Dr. Brendan O'Shea:

Much of the early research on chronic disease management originated within hospitals where specialist colleagues chiselled out heart failure, hypertension and chronic obstructive pulmonary disease, COPD, undertook studies and work, and designed their hospital services around those single disease models. That is impossible to translate. It is expensive to deliver. All the really great research on the complex co-morbid patient now is coming out of general practice and we are leaving the committee several excellent examples. Dr. Liam Glynn's study is of 6,000 patients and relates to Irish health care. One may view the history of it, but we are here today with these patients. There are considerable efficiencies that can be delivered if primary care is resourced to look after it. We can embrace complex co-morbid patients and the evidence from abroad strongly suggests that we can make a real difference.