Mr. Paul Bolger:

I take the Deputy's point and I will take his question in two parts. There is a need for an investment and for additional capacity within the system. There is an evidence base there to support that. What we can see through the likes of the NTPF is that if investment is made in the right area, more patients can be treated. I agree the NTPF is a process that is in place to treat public patients and to look at maximising capacity across the board, including in both public and private hospitals and the long-term plan on that, as it is set out in the national development plan, is the development of elective-only hospitals. I disagree with the point that we do not need more capacity but I fully agree with the point that it is not just about more capacity and that we have to look at how we go about managing things differently.

When it comes to the inpatient on the day case side, the majority of it is treatment in hospitals. That is where people need to be treated in most cases. There are examples of where certain elements of it can be moved into the community but in general, those people need to be treated in a hospital. In terms of the outpatient, and there is a lot of work going on in this area, there is a huge opportunity to move a lot of that activity and this is what is the basis of Sláintecare and other plans over the years. For example, we are told that most people who turn up for an outpatient appointment require two appointments. They perhaps need a diagnostic and a meeting with the consultant and in many cases they are referred from their doctor just to receive the diagnostics. I am not telling the Deputy anything particularly new here but the more of those services that are available in the community, the less pressure that will be on the consultants in the hospital system who do need to see a certain proportion of the people. The capacity plan is clear that there is a need for additional capacity. It is not just about beds and that is a point we might get to in terms of some of the staffing. It is easy to identify additional beds. It is about beds, additional staff and capital investment but it is also about reform. That is what is happening. The challenge is that we do not have enough slots to treat all of the people.