Mr. Edward Mathews:

We have no difficulty with such a review. Our belief is that the public must have confidence in the delivery of a service. We have said very clearly that no single group, no single occupational category or single influencer can act as a vested interest to block either the future advancement of the service or to influence the service unduly in the future. In that context, we believe there should be the equivalent of a public health inspectorate to monitor delivery of care and ensure value for money, such that in regard to money devolved at unit level there is no free-for-all but an obligation to operate from an evidence base in relation to staffing numbers.

On the Deputy's question regarding the independent review, as I said, we have difficulty with a review. We can look at the OECD average of 2.8 versus 4.8 per thousand of population, the loss of 2,000 beds and the recommendation of a former Minister for Health in the context of previous reductions in bed capacity of a cushion of six co-located hospitals with up to 400 beds each, which never materialised.

We have no difficulty with or fear of an independent bed review. We know we must reduce the number of patients who are fit for discharge and should not be in the hospital but it is our belief, and the evidence will show, that pending moving to a more integrated primary service, there is a need for more acute beds. That is why we are recommending the higher spend in the interim period. We have no objection whatsoever to an independent study which receives submissions from interested parties and reaches determinations. The OECD figures point to the necessity for that and, if nothing else, the emergency department figures can leave no one in doubt, as do the waiting list figures, that there is a need for a mixed in-patient bed capacity, both five-day and over seven days.