Rose Conway Walsh (Sinn Fein) | Oireachtas source

I thank the witnesses for their presentations. I was listening to them in the office, although I was not physically present. One of the issues that concerns me about the health service is the cost-benefit analysis that is done on the decisions that are made. It is not obvious to me that the cost-benefit analysis on some of the decisions is correct. This includes some of the decisions to close district hospital beds and so on and the impact that has in the short, medium and long term. Is it possible for the HSE to supply to the committee secretariat or to members exactly what elements are used in the cost-benefit analysis? That would help us to understand the decisions. I do not have confidence in the cost-benefit analysis models that are being used, either to make decisions on the closure of beds or for centralisation of services. I take the point made about the centralisation of services and the improved outcomes and I would certainly agree with that, but we need to see the sacrifices that are made for that in terms of access to health care services in rural areas and the importance of putting in place services at a local level where it is safe to do so. We have not done that and have failed dismally to do that.

I take it from the accents of the witnesses that they would be very familiar with the NHS in the United Kingdom. I know that Mr. Stevens was looking at the model of moving away from the centralisation and privatisation model and bringing it back to communities. We have continued to talk about that for 20 years but we have not put actions behind the words.

I cite the most recent decision in respect of the withdrawal of the Versatis plasters from those who have a medical card. I am not at all satisfied that there was a proper cost-benefit analysis done in reaching that decision, that affected 25,000 people, in terms of the extra hospitalisation, medicines and anti-depressants that were required. Leaving aside the humanity of the decision, if we are looking at the impact of the decision economically, I do not believe the decision was correct.

I would like the witnesses to expand on the question of modelling and how we can have more transparency and accountability around the modelling and adoption of new drugs such as Translarna and the impact that would have. How can Britain provide free GP care for 60 million people and we cannot do it for 5 million people? As a person who lived in Britain for a long time and accessed that service, I cannot understand why we cannot do the same. Will the witnesses give us three primary reasons why they think that we are failing to do the same here?

The document provided to us is good, but has the scenario of an all-island approach to the delivery of health care been considered? In the timeframe 2000 to 2031, there is a growing realisation that we are working towards a united Ireland and an all island approach to services such as health care, education and so on. It is imperative that those models are being worked out properly in the Department and the HSE, in particular that they would look at the impact of Brexit. There is much more I could say about primary care in the health service, but I know other members wish to put questions, so I would appreciate a response on those key issues.