Dr. Sara Burke:

Perhaps I will take the second last question next, which was the point the Deputy made around how important it is to have buy-in from medical professionals. The Deputy spoke specifically about doctors. In fact, that is very much changing now internationally. The literature is around healthcare professionals and clinical leaders who are not necessarily doctors. A really good physiotherapist or occupational therapist can be just as important a clinical leader as a doctor. There is a strong literature around that and they are needed, but there is also very strong literature around how doctors in particular are often the ones to oppose any type of reform. Once one begins to do it, most of them come on board but there is significant work to be done by the implementation office around engaging clinical leadership - not just doctors but all healthcare professionals and clinicians across the system - to get behind this plan. I do not believe that has been done yet and that is why we specified in our opening statement that the aspects in the strategic implementation strategy around public engagement, workforce engagement and, particularly, clinical engagement and around integrating clinical and corporate governance are really key parts that have been missing from the Oireachtas process so far. That really needs to happen.

Most people go into clinical work of some type or other with the intention of looking after and caring for people. Most people in the system find their jobs extremely difficult at the moment. It is really hard. It is like a case of survival of the fittest. Providing the best quality of care is an obstacle course. If it can be demonstrated to the workers providing that care that this is going to be better for the people who use the services, most of them will come on board. That brings me to the Deputy's first question, which was about the most important aspects of implementation for increasing access and reducing waiting times. There are two questions in that. I will deal with increasing access.

One has to begin showing people the difference that it will make in their lives. A significant part of Sláintecare is shifting care outside of hospitals into the communities and much better primary and social care. Everybody, not just people with medical cards, needs to be able to access the services without a long wait time and, critically, without a charge. Whether that is free or low-cost can be determined. Most of the literature supports the no-cost rather than a low-cost element, particularly if one is trying to get people to use it. It can be used as an incentive for people to use primary care services. Suggestions in the original report like universal child care services, early intervention and child health prevention work and universal palliative care are good. If one uses those aspects, one gets buy-in from the population. The Deputy is wrong. I do not think the public knows about Sláintecare. However, if one talks to people about what they want from their health system, then one can get them on board.