Professor Steve Thomas:

Myself and my colleagues will present a few of the slides that we drew from last week's final workshop on the pathways to universal healthcare project. We have selected slides that we believe will provide a useful focus for the committee.

In terms of the first slide, one of the issues that has come up with Sláintecare is whether it is too expensive to implement. Obviously, a further question is whether it is too expensive not to implement, given the current overruns in the health budget. The original Sláintecare report was focused on a ten year implementation plan. A lot of the activity, particularly around entitlement, expansion and the transition fund was front loaded into the first six years, with a maximum amount of €460 million expansion related to entitlements per year, from year three. In our work we consider what might be the effect of changing some of the assumptions behind that. We keep the basic costings and basic items but shift some of the underlying assumptions and look at a 12 year implementation plan. We do not frontload it into the first six years but spread it out more evenly across the timeframe.

We push back the start dates of a couple of items, for instance, the inpatient hospital fee removal to year two and the emergency department fee removal to year 11 from year eight. We stretched some of the phasing, particular around universal primary care, which is now elongated to six years for implementation rather than five years.

With the freeing up of GP care and replacing private income in public hospitals, we looked at both phases and took them back a bit and stretched the phasing to get our house in order for preparing and implementing those policies. We try to change some of the underlying assumptions. It is interesting to then look at what impact that has.

On the bar chart, I show the entitlement expansion cost required for each year on the left hand axis. We are running at approximately €250 million for the first five years. By the end of the 12 years, we still arrive at the figure of 2.8, which is shown by the line chart. On the right axis, members can see the total amount coming to €2.8 billion, so that is consistent with the current entitlement expansion detailed in Sláintecare. That will give members a slight idea of the rephasing.

If one goes to the next slide, one can do a comparison with the original Sláintecare costings, which are in orange, and the revised and rephased Sláintecare costings in blue. Substantially less is required upfront but, at the tail end, there is more investment, so it is more evenly focused.

On the next slide, we can do it for the transition cost because if we have a 12-year period rather than ten years and we are elongating the phasing, or delaying the phasing of some of the components slightly, we can redistribute some of the transitional costs as well. The impact of this is to reduce some of the initial burden on the budget. Interesting work was done by the Nevin Economic Research Institute, NERI, particularly for year one. There may be budget constraints but subsequently there will be enough fiscal space to implement Sláintecare. This way of rephasing may get around some of the initial problems with affordability.

I will ask my colleague Dr. Bridget Johnston to follow on.