Let me try to take the questions from the top and refer some matters to my colleagues.
To respond to Deputy Reilly, the Minister indicated to us that she was taking our report to the Cabinet - I would have thought that would be done about now. She also indicated that she accepted most of the report's contents. I do not believe she accepted all of it, but she was very positive about the general direction and thought it was a significant contribution. Throughout the process she had emphasised our need to be independent in order that whatever we produced would be of value not just at the time the report was produced but would also produce information on the health system that would be helpful to anyone who was trying to improve it.
If one was looking at what one might do at this juncture as first steps, as a group, we consider that increasing ability to pay for service delivery, for example, in the hospital system would be very appropriate. Therefore, moving to a larger share of the budget which was Casemix based would be appropriate in a certain way, but it would be small relative to the total. The roll-out of the protocols being developed by the HSE with the involvement of Dr. Barry White and Dr. Colin Doherty is crucial in trying to develop the link between hospital care and primary care and deal with chronic disease management. If we do not set the protocols before setting the efficiency drivers, safety could be compromised. The group believed it was very important to set the clinical protocols ahead of the new price drivers.
There have been some developments in the past six months since we started our work in adopting a more aggressive approach to getting good deals from the pharmaceutical companies and pharmacists and more could be done in that regard. We are aware that full economic costing is coming to the fore in public hospitals for private patients, which is important.
The Chairman asked about the role of the National Treatment Purchase Fund. The group was very concerned that, while it was originally set up to shorten waiting lists, as time passed there was a moral hazard issue if it was always there as a backstop. Our starting position was perhaps we should abolish it immediately, but then we agreed there was something to be learned because it had driven efficiencies in the way people were doing things, given that there was price-setting involved. We believe there is a model that could be derived, not necessarily the same as the NTPF, but in that general direction. In the report we stated that if there was not a separation of the commissioners from the providers, one would want to move it into the HSE, which would make sense. One would want to have an independent group overseeing the process, as mentioned in the report.
Deputy Reilly asked about accurate and real time data in the system. There is no doubt that the system is not good from a data point of view, but one could become obsessed by the big giant IT project in the sky that would answer everything. The use of data at the point of decision making and having them available and transparent to people within the system are very important.
Deputy Jan O'Sullivan rightly pointed out that we had proposed a graded payment system for primary care rather than having a single universal payment at this juncture. I ask Professor Normand to address the matter.