is very hard to assess whether it was a forecast with the best of intentions or whether it was just a forecast with other intentions. How does one assess where health policy analysts vis-à-visthose who deliver health policy such as the Government, the Department of Health and possibly even the HSE may be steered because of political considerations? In respect of laying off staff and cuts in numbers, we were always told that it was able to deliver but it was quite evident that when one drilled down through it, it was not able to do that. Where can we independently ensure that workforce planning models are independent of the decision making of policy makers even though the model on the policy is being assessed? This is critically important. Could Dr. Kinsella address how we assess private health insurance vis-à-visrolling it into a public health model?