Dr. Stephen Kinsella:

Yes, it happens elsewhere. It happens in certain countries like the Netherlands, but other countries integrate them. Typically, it depends on how the system evolved. Essentially, our health system evolved from the Catholic church and a series of 19th century Victorian systems that were effectively designed as workhouses. Our hospitals are in certain places because of a decision that someone made in the 19th or, in some cases, 18th century. We have stuck with many of these systems because they have been there. Some of the governance arrangements are 19th century ones, which is bizarre. We are stuck with a large number of systems because that is how they were in the past. Our approach to mental health, for example, has been to ignore it for generations. This is why one is separate from the other in physical, funding and governance terms. I hope that our approach will change, but it depends on one's starting point. New Zealand does not do it in the same way and instead uses an integrated model of care. New Zealand is an interesting model of health care delivery. Not all of its staff are permanent and pensionable, but it is efficient and good value for money and everything is integrated in terms of funding and delivery. I do not want to give the Deputy an "it depends" answer, but it is where we came from.