Stephen Donnelly (Wicklow, Fianna Fail)
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We should have fewer GPs. It would appear that we have more than enough, on the face of it, and more than enough acute beds. The reasons given are the lack of integration, misaligned incentives and public health. The witness may well be correct on the lack of integration. However, when taking a systems view, it probably does not matter that much. What does a lack of integration mean? It means that people are going into acute settings that might have been seen in the community, or people who are going in for referrals to specialists who perhaps could have been seen by a physiotherapist. We actually appear to have more clinical assets in the primary care settings and more clinical assets in the acute setting, so a lack of integration may suggest that we have people who are going into hospital who perhaps should be staying in the community. However, if we have more assets in the community and more assets in the hospital, once adjustments are made for a younger population, then I am not entirely sure that I buy lack of integration as a reason.