Billy Kelleher (Cork North Central, Fianna Fail)
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I have a few points and observations. Reference was made to the National Treatment Purchase Fund being a symptom of a malaise in the public health system and that it is an expensive way of doing its business.

I do not know whether that is the case, because we do not know how much it costs, for example, to do a colonoscopy in the public system. How much does every individual procedure and diagnostic cost? I do not think we can compare until we have an analysis of the costs for these treatments in the public health system vis-à-vis the cost in the private health system.

The other issue about private health insurance is that while it only contributes 9% to the public health system in terms of income, it contributes much more by the fact that those with private health insurance are not depending on the public health system. We have to keep things in perspective if we are to reach a conclusion. How many people are treated in the private health system who would otherwise be in the public health system if they did not have private health insurance? There is no doubt that if the public health system is under pressure as it is, carrying out all those additional treatments and diagnostics in the public health system would probably cause it to collapse.

The challenge we have to face is how, over a period of time, we can get to a situation where we can extrapolate the interconnectedness of the two systems so that we have a stand-alone public health system. The success of a public health system would be the fact that people would feel no need for private health insurance. The UK has the National Health Service and I detect a slow, incremental increase in private health insurance there over the last number of years because of the pressures the system is under. In a taxation-based model, the public health system is dependent on the public purse. When there is a squeeze, the whole thing comes under huge pressure. We will have to look at how we can ensure a certain level of ring-fencing in critical areas over a period of time.

In terms of a public health system and GPs, we all talk about primary care and we have a primary care strategy. Ms Loughnane spoke about 1988. Rory O'Hanlon was appointed Minister in 1988 and at the time he spoke about primary care being the bulwark for developing our health care system. This was in 1988. We are a long way away in terms of years, but not in terms of progress. The key issue in all of that is GP-led services in the community. What are the view of the witnesses on GPs being employed directly by the public health system, as opposed to the contractual arrangement we have? Due to the difficulties we have in attracting GPs into particular areas, there is going to be a certain amount of cherry-picking. It is a proven fact that in key areas where there are bigger socioeconomic problems there are also poorer health outcomes. That is where we need more GPs, not fewer. Regarding employment and contracts, where do the witnesses see the role of GPs being directly employed by the HSE?