Mr. Paul Reid:

I am happy to take that piece and the previous question that was asked. First of all, in the national service planning process and in the Estimates process we do look at demographics, at existing levels of services and at inflation. All of that modelling is done at the Estimates process and it is further done in the national service planning process in the allocation of funding. Consider in particular the last couple of years and this year. If we talk to people in the NHS in Scotland, in Northern Ireland, and in the UK - and I have spoken to them - and if one speaks to those in the Dutch health service, the reality is that every health service has been hit by some unknowns coming from Covid. First of all there was Covid itself, and the volume of activity it has driven. Second, there is some of the delayed care that we are seeing coming from it. Third, we are seeing a higher frailty level of older persons. I gave a figure, probably last week. I was in the University Hospital Waterford two weeks ago. I walked the wards in a 450 bed hospital where 270 of the patients were over the age of 75. That is what we are seeing, and it would not have been predicted to the level we are seeing. Modelling is being done by Dr. Colm Henry and others in the Department that looks at the frailty rate of a 76-year-old person now versus the frailty rate of a 76-year-old person two years ago. Certainly it has deteriorated. There is modelling that we do but there are things that happen that impact on our services. Certainly with older persons I would say that the biggest challenge we are facing in the health service in the next ten years - not 20 or 30 years - is higher frailty challenges in older persons. Thankfully we have a health system and a country where people live longer than any of the EU averages, one of the highest rates in the OECD and much higher than in the UK. We have longer life, we have higher complexity and we have higher frailty. It is going to put further pressure on the funding streams and the health system.