Dr. Brian Turner:

I will start with Deputy Kelleher's questions on the disentangling of private treatment in public hospitals, and whether the capacity exists in the private sector to treat complex conditions. Part of the disentangling of private treatment in public hospitals will require contract fee negotiation with consultants. I am aware that the last contract renegotiation took about seven or eight years, so that will not be easy. However, it should not stand in the way of trying to achieve a single-tier public hospital system.

There is some suggestion that the private hospital system has capacity at the moment, and certainly the waiting times are not as long. There seems to be a better capacity situation in the private system than there is in the public system at the moment.

As regards complex treatments, people do not give up their right to be treated as public patients if they have private health insurance. For complex treatment, people can still be treated in public hospitals as public patients. We would need to get waiting times down, however. People who currently have private health insurance are used to shorter waiting times. If one removes private treatment from public hospitals they may well face longer waiting times. There may be some push-back from people with health insurance in terms of any reforms to the system. That being said, we have to design the system for the population as a whole and not for any sub-segment.

The privatisation of the GP service is an interesting point. GPs are private contractors and they see a mixture of public and private patients Although every so often there are anecdotal stories to the contrary, by and large there is no discrimination between public and private patients in GP care. That is certainly something from which we can learn. Why is it that GP services are accessible by all patients, whether public or private, within a reasonable timeframe? Could we replicate that in the public hospital system, at least in the short term, while we move to try to disentangle the public-private overlap?

Affordability is an issue in tax relief. There is a temptation to characterise the public-private divide as haughty businessmen with bunions kicking little old ladies on social pensions with heart conditions out of beds. It is not quite as caricatured as that. About one third of those with private health insurance are in the C2 or DE social classes, which would be typically referred to as working class people. Therefore, membership of private health insurance schemes goes right across the social strata in this country. Obviously, however, those on lower incomes will be most affected by any increase in price as a result of removing tax relief for private health insurance. The compensation for that would be that if one is investing money in the public system and the public system becomes more accessible, not as many people will require private health insurance in the first place.

The affordability of increasing capacity will be key. That is why, in my opening statement, I mentioned that we need to be upfront about this. It will cost a lot of money. We are not talking about hundreds of millions but billions if, for example, we were to increase our bed capacity by 9,000. I do not think it will happen, certainly in the next ten years, but our current bed capacity is roughly 15,000 so we are talking about a 60% increase. Let us say that we increased bed capacity by 50% in the public sector. The Central Statistics Office, CSO, figures suggest that, in 2014, Government spending on hospitals was about €4.5 billion. Therefore, by increasing capacity by 50%, we are talking about roughly €2.25 billion, although there are a lot of adjustments to be made.