Mr. Chris Nightingale:

I will answer Deputy Stephen S. Donnelly's questions about the scope of the review. Some good questions were asked. The exclusion of mental health and disability services from the scope of the review was agreed at the start when the terms were set out by the Department. The main reason for the exclusion was the potential lack of availability of good and timely data in the areas of mental health and disability services. Given that ongoing work was being carried out in these areas and in light of the timescale for the project, it was felt it was better to focus on acute primary care and social care services.

The Deputy's second point was related to the resources included in the primary care part of the study. As he pointed out, we picked up on GPs, nurses and some of the allied health professionals in the study because of the availability of relatively good data for the numbers of resources in these areas and the activities undertaken by these professionals. The data in question were broken down on a granular level in terms of the patients they were seeing. This meant that we could do our demand forecasting on the same basis as the other parts of the modelling. I would not expect the addition of additional resources to have an impact on the results achieved on the basis of the resources included in the report. The inclusion of other resources in the outputs would give a further richness to the report. By including other primary care resources in the modelling, we would see the impact on them. It would not have a significant impact on the resources already included in the review. We are relatively confident that the resources at which we have looked would be taken into account in the modelling.

The Deputy asked a particular question about the over 65s. The second scenario we set out focused on the elderly cohort of patients and particularly the chronic conditions suffered by such patients. Essentially, we analysed whether we had missed the impact on those under the age of 65 years. As a baseline, we looked at primary care services across all three sectors and patients of all ages. This ensured the total population was included. Our analysis was not limited to those over the age of 65 years. As has been pointed out, the particular scenario we considered looked at changes in the model of care for patients over the age of 65 years. There were two reasons for this. First, given that the main impact of this scenario would be on the over-65 years population, we felt that by considering them we would cover the main impacts on chronic conditions of changes in primary care services. Second, we wanted to enable the scenarios to be added together. When we were looking at improvements in hospitals in the third scenario - the efficiency scenarios in hospitals and hospital systems - we mainly looked at people under the age of 65 years. This meant that when we were adding the scenarios at the end of the report and looking at their combined effect on the baseline, we could be confident that we were not double-counting impacts from overlapping scenarios. By ensuring the combination of the three scenarios could be additive and, therefore, their combined impact could be seen, we could deliver a simpler story and message at the end of the report.