Mr. John Armstrong:

In the interim it is no different from any other organisation. We need to try to understand the sources of the costs. Procurement is clearly one. Obviously we have large staffing issues in terms of doing that and they have been addressed separately. They are issues beyond our health insurance market - the Croke Park agreement, etc. It is quite difficult to manage. Something fundamentally will change.

The incentives will change significantly when UHI comes because the funding stream will shift to insurers rather than directly to hospitals, in some senses, and the public system. That is a potential conduit for many changes. Potentially it will change profoundly the way work is done. Insurers may then have a responsibility to deliver a quality service to their members.