Dr. Ambrose McLoughlin:

As for the small hospitals framework, this is a very important document and the work of Professor Higgins is very important. To be clear, in response to the questions from Deputies Fitzpatrick and Regina Doherty in particular, we will have intense consultation with clinicians on the ground and will engage with GPs. I note we have a structured approach to this consultation process. For example, independently of my Department, Professor Higgins is engaged in that dialogue at present. Moreover, there will be further dialogue. Deputy Doherty is correct, in that we must deliver the contents of these two documents in a way that ensures people understand it is about patients. It is about giving patients the best option, that is, the safest care possible. Deputy Fitzpatrick made a point that I would like to get across, which is that these smaller hospitals have a hugely important role to play in the future of our health system, and this will be clear when the documents are published. There is a range of services that currently are not provided in the small hospitals, which create pressures on larger hospitals to provide. Consequently, there is an opportunity for a market niche for small hospitals which, in my opinion, will bring about a pathway to an orderly, structured hospital system at local, regional, super-regional and national level. This is of critical importance.

As for the matters raised about the political and the parochial, while I am probably out of line on this, there will be a need for very strong political leadership across parties in this regard. Part of our strategy will be to engage, perhaps with this joint committee, and with others in the political system at a particular time to explain precisely what is intended in respect of the small hospitals framework and the new hospital groupings in order that the representatives of the people will have a comprehensive understanding of what are the issues. On the matters raised by Deputy Dowds with regard to the Health Service Executive, I will ask the director general-designate and chief executive officer to deal with that.