Dr. Eddie Casey:

This idea for a study could be very useful. We in Ireland often have the experience of suddenly firefighting and finding ourselves with a hole in the public finances that requires us to embark on austerity measures. That is a very bad time to have a strategic overhaul of spending because we are just looking for savings wherever we can find them. It is not done in a clever fashion. At a time like this when there is relatively more abundance and a bit of breathing time, we should use it as an opportunity to look back over what we are doing and where we can make things more effective. Health is the only place we should be starting on this front. We have had spending reviews for a long time now and IGEES has been around for a while. The focus has tended to be on lots of different areas but health is clearly a perfect area into which to sink our teeth. It needs to be done comprehensively.

Along the line of what the Cathaoirleach is saying, it is sometimes hard to see the data. We find ourselves asking all the time in respect of health where the data is. The long-standing problem the sector has had is that there is no good set of information systems in place. A lot of the information is very hard to get and not in a great format. That means trust is more likely to break down between the Department of Public Expenditure, National Development Plan Delivery, and Reform, on the one hand, and the Department of Health on the other. If they are talking to each other but no one is able to draw on good information about what is actually happening, it is a perfect environment for distrust to grow. That is what we are seeing a little. There needs to be a bit of quid pro quo. In order for the health service to get money, which we think it probably needs just to stand still, it needs to be able to show that good planning and good information systems are place. How is that done? A bit of money probably needs to be spent to save money in the long run. There is an element of not going down the road of penny-pinching but spending to save money in the long run.