Mr. Tom Maher:

With regard to a national or single service, the National Health Service, NHS, in the UK is an interesting example. It is a single service but many of the authorities within the NHS are becoming commissioning agents for services. Those services are accessed through any number of different providers. In terms of the mental and physical health infrastructure that exists at present, there is enough there to provide for that single health service. It is more about how those providers are used, as opposed to subdividing the health infrastructure into state, independent, voluntary and private. The NHS model of commissioning would work well.

Members asked about the implications of a relatively low health spend with regard to the overall health spend. There are three impacts in this regard. The first has been mentioned briefly already. Staffing levels are a difficulty in the context of providing a high-quality service. I refer specifically to recruiting and retaining high-quality staff. The other major impact on a low spend or relatively low spend is access. People do not have access and with mental health care, there are sociological barriers to accessing mental health care in the first place arising from stigma. This arises where people simply will not access services because of the stigma associated with mental illnesses. Where services are not available it is an additional barrier. If people do not access services, particularly with mental health, over a long period - the research we have done suggests some people wait up to ten years to access quality care - it will only disimprove a person's mental health. That will then lead to a longer recovery time. Lack of investment will reduce the quality of services generally.