Ms Cliona Loughnane:

Again, I might just go through a few questions and then I will pass some on to others.

Deputy Kelleher spoke about the 9%. Not all private care is being provided in private locations and by private operators. It is about the mixing of the two. Often people are getting access to diagnostics through their private health insurance and then they are getting onto a waiting list to which other public patients who are waiting for diagnostics are not gaining access. It is more complicated than in other countries, where private insurance entitles one to private care in a private location. It is important for us to try to figure out how we can address that issue.

In terms of making the public health system more attractive, Mr. Gordon will talk to us about Deputy Kelly's question on what we are talking about when we refer to universal care. In terms of making it more attractive, there is the ten-year vision, but there is also the question of how we maintain the system as we work towards the that vision. I wonder whether there is an opportunity for this committee to make some recommendations about that. There are issues around maintaining the health budget and getting it back to where it was in the 2008 period. There are certain recommendations like that regarding a real focus on certain waiting lists within the public system, for example. Again, as we are so interested in patient outcome and patient quality of care, resourcing of the regulation within the system is something that will need to happen. As has been pointed out, we need to recommend resourcing of primary care. There has been an agreement in respect of primary care for a long time, but the resources have not been going that way. In terms of the committee's work, there might be the potential to make some kind of stopgap recommendations as well as the vision recommendations. I was going to make the point Deputy Shortall made that we may be about to see salaried GPs in the system for the first time. It seems to make a lot of sense to have salaried GPs. In other systems where there are salaried GPs, those GPs can be incentivised and involved in health and well-being. It makes more sense within a system such as that. It seems to have many potential benefits.

There has been some conversation about the NHS. I agree there have been many changes to the NHS since it was established in 1948. The Health Reform Alliance is not saying that what Ireland needs is an Irish NHS. It was just being used as an example of where a vision was articulated and actually came to fruition. One thing that can be said about the NHS, no matter what changes have happened, is that there is still a commitment to universal access to care that is free at the point of access. That is what we are talking about. As Mr. Gordon will say, we have to ask what the care we are talking about is. The NHS can be commended for that at least.

If one looks at Irish patients in the Republic compared to their counterparts in Northern Ireland, one can see the difference between having access to that kind of care free at the point of access and not having it. There was a study in 2007 which looked at people who were ill but who did not go to their GPs. In Ireland, 20% of patients said they had been ill in the previous year but had not gone to their GPs, whereas in Northern Ireland the figure was less than 2%. This just shows that where care is free at the point of access, particularly that kind of lower-level care, which is the care we really want people to be able to access to stop them getting to the high level care, it does make a difference. The mention of the NHS is illustrative rather than anything more than that.