Dr. Brendan O'Shea:

The time is shortening, so we might give some punchy answers. We are saying that nothing will happen without legislation, that we have had acres of policy that has become meaningless. Members must legislate. They can legislate for the electronic medical record and make the hospitals catch up with general practice. They can legislate around a contract. They can ring-fence funding for primary care. We are not all that concerned about what stream it comes under, but it should be protected in order that our primary care system is funded at least in line with other OECD countries.

Regarding the insurance industry, members can legislate so that if insurers are to be allowed to operate in this space, they must recognise general practice. If I operate on an ingrown toenail in my surgery, the insurer will have the same procedure funded in a private hospital for four times the amount, so there are perverse incentives that are costing. This is what is driving up insurance premia.

We will move on to the members' questions. Deputy Harty raised a very interesting point about whether there is an inevitable bulwark or obstruction between primary and secondary care. In Ireland we do many things twice. There is the private secondary care system and the public secondary care system. We are concerned about our colleagues in the public hospital system because they are in a very difficult space, even as we are, and we feel that the majority of our specialist colleagues in the public hospital systems are absolutely equally demoralised about what is going on. When we get an opportunity to talk to them, good things will happen. We can see it in Carlow-Kilkenny, and several questioners have asked whether Carlow-Kilkenny is good or bad. Carlow-Kilkenny is progress. Carlow-Kilkenny is an improvement on what was. Carlow-Kilkenny-----