Professor Allyson Pollock:

Most countries that have put in a national health service began from an imperfect base. The UK was no exception. It was highly fragmented. There was a patchwork of services with significant inequalities. For that reason, a law is needed that places on the Minister a duty to provide services throughout Ireland. That is the only way to overcome the fragmentation, imbalance and inequity in resources. Of course there is a move to try to improve resources all the time, but that cannot be done without an Act of Parliament. This course of action would not preclude the committee from beginning to work to improve primary care services, to increase the level of funding and to take initiatives forward. I would argue that this needs to be part of the plan. There is nothing preventing Governments from putting more money into primary care by increasing funding from the current level of 3%, which is abysmally low, and by increasing cover. If the big picture and the big vision for this committee is universal health care, it must stick to that. There are risks associated with zooming in and out. If one zooms in too close, into the very micro-details of the health system, one has to cover everything from how primary care and acute health services are run in small areas to the allocation of resources. I feel that the committee's job should be to focus on the big picture - the big vision of how Ireland can get to universal access and how it can provide for the duty I have mentioned. There is nothing to preclude anyone from building up primary care as legislation is going through, or from putting the planning in place. I know it can take a couple of years or more for legislation to go through. I would not say it is a case of one or the other - I would do both at the same time.

The Chair also asked an interesting question about human rights. She seemed to be wondering whether individuals can argue that they have a legal entitlement to health care. I would caution against such an approach. Brazil, for example, provides for a right to health and to health care in its constitution, but it has not managed to address the huge inequities in its health system. The courts there have been used by individuals who can afford access to justice to exercise their right to health care, but that is not solidaristic. If those courts make very peculiar decisions under the Brazilian constitution, that creates even more chaos and inequality. I think I need to understand more from the committee about what it has in mind when it talks about a legal entitlement to primary health care and community care at the local level. My view would be that if the duty flows from the Minister - in the UK, the Secretary of State for Health - all the structures and resources would follow those duties, powers and functions.