Billy Kelleher (Cork North Central, Fianna Fail) | Oireachtas source

I welcome the witnesses. Some of the detail has already been raised but the witnesses spoke about closer integration between the systems, including the primary care system, the public health system in an acute hospital setting and private hospitals. Reference has been made to an ideological debate and we had such a debate some years ago in the context of co-location. That was quite divisive. When the witness speaks about closer integration and co-operation with the public system, what does he imagine or propose? Would it be in the context of service level agreements or is there more intertwining in the view of the witness?

The complexity issue is often raised and there is always the suspicion that there is cherry-picking of patients, with those cases that are more complex and potentially more costly being referred to the public hospital system. I assume the public hospital system would still be paid by the insurer when there is a referral from a private hospital. Will the witness provide some clarity on the issue? Mr. Fitzgerald has indicated he has no evidence of overtesting. In speaking to insurers, they might say the opposite is the case and there is a need to be very vigilant about the number of diagnoses a person is put through to ascertain health status. It has been raised with me by insurers. There are other views on the matter so I would like more clarity on it.

I presume the accident and emergency departments mentioned by the witnesses are primarily urgent care centres in a real context. To be honest, they are not places one would go with heavy trauma. What complexity of case could be dealt with when a patient comes through the door of the accident and emergency department? Are they the type of Swiftcare operations with which most people would be familiar?

The association cannot speak for each individual hospital. There is much highly specialised diagnostic equipment in private hospitals and it is probably much better than what we see in many of our public hospitals. What sort of process is used to procure that type of equipment? Is it done through lend-lease management systems, full capital buy-out or is there a myriad of contracts? Who maintains and services the equipment? Are there purchase or maintenance service level agreements in place? It seems that in the public system everything is purchased upfront and maintained through either the hospital's maintenance systems or some form of lower level maintenance contracts. Will the witness provide some clarity on what happens in the private sector?

I do not want to repeat the issue but there is a shortage of consultants in the country and the public health system has a very difficult task in trying to recruit or even maintain staff. A large number of consultants are completing fellowships abroad, as the witnesses have indicated, and attracting them home is proving very difficult. I understand the commercial confidentiality aspect but when the witness said hospitals are recruiting consultants who would traditionally have gone to the public sector, what types of remuneration packages over and above the public health contracts are being offered? I am not referring to a specific context but the loose talk around the private health providers.