Mr. Leo Kearns:

I think it is but we need to get beyond the principle to how it gets operationalised and how we make it real. There is no doubt about it, but one cannot do integrated care, population-based care planning or care delivery if one is not looking at a budget across all of that. In fact, a prime reason we have such a dysfunctional system is that we have all these multiple budget lines where the budget goes off one way but never goes horizontally across.

That principle is clear, as is the fact that this cannot be done in Dublin, but it has to be done within the region, with the people who should know their population best. They should have the facilities and the skill sets to be able to understand their population and how they allocate their budgets. I think there is highly likely to be quite a bit of the duplication going on at the moment because of the way the budgets are organised. I have no doubt that one of the main reasons behind the blockages that we are seeing in various parts of the system are to do with this lack of joined-up planning, budgeting, clinical services and so on. What we still need to see is how we move from where we are to that. That is the destination and there can be no deviation from that. That is a principle we must stick with. From everything I hear, people understand that is where we have to go and this is why we emphasised the scale of this. There is quite a bit of work to be done to understand how one makes that real.