Dr. Austin Byrne:

I wish to address Deputy Kelleher's question about sub-specialisation. There is definitely a role for it. That has been internationally proven. Efficient high-volume turnover is the key. A certain volume of procedures need to be done to a certain standard. The difficult is the current manpower deficit.

I will make a brief comment on the salary question referenced earlier by Deputy O'Reilly. I would collapse at the thought of my practice nurse becoming a HSE employee. I realise that may sound abrupt, verging on rude. However, we know from looking to the public sector that levels of efficiency are perhaps well under half of what they are in the independent contractor sector. We know levels of sick leave are approximately four times higher. We know that public health nurse visits probably cost the State approximately nine times the cost of funding a practice nurse visit after we factor in all the associated costs. Moreover, we have a barrier to innovation. If I want to change something, I have to refer up to national level. Things can only be done on a national level. There are barriers to local changes to meet the needs of the individual community and small pockets of people. It is a fine idea to try to separate us from some of that workload, but I do not believe it will happen.

Deputy Kelly was mad for a number. Am I going to give him a number? No, I am not.