Mr. Liam Woods:

I take the Chairman's point about capacity. The points made about the opportunities to improve efficiency and flow within hospitals are well made. There has been a lot of progress in that area. That is reflected in the underlying data on the volumes of care being provided in the hospital space but there is no doubt that there is more to do. Work specifically focusing on that is under way at some sites.

Recruitment and retention are clearly key to expanding the service. The Chairman is correct to state our response capacities involve our doing everything we can within the capacity we have. We must grow it where we can but we must also invest in primary and social care. Work in this regard commenced last year. The integrated care programmes, particularly relating to certain chronic conditions, and the programme for the care of the frail elderly are designed to provide models of care that will support citizens outside the hospital environment, at home, in a primary care environment. That work is commencing. It is very important work because this is an area of significant current demand and one that will be subject to growth in demand. The Chairman is right to conclude that the hospital system could not deal with all that demand in volume terms. It would be inappropriate for it to fully consider doing that. The Chairman's points are well made.

From my experience of driving the country and visiting sites, I know there are many areas of care and hospitals where excellent service is being provided, and staff are very motivated in this regard. I fully agree that they are sometimes delivering care in conditions that are far less than ideal for delivering care. Sometimes they are delivering care in very modern facilities. The story varies as one goes around the country.

The capacity to recruit and retain staff is key for us. The investment we need in primary social care and in expanding hospital care where we can in the coming 12 months and the 12 months thereafter will be very much dependent on the response to providing an environment that is attractive to work in, has adequate remuneration and is competitive internationally. There is no question about that. Those are the kinds of drivers we need to examine.

Creating a vision that sets out a journey for the future health system is necessary. The report the Oireachtas will produce will be an important component. Achieving a coherent, singular view on the direction of travel and providing that for staff around the country is important at a higher level in the here and now. We are in competition internationally for staff who are actually difficult to get and we will have to continue to advertise and seek to provide flexibility in the manner referred to by Senator Burke if we are to attract them.