Mr. Martin Varley:

We made a substantial submission on this matter to the independent review group. The key question is what would happen if we were to separate the private and public systems. The report appears to me to be based on the premise that this would create capacity in the public hospitals because a proportion of the population with private health insurance use public hospitals. Our analysis would suggest that they use the public hospitals out of necessity because the equivalent care is not available in the private settings. There are specialist areas, for example, cancer care, ICU care, maternity care, paediatrics, organ transplantation, stroke care, trauma, neurology and complex surgery, which, by and large, only happen in the public hospitals. This could be fragmented and replicated across the private hospitals but the country is not large enough to have two groups of specialists. We have enough difficulty trying to recruit and fill public contract posts such that trying to replicate the system in two settings would be highly questionable. The population of Ireland is not much bigger than that of the greater Manchester-Liverpool hub and duplication does not make sense. Also, if we take €650 million to €700 million per annum out of the public hospital budget are we guaranteed that it would be replaced? We do not believe there would be much of a reduction in the number of patients presenting. The same patients will present albeit one would forego the private health insurance income that the public hospital would have received. This whole basis of the report is open to question. We do not believe it would lead to a stronger medical service in the country if we fragment it. It would be better to develop centres of excellence, as we have done with the cancer centres. Fragmentation is not the best approach and 45% of people continue to have health insurance and to pay for services when they use public hospitals.