Mr. George MacGinnis:

There is a starting point in a process. I fully understand the questions and their thrust. As we work from where we are to getting a comprehensive solution, we need to put a few building blocks in place to develop a more sophisticated analysis. Doing an overview of capacity needs based on an assessment of the demand and the trends of the demand is the right first step. As I indicated in the opening statement, that sets out a landscape around which we go. It is not that we have then not done a workforce assessment. Why do we think it is the right landscape to go for? We know we have not modelled all the workforce in detail and we have set out very clearly a recommendation that a comprehensive workforce assessment is needed. As we worked up the scenarios, we pulled together workshops with a number of very senior people from across the system. These were not just system leaders but representatives from patient bodies and the like. We worked through with them the scenario in reality and what it means for Ireland. We looked at what is a reasonable quantification for the scenario. The way we constructed those takes account of people's views of what they think was deliverable, knowing that what we are giving is a broad order assessment of what is needed.

Both ends of the spectrum are pretty horrendous in terms of implications. Members have already pointed out the business of how long it takes to build a hospital. One asked a question specifically about expert opinion on there being too many beds. That was a view put forward by one of the members of the OECD panel and the view was that other countries are not building beds. When we considered it with the other members of the international peer review group, we saw that those countries that are beginning to get away with fewer beds than recommended have already done significant reform in their primary and community care and are already supporting patients in different ways. Given where Ireland is, it is a reasonable capacity assessment. Given the time and difficulty in bringing in capital infrastructure, one that looks to the minimum one can get away with is the best.

This leaves us with profound questions about how to get capacity and how to address the fair deal question, for example. It is about how to build that capacity in Ireland and the mechanisms for doing that. We have not looked at that in detail. As I stated, we have had some expert opinions from people across the system who have helped to shape those scenarios. The next stage is to look at that in detail. If we contrast the 2007 review with this one, in financial terms this iteration poses many more revenue and expenditure questions than were ever posed in the 2007 review. It puts on the table a much more comprehensive financial view of the scale likely to be needed. As I said, there are two extremes and perhaps the achievable goal will be somewhere in between. We think it will be closer to the reforms scenario option than the building option as we go on. Does that help to answer those questions?