Dr. Stephen Kinsella:

I will do my best. Defining the structure in governance terms is very important. The correct structure evolves. These things must evolve. Data quality is variable everywhere. One of the ways one assesses data quality is by using this minimum data set requirement. There is an international standard. If only 9% of the nurses fill out a survey about what they do on a daily basis, perhaps the information in the survey is not that great. It is that kind of idea. There is a minimum data standard that is pretty good.

Sectoral issues abound. It turns out that we have pretty good data about the medical sub-specialities that are working. Examples would be cardio-thoracic surgeons. We know exactly how many of those we have in the system because one could probably count them on two hands. There is capacity in the system to do that.

Are we prepared for technical change? I would say that the answer is "No" right now. Quite simply, we only perceive technological change as an increase in the cost of delivering medicine. There is a lot of data on health inflation, which runs far in advance of the inflation rates for other goods. Some of that is as a result of drug pricing, etc., but some of it is simply as a result of the newest technical "whizz bang" thing that will deliver better care but cost a lot more.

How do we hold the forecasters to account? The answer is that it is legislatively backed so nobody can back out of it because it is enshrined in law that this is something that needs to be done as part of the budgeting cycle. If one does not do this, the political system is, for want of a better word, insulated from this. One can simply point to the legislation and say, "look, it is not us, it's those bad people who legislated for this in the past", who may also be us. The hue and cry about this may be less than one might think because there is a fair amount of data to back it up. When one has external experts saying that this is the best standard of care given in light of where one is - I am sounding awfully political because I know that another debate about this is taking place - and this is what it should be, people tend to go with that, generally speaking.

What is the best example of engagement? The regional fora in the Scottish example were really excellent. They had two people whose only job was to go around gathering this data. They were two principal officer-level people driving Scotland just hearing what people had to say so these two people amassed an enormous amount of soft knowledge and had amazing emotional intelligence. When I spoke to them, they really knew when somebody was on the level and when they were not so there was credibility there.

The ideal planning length is somewhere between three and five years. Seven years is too long. One forgets what it was. I would imagine that, for us, three years is probably where we want to be because we still have a single-year budgeting cycle. However, we have a system with over 100,000 people working in it and it is very difficult to turn that in under five years.

In respect of the 25% increase in terms of support staff management and administration, there could well be agency people in there. I do not know. They do not drill down into the data. I can check with the HSE and come back to Deputy O'Reilly.