Dr. Sara Burke:

As members of staff at the school of medicine in Trinity College, we are delighted Deputy Durkan got such good care because St. James's is one of our teaching hospitals. On the issue the Deputy raised about not doing one given thing and about how everything is a priority in health, he is right. Part of the challenge of health policy and health system reform is that it is very complex and there are competing priorities. However, in a way, the job of the political system is to decide, at a very high level, what the priorities are. It is then for the system to deliver on those priorities. I disagree with Deputy Durkan as to delivery being demand led. Some of it is demand led but, if we are doing things right, much more is needs led. We should be doing much more prevention, public health work in the community and empowering patients to manage their own chronic diseases. There will always be points in most of our lives when we will need acute hospital care, but most care is not acute hospital care. That is where planning, care outside of hospitals, care in the community and empowering patients become very important. A reformed system would not always be demand led. It should be led by population need.