Billy Kelleher (Cork North Central, Fianna Fail)
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I welcome the witnesses and thank Ms King and Mr. Doran for their presentations and the more detail submissions made to the committee. I have a couple of questions which seek to tease out how we move from where we are in terms of developing a strategy to implementation of what we all hope we can achieve at some stage, namely, a universal public health system with access based on clinical requirement. We have to live in the world. That type of system will have to be funded by the taxes of the members of ICTU. We must get to a stage where we have a sustainable health system. Ms King referred to funding equal to 10% of GDP. While 10% is an arbitrary percentage figure, when GDP is growing rapidly, as the case may be, hopefully, in the future, or shrinks rapidly, as was the case not so long ago, the result would be a system that is not underpinned on a sound financial basis in terms of longer-term planning. I would welcome more clarity on whether the proposal for a 10% of GDP spend is an aspiration or whether the spend needs to be more clearly defined.

In regard restructuring fatigue, the HSE was established in 2004. It then hit the sands in 2008 in terms of the financial melt-down and cutbacks to services. One could argue that the HSE did not exactly hit the ground running and was quickly in huge difficulty in terms of financial resources. The nearest we have to a public health system is the HSE, in aspiration at least. The broader issue that we need to address is the value for money provided by the HSE and what it has up to now delivered. My questions for the witnesses are primarily around the issue of staffing levels. Has a comparison been undertaken of staffing levels in other countries in terms of grades and professional competencies? Very often, I find that when comparing figures I am not comparing apples with apples, but apples with oranges. People are flexible in their views in terms of what exactly is a comparator. In terms of the research by ICTU and its effort to come forward with a logical proposal in terms of how we develop a universal health care system, does it have statistics based on comparisons, bearing in mind that some of our public health system is crossed with a private health care system? In other words, what are the statistics for the public health system when one strips out the private health care system?

Mr. Doran said that in terms of cost of delivery one of the biggest challenges facing us is that of demographic change, life expectancy, co-morbidity, chronic illnesses and diseases, people living longer but also living with chronic diseases and neurological illnesses and so on. In this regard he said that the public health system should deliver all of the care for elderly people, over a period of time. Is there any cost to support that or is that an ideological view? Mr. Doran might elaborate on whether the public health system can deliver health care cheaper and more effectively than the private system, taking account of how this is currently done through the fair deal scheme.

On hospital capacity, there is no doubt but that there has been a stripping out of beds in our acute hospital setting in particular. It was stated that we have now arrived at the perfect storm in terms of poor supports in the community in primary care, life expectancy and demographic changes, the flip-side of which is that everybody ends up in our emergency departments on trolleys. In that context, where would ICTU start if implementing a plan? Would it start at primary care level by frontloading primary care investment initially, would it favour transformation of the whole system overnight or, in the context of a 15-year timeframe, what would be its priority to alleviate the immediate problems facing our acute hospital system, emergency departments and people on trolleys?