Dr. Ambrose McLoughlin:

I am very happy to help the Deputy. The position is that the Department has been working with many interests on the development of the small hospitals framework document. Simultaneously, a group under Professor John Higgins is examining the future configuration of hospital groups. These matters will be addressed by the Ministers and Cabinet sub-committee in due course. I do not have the precise timeframe but expect that the document will be published in due course when the decisions have been made at a political level. Professor John Higgins is working around the country. There has been fairly intensive consultation. Even after the publication of the reports, I am sure there will be continuing dialogue with a view to shaping the very best hospital system possible for the people.

I do not want to get into the issues associated with coeliac disease. I am very sensitive to the fact that there are those who may feel aggrieved at the decision that was made. Gluten-free produce is available in normal supermarket chains now. Gluten-free flour, for example, is a lot less costly than it used to be and is available in the large supermarket chains for between €2 and €3. One can buy products that were not available heretofore. Through the health system, such products would cost €9 or €10. I saw a price of €8.93 charged by a community pharmacy. We are in very difficult economic circumstances and no item of expenditure can be excluded. I do not want to be seen to be avoiding any area. In fact, the value-for-money report on disability identifies a number of areas that will have to be examined carefully to determine whether value for money can be obtained. Unfortunately, we are where we are and must live with the reality of the challenging economic environment.

Moreover, as a Department we must work with the HSE in a collaborative and cohesive manner. I assure the joint committee we work very collaboratively with all in the sector and this will be continued as we roll out the strategy.

I wish to take up the point made by Deputy Healy. The strategy is very important because one must know where one is at a particular time. One must have an idea about where one will be in three years' time and how one is going to get there. Consequently, the three questions are: where is one now, where does one want to go and how is one going to get there? This strategy maps out that process in a systematic way and I am hugely confident we can deliver on this and deliver the programme for Government for the Ministers. In that context, I am happy to inform members there is a strategic framework document, which is to be considered by the Ministers and subsequently will be managed through the Cabinet and the Government. There will be a publication in due course and I expect this will be done in the coming months.