Mr. John Connaghan:

I will add some colour to Mr. Breslin's remark. I thank the Deputy for his kind opening remarks.

What examples do we have of the ability of the health service right now in Ireland to pursue good value for money? That was the first question. The second question is: how can we spread that best practice throughout Ireland? I will consider the three different types of value-for-money activity in terms of our pursuit of better value for the public purse. One is what I would call the usual suspects. They are the basic things that are non-clinical in essence. They are good procurement, conversion of agency posts into full-time and substantive posts, efficiencies in back office services such as print, energy and postage, and shared non-clinical front-line services. We do not need to have 29 or 56 of everything for Ireland. They are things that are being pursued right now by each CHO and each hospital group. That is the first category. One must understand that the first category only touches a certain element of the cost base. One needs to look beyond it in terms of being able to look at the entire €15.2 billion.

The second category I will draw the committee's attention to is clinical efficiency. We need to do a lot more in that regard. Clinical efficiency does not mean we need to get our clinicians to work harder - although maybe in some cases we do - but to work smarter with better technology and more modern methods of delivery of services where we help clinicians to do that. An example is the pursuit of theatre efficiency. We know if we were to arrange things better and look at the best performing theatre system in Ireland we would probably get more throughput but to do that we would probably need some investment in things like theatre systems and new and innovative ways of working. That is an example of clinical efficiency.

The third and biggest area, which is where most of the €15 billion would lie, is in what I would call efficiencies associated with the model of care. I will boil that down into a couple of big things. Sláintecare gives us a hook here. One of the big hooks is the separation of elective and unscheduled care. I came from a system where we had developed that over a five-year period. What we found by separating elective and unscheduled care was much greater efficiency in terms of throughput because it was unrestricted and not stopped by the vagaries of winter. Where there was protected elective time we could plan efficiency and throughput through a system, which in that case was protected. The idea in Sláintecare to do something with investment in that would drive better clinical efficiency. Another example is we can do things differently. Mr. Breslin made reference to the fact we are doing too much in acute systems. If I take some of the examples such as the Sligo air care model or the Letterkenny urology model, which move activity out of the hospital system into the community, they mean faster delivery which is closer to home and also more efficient. It allows clinicians in the acute system to concentrate on the things they need to concentrate on. They are three buckets of things on which we can pursue value for money. We are only part of the way down that road.