Mr. Liam Woods:

We need to look at the fact base and what we can do. The international evidence base, as it refers to clinical practice and location of care, is precisely what we use in clinical planning. Orthopaedics is an example but there are many others. There is strong awareness in the HSE, both at population health planning and individual clinical practice levels, as to the need for services and the ideal locations for such service provision. The thinking which the committee engaged in with regard to the Sláintecare report, relating to the appropriate location of care, is an important dialogue which has been referred to on a number of occasions here. We see high appropriateness of admission in acute services. When we look at appropriateness of a day of occupation of a hospital bed, we see an opportunity to move people into community facilities or home, with support. We have to seize that if we are going to get the best value and the best health outcomes at the lowest cost to the taxpayer and to the Exchequer. Those models will drive where we need to go. That is about both investment and change; it is not one or the other. There is a requirement for both. I would be happy to get into a deeper dialogue about the learning relating to the models of care and integrated care delivery in chronic conditions. There is interesting work in the HSE on supporting chronic conditions on an integrated basis across hospitals and community care. That kind of work is a major part of getting the system right in the future for the population demands that we clearly have, which will grow significantly.