Mr. Mark O'Donnell:

It depends on the service we are looking at. There are multiple factors involved there. Looking at any sort of organisational performance, it will be a mix of people, processes and systems. If there are gaps or failings in any one of those three, there will be issues.

Taking the survey that Croí carried out on echocardiography services, which is a critical diagnostic tool that is used, we found that the average waiting time for an echo was six months in the public system, up to 12 months in some cases. A person with private health insurance could access that typically within a month, which is a huge difference. There is a factor of six there in terms of delay. There are a number of issues there. One is that there is a shortage of cardiac physiologists to carry out the tests in the first place. Looking down the track, there is not a sufficient pipeline coming from third level with that qualification to meet future demand, let alone keep up with what we have now. The other part of that is around the systems. For example, somebody accessing private healthcare for an echo can get a direct referral in for that. Somebody in the public system has to be referred by his or her GP into an outpatient clinic to see a cardiologists and then referred on for the echo, so there is an extra layer, more friction and another step to go through.