Mr. Tony O'Brien:

I have just one. I fundamentally agree with everything the Secretary General said regarding elective hospitals. In fact, I would perhaps go a touch further and say we will not meet our current challenges without them. The answer on primary care centres and their funding models is absolutely complete. We do need to retain all three tracks if we are to achieve our objectives. I have to declare an interest in that, as a child of the NHS, I bring a certain philosophical approach to the nature of public-private health care that colours my opinions to some extent. I have no hesitation in fully grasping and attaching myself to the notion that public hospitals should exist for public patients. The challenge is that the journey from where we are, which is not a great place, to where we need to be is quite a crunchy one that will require the making of a number of difficult choices, not least of which is on the extent to which the funding of the current public health system is intertwined with €600 million or €700 million in income from privately insured patients. It could not withstand the simple loss of that income. The reality is that the income comes at a price of considerable subsidy in many instances to private health insurers. The per diemrates paid to a public hospital, by comparison with the rates that would be paid to a private hospital on a fully absorbed cost basis for the same treatment, leave a big delta in the sense of the public system picking up the price of the private health care in many instances.

The third reality is that the private health care system is simply not big enough to absorb or capable enough right now of absorbing all the private work in the public system. One must ask whether it would be desirable to create conditions in which the private system would grow to the required extent and how that might act as a competitive magnet for the key staff we need to provide for the large acute hospital system. These are just some of the questions that need to be thought through as we decide which route we take to get from here to there.