Dr. Liam Glynn:

I will respond to Senator Colm Burke, whose question was very pertinent. He has identified the two key issues we have a problem with in the Irish health care system. One is in the hospital system, where there is undoubtedly a bed capacity problem, and the other is in the primary care system, where there has been huge under-investment for many years. The answer to the Senator's question is twofold. We must deal with bed capacity. However, if we invest in primary care, the pressure will come off the hospital system. The issue we must get real with is that we will have to front-load the funding for primary care.

One of my roles as an academic is to look at this in detail and the data and a huge amount of international evidence show that we will get a bang for our buck if we put the money into our primary care system. We know that one extra GP per 10,000 patients has an effect in reducing emergency department attendances and outpatient visits. If we reorientate in that direction we will get a return on the investment very quickly. The famous Rhode Island experiment is often quoted. The state of Rhode Island in the US reorientated its health care system towards primary care and it got a fifteenfold return on its investment, even greater than the €1 for €5 that was already mentioned. That was achieved within a 12 month period. The crucial issue is that we must believe that we will get a return on investment if we resource primary care.