Dr. Josep Figueras:

I thank the committee for the privilege of being here. I will say a couple of things about where I come from because it will very much guide my remarks to the committee. I am the director of the European Observatory on Health Systems and Policies which is hosted by the WHO, the European Commission, the World Bank and a number of member states in Europe. Ireland is part of it and so are Switzerland, England and many others, including the Nordic countries. I am not doing marketing for my organisation, but rather trying to give a sense of where I am coming from. Our job is to gather and compare evidence. One aspect of that, which may be of help to the committee, is that we have been doing a number of comparative studies to develop evidence and work with policy makers in their role. We are concerned with knowledge brokering and how we use evidence in a way that is practical for work. As the English say, the proof of the pudding is in the eating so I will tell the committee what I have to say today.

I wanted to do two things and I will ask for the committee's suggestions. The first is to give the committee a sense of how Ireland looks in the international and European context against a series of measures of performance. I will not make it an academic exercise but try to draw lessons about what we can learn from other countries in the region. In addition to that, I will suggest a possible framework - not a normative framework - to think through the various issues the committee is concerned with. My terms of reference, like those of the committee, were very wide. It would take me several hours to go through all the areas the committee is looking at and which are in my terms of reference. There are two ways to go about it. I will not subject the committee to all my slides. They are a background so that I can answer the committee's questions with evidence. There are two ways to go about it. One is to have a bit of a menu in ten minutes of introduction and then go into detail on any of the areas the committee wishes me to address. The second way is that we could go into each of the areas. For instance, we could start by looking at funding issues, supplementary ways of financing, or the role of the private sector. We could also talk about the skill mix. Many of these areas are in the committee's terms of reference. I could take them one by one and we could then stop and divide them. I will do whatever is best for the committee. The slides have been distributed to members of the committee but they should not worry, I will not go through all of them. I will use them as a background to be able to address questions with actual evidence.

I congratulate members for putting this committee together. One of the things we have learnt elsewhere is the need to have some stability in the reform process. The idea of putting a multi-party committee together to create consensus is a very wise decision that I wish would happen in many other countries in the region where we work. The second aspect is that what the health care system is facing is not only an Irish issue, it is an issue across the region. Two days ago I was in Helsinki presenting to a committee similar to this one with senior policy makers and civil servants where we did an evaluation of the health system reforms there. Many of the issues we addressed there were very similar.

Another concept I will refer to a lot today is that of specificity and what academics call path dependency. There is no such thing as a technical decision that applies to all countries even if academics like certain ways. It has to be very much tied to the history and the system. I am sorry for these long preliminary comments but, as I said, I could do ten minutes and give the committee the menu. Perhaps I could even start with my conclusions and then ask members to push me to any of the areas I have mentioned or I can take it area by area, whatever the committee prefers. I hope I am not being too informal in my approach to the committee. I hope it is okay that I do it this way.