Dr. Matthew Sadlier:

The points raised by the Deputy were very wide ranging. I will address his question about the cuts to salaries in 2012. The Deputy is right. We were in a financial crisis but we imposed a 30% cut on new entrants. The day that was introduced, it saved zero money for the country because there were no new entrants. Within the first year, it saved a tiny amount of money because savings are only made when people are appointed. The argument that this cut did anything to help the financial status of the country at the time of the crisis does not make sense because it was imposed on staff who had not even started working in the service. Agency fees are way beyond what we would pay if we just paid the doctors the salaries that were agreed.

I go back to my experience of working in the health service. The Hanly report was published within a year of two of my graduation. Ultimately, the question of how much the health service will cost to run is a political one because it depends on what sort of health service we want. Do we want small hospitals around the country or do we want all the hospitals to be in one big city? The Hanly report spoke about cost savings and economies of scale of moving to large centres. The question arises as to what sort of health service one wants from a political perspective. One must then cost how much it will cost to deliver that health service. We keep making comparisons with other European countries but they run their health services very differently. One could argue, probably correctly, that certain European countries have very urbanised populations, do not have the low population density we have on the west coast, can run larger hospitals and have economies of scale. However, ultimately, once we have worked out what sort of health service we want to deliver, we must then work out the cost of delivering that.