Dr. Donal de Buitléir:

The key to it is that an early decision needs to be made whereby we stop issuing contracts for new people that allow private work in public hospitals. We need to pay people properly to do proper public service. That is going to have to be done anyway, because the emergency salary cuts are going to be restored and we should get some value for that.

Moreover, the €524 million that insurance companies pay hospitals is very unstable income. There is a lot of talk about ephemeral corporation tax revenue but this is another element here. If we do nothing and maintain the existing system, that money will drift away in any event. People are waking up to the fact that when they are given this form in the emergency department, their treatment does not really change. They may get slightly more attention from the private consultant but effectively, they are paying for something they get for nothing anyway. This is putting up the cost of their insurance premia and the insurance companies are waging a very effective campaign to draw this to people's attention and this money collected is falling.

The question is how far will it fall. I would not bet on this money continuing to be available. People say our proposal would cost €650 million, but if we maintain the existing system, we will have a lot of these costs. It could be phased. I pride myself on being somebody who is very concerned. I have spent 40 years looking at the public finances. I started in Revenue and we would not want to do anything stupid that would actually wreck the system. I am satisfied that if we were to do this in an orderly and progressive way, it could be afforded. It is a question of whether we want to do it. How important is it and how important is the principle that people should be treated equally in the public system?