Dr. Maev-Ann Wren:

If we had consistently planned for the past 15 years, we would be in a very different position from where we are now. The history of health care expenditure in Ireland shows that expenditure tends to follow the electoral cycle. It tends to increase coming up to elections, with cutbacks in intervening periods when Governments want to reduce tax. For that reason and for other reasons that need no explanation, we substantially reduced the public service workforce during the period of austerity at a time when our population was still growing. We substantially reduced the number of people working in our hospitals and across our health care system. We incentivised retirement and carried a pension cost for that. If we were to acknowledge and regularly update our demographic projections, look at our current use, as we have done, and project the implications of that use into the future, it would represent a considerable advance on the way in which the Irish health care system has historically been run. This has been done at an earlier point in other countries.

Deputy O'Reilly or Deputy Kelleher asked about countries that have provided better primary care. There are countries which have placed a deliberate focus on targeting the provision of more care in the community than in hospitals. Sweden, for example, has changed its whole system of financial incentives for hospitals and for local government, which supplies community care, in an incredibly effective way. I think planning can be quite effective in this area. I emphasise that there is still uncertainty about population projections. That is why we are providing a range. As my colleague has mentioned, there is uncertainty about the evolution of health as life expectancy extends. That also affects the range of our projections. There has been a welcome development in recent months. Since we published our report and since the Department published its other work, there has been a recognition that we need to respond to population growth and ageing and increase capacity across the health care system. I think that is really a sea change in health policy in Ireland.