Mr. Jim Breslin:

Certainly at the health committee the Department was very anxious to try to support the all-party consensus that was produced by the committee and the Minister has been very supportive of it. Work is under way to try to bring that into an implementation plan. If I were to pick one element of the overall Sláintecare vision, it is that piece around primary care and moving some of the work that happens in hospitals back into the community, but also intervening earlier in more accessible care such as home care and self care so that people, increasingly, manage their good health. We are very strongly supportive of that.

We are doing some things in advance of the finalisation of the implementation plan. As we discussed earlier, we have opened negotiations with the Irish Medical Organisation on a new GP contract. A key priority for us in that would be chronic disease management, so that somebody with diabetes or chronic obstructive pulmonary disease, COPD, would not have to wait for an exacerbation of their condition and end up in hospital but would have it managed in primary care. We are also rolling out community nursing and in particular advanced nursing in the community. Somebody with asthma or another respiratory problem such as COPD would have an advanced nurse that would be trained in respiratory illnesses and, under a protocol, either in the primary care centre or in somebody's home they would be able to visit them over the course of a year and prevent their admission into hospital.

When we look at the type of money that we spend as a country, we have now reached a point where we are spending at least the average if not above the average. In total terms we spend the eight highest of OECD countries. In terms of public expenditure we spend the 12th highest of OECD countries but we do not manage as well as some others because we have people who are not accessing services in the right way and we need to develop primary care and make sure it is more accessible. We have done the research on this, and if we do not do that, when we look at the capacity we will need to put in place to respond to an ageing population, we just could not afford the type of numbers of acute hospital beds that we would have to put in place to continue with the model we have got. It is not even a case of affordability. We could not staff them or find space on the hospital sites that we have got, so we have to put the emphasis on primary care and also to put a statutory scheme in place for home care. There is a clear consensus now across all areas of the House in relation to that and it is one that we would be very anxious to deliver on with colleagues in the HSE over the next ten years to try to realise that vision.