Professor Michael McMahon:

Having taken the other side a moment ago, I will take the HSE's side for a moment, being a proper, two-sided economist. As we point out, one of the issues that makes things difficult for the HSE is that the ELS or standstill costs are not calculated appropriately but it is still asked to deliver the same services. We are not saying the HSE should not deal with people over 70 years old. That demographic has grown predictably and yet each year, the budgets are chasing their own tails. Each year, it looks as if the health sector is not delivering but some changes are predictable. As the note from Dr. Casey and Mr. Carroll showed, looking at the demographics, we could have done a much better job in advance of establishing the amount we would need to provide a level of service. At the second stage, we need a conversation to decide on the appropriate level. That is for the political process to do. If that level is too much or too little, we adjust and choose where revenue sources are going to come to pay for that service. There is a problem at the moment on the budget side of the health sector whereby we do not budget correctly and then look at overruns and think the sector has completely lost the run of itself when if we had budgeted correctly, overruns would be small and we would not be thinking they are completely out of control. There are two elements to the issue and we really need both and not just one to be sorted out.