Mr. Paul Gordon:

On Deputy Kelly's point, in terms of formulating a plan for progression to universal health care, we need to look at who will be covered, who is already covered, who needs to be covered and whether there is an expansion in that. We also need to consider what services are already covered, the quality of these services and what else will fall into that category. Finally, we need to look at what out-of-pocket payment costs will remain and how far that will extend. With that there is a need to acknowledge that it is not just about ensuring a package of health services but also ensuring a progressive expansion of those services when funding is available. The World Health Organization's guidelines on universal health care, while similar in wording to our Health Act 1970, are a little broader and less conditional. There is also a need to protect those at greatest risk. For example, in the six or seven years following the economic downturn, people were paying an extra €100 a year per person on medical care and prescriptions.

Out-of-pocket payments rose by approximately €600 million between 2008 and 2014. There are people who face what are described as catastrophic out-of-pocket payments, which means they forego regular staple goods or services to pay for medication. We know, as do Deputies from individuals coming to their constituency offices, that people face a decision between paying a prescription charge or buying food for themselves or their families.

From our perspective, there needs to be a continuum of care. This is a multifaceted structure, which involves health promotion, disease prevention, diagnosis, treatment, palliative care and an integrated social care model.