Mr. Richard Corbridge:

On the question of e-referrals and how we get to 100%, it took us until May of this year to get all hospitals enabled to receive electronic referrals. Over the year that we have moved from 0% to 40% of GPs, we have moved from no hospitals to all hospitals being able to receive an electronic referral. Obviously the rate limiting factor in being able to send an electronic referral is that the hospital needs to be able to receive it at the other end. The Deputy's point is absolutely valid that there are practices out there that are not digital today, but it is only around 3% of practices. The electronic referral solution that has been deployed is agnostic of the GP system that is already deployed. It is a web-based solution that GPs can access easily. It has been built to make the process as simple as possible and to illustrate the efficiencies and savings to the GP practice of using it. The target we have set ourselves, not just in new referrals but in a number of places, are stretch targets. We are setting these targets to allow the team to have room to stretch and believe it in terms of where we can get to with e-referrals and other subjects. That is why we have said 100% of practices by April of next year delivering electronic referrals. That is direction we are taking in that space.

The issue of savings, specifically with regard to epilepsy and haemophilia, was raised. The savings relating to epilepsy that were called out at around €5 million are based on the fact that if we could sequence the genome of everybody with suspected epilepsy, we would know the type of drug with which to treat them. Last year we spent €5 million on drugs while trying to find out which was the right one for treating patients with suspected epilepsy. That is where the €5 million in savings comes from. If we spend money on sequencing the genome, we know the right drug to use straight away and, therefore, we save that €5 million. The money that was suggested around haemophilia arises from savings around the supply chain management. If we do not have a supply chain solution that is deployed to the patient then we do not know whether the patient has received all of the treatment he or she needs or whether the patient has had a bleed. Therefore, we are constantly sending the treatment to their fridge in order that they have it on board. The Irish Haemophilia Society did some work in the past two years to try to understand how an early version of that solution was saving money and that is where those figures came from. They are very specifically savings related to drug wastage, with drugs being stockpiled in patients' homes, as opposed to any of the other additional savings that are in that space.

Reference was made to primary and community care and how we get GPs involved and move it forward. Our work with the GP systems suppliers of Ireland, of which there are two main players, has been forthcoming in terms of how they adopt the individual health identifier, IHI, and put the electronic referral and e-pharmacy solutions into their systems. We believe the relationship is in a good place with those systems and with those people and will drive forward a change in that marketplace. The fact that Ireland only has two organisations to engage with to drive forward changes in those systems is phenomenally useful for us because we can build relationships and standards and have the design authority to put those systems in place. It enables us to drive forward how we extend the functionality that is available in GP systems out into the community.

One of the four pillars of the electronic health record, EHR, is to deliver EHR functionality into the community. We believe community is an easier place than an acute hospital to deploy the EHR because currently there is no digital solution there. Therefore, once the business case is approved, we will focus on having an early win in the community around the EHR.