Stephen Donnelly (Wicklow, Fianna Fail)
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In some areas, yes. Some outsourcing, if one could call it that, works very well, such as with GPs, pharmacies and so forth. We are all happy with that. From an ideological perspective, my view is that core services within the HSE should be delivered by it.

The Minister of State, Deputy Butler, may speak to it, but neither she nor I are happy with the percentage of private nursing home beds. It has increased dramatically. There needs to be a reset, and the commission that started earlier this year is looking at exactly that.

In the operational areas, agency is a big one. An agency is basically outsourced labour, mainly within the hospitals. It is a combination of medical, nursing and support. The Deputy mentioned radiology. I do not want these things to be outsourced. I would prefer that our agency bill was very minor and just used to plug holes where necessary. Part of using agency is we want to grow the services for patients quicker than we can scale-up the HSE. I will give one example and then I will stop. I refer to State-funded IVF. What was proposed to me was that we would build up new IVF clinics or assisted human reproduction clinics within the HSE and then make that available to patients as and when they became available. I took a different approach. I said we should make it available now. We use the existing private capacity while we build up the public capacity, and then transition across. The minor injury units is another example. There are a few privately run minor injury units but we want them to be publicly run. For me, it is less about cost effectiveness and more about speed of scale-up.