Mr. Jim Breslin:

It is a case of all of the above. Nobody could say that every euro is used as effectively as it could be by the HSE. That is the experience of health services the world over. We have some distance to go to ensure that we are best in class in the delivery of services. The expanding and aging population is placing us under pressure to grow services and that pressure will continue. Waiting for additional money to fall through the letter box every year for investment in new services will not be sufficient to address the demand for those services. We must also consider how our services are organised and how productive they are. That is at the heart of the Sláintecare report to which Mr. Connaghan made reference. One often finds that individual parts of the service are working productively but that services are not properly joined up and the right services are not being offered in the right places. Taking the example made earlier, a person waiting for a year for speech and language therapy will experience developmental delay as a result and his or her requirements, when eventually seen, will be significantly more complex than would have been the case had earlier treatment been provided. Putting resources into a primary care community setting for far more accessible care can often help us avoid some of the more expensive approaches of highly specialist care such as acute hospital care and so on. That is key to the Sláintecare vision. Also of significant importance is working very smartly, using information and technology and doing things really well. I earlier mentioned telehealth in that regard. We need to move forward with a huge reform agenda. While that will not be delivered with a static budget, nor can it have an open-ended chequebook.

No country in the world can afford that.