Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

I thank the witnesses for their very considered review. It is worrying. The witnesses have been forthright and have called out the areas about which they have worries. I am going to make one nakedly political point to which I do not expect them to respond, although it is relevant to implementation, and then I have four questions. The political point is that healthcare has been extremely badly managed at a political level over the last few years. A lot of that is down to poor implementation and an inability to get things done on the ground - to open up an intensive care unit bed here and there, as required, to make sure that a surgeon gets hired where needed and so forth. I see that incompetence - and this is my view, I am not transposing it onto the witnesses - rolling into the implementation of Sláintecare and it worries me.

My four questions are as follows. The public does not really care about Sláintecare. It is a reconfiguration strategy and it is very important for the future of healthcare and Fianna Fáil is fully signed up to it, but the public does not care. The public cares about getting access to medical care, be it in their home, their local GP clinic, a primary care centre, an acute setting, a rehabilitation setting or wherever else. There is a danger that, as the focus moves on to this shiny and extremely complex and difficult healthcare transformation, the most important thing, which is getting boys, girls, men and women access to doctors when needed, will slide. Could the witnesses point us to what they believe are the most important implementation aspects they think will increase access or reduce waiting times quickly? That is what the public needs. That is what people are screaming for.

The second question is on universalism. Universal healthcare is defined as the ability to access healthcare without incurring undue financial hardship. Sláintecare is ambiguous on this. It talks about universalism, which does not necessarily mean free, but it also talks about free. It interchanges those a bit. The witnesses have raised serious concerns about universal access. Do their concerns relate both to free access and to universal access as the World Health Organization defines it? In other words, they seem to be saying they are concerned about the future ability of people to access healthcare for free, based on what they have seen about people's ability to access healthcare without incurring undue financial healthcare would the witnesses be concerned regardless of which definition of universal is used?

My third question is not really covered in the witnesses' assessment but I imagine they will have a view on it. I have worked on healthcare reform abroad and the single most important thing for healthcare reform to work, assuming one is travelling in broadly the right direction, is the buy-in of doctors. It is the single most important thing. If doctors, particularly senior clinicians, do not buy in, healthcare reform tends to fail. The doctors and their unions are pretty scathing about Sláintecare. These are public statements they have made. I am sure there are individual doctors who buy into it but at an organisational level they have been heavily resistant to Sláintecare, which is something that has to be addressed. Do the witnesses have any thoughts, reflections or advice for us as an Oireachtas with regard to trying to achieve buy-in for Sláintecare and for this implementation at a senior clinical level?

The final question I have is on the costings. I thank the witnesses for the ones they have done. As I read the slides, they have done two - the costs of expanding entitlements and the costs of the transition. Both get to about €3 billion or thereabouts. Have they done an analysis on the total cost, that is, the cost including the cost of entitlement, the cost of transition, the cost of scaling up and any other costs? Do they have a total? Getting to Sara's point, that there is either buy-in for this or there is not, if there was buy-in people would be thinking at a very serious level about deploying very serious resources against this. I am not seeing that from the Department of Finance, the Department of the Taoiseach, or the Department of Health. A total figure would be very helpful. How much do we really need to pour into this, either against the original Sláintecare profile or the witnesses' revised one, which is slightly less front-loaded?