Dr. Stephen Kinsella:

With our current population density, one would keep everything separate. With a population of 7 million to 8 million on the island in 30 years' time, which is what this committee should start planning for, Dublin will have 2 million or 2.5 million people, which is probably the population density per square mile of Los Angeles. Places like Limerick will have 300,000 or 400,000 people. It is a different proposition. There will be areas of the country where almost no one lives. Interestingly, it will be back to the same level that obtained before the Famine, when 8 million people lived on the island. In such a situation, one would plan to integrate services as the population grew and aged.

I will offer an example. The Deputy asked whether there was a section of the health service that we could do something about now. The answer is "Yes", and it is the national children's hospital. It is a big piece of capital infrastructure, but it is not there currently. We could plan for the workforce that will be involved. For example, we could place Child and Adolescent Mental Health Services, CAMHS, in there. As the system evolves, one builds things in. We could fix that. There is some talk of moving to the trust model for our large hospitals. As one moved to a trust, one could build in that workforce planning along with the legislative and financial backing.

Regarding ratios of staff in various countries, I have seen many studies. My sense is that this work would have to be done at the service level, which would mean contacting all of the major professional organisations and asking them what they believed best practice would look like if, for example, they delivered ophthalmic surgery. One must listen to the service users and service providers. If one does not, one ends up with a load of nerds producing spreadsheets. That sounds good to people like me, a nerd who produces spreadsheets, but does it help those who are on the ground delivering services? This was the feedback from all of our expert interviews. While we could generate a baseline, we would need to ask the experts first.