Mr. Tony O'Brien:

I will respond to questions in the order they were asked. On the hospital group report, we have not substantially taken the financial impact of hospital groupings into account in the service plan because it is not our expectation that there will be significant yield from that this year. Our expectation is that Government will conclude its deliberations on that issue in the coming weeks, make its announcement and then assign responsibility for the implementation of groupings to the HSE. We will take that forward on a group by group basis. It is logical to expect that the different composition of the groups will create the different dynamics around the process and pace at which they will move. There will be significant potential benefits of various kinds arising from the groupings. There is no particular dependency on this in terms of the financial arithmetic for this year.

The small hospitals framework, which arises from the Health Information and Quality Authority, HIQA, report, which we refer to as the Ennis-Mallow report, relates to the following hospitals: Louth County Hospital; Our Lady's Hospital, Navan; St. Colmcille's Hospital, Loughlinstown; Bantry General Hospital; Mallow General Hospital and the Mid-Western Regional Hospital, Ennis; Mid-Western Regional Hospital, Nenagh; St. John's Hospital, Limerick; and Roscommon General Hospital. This is primarily an issue of ensuring patient safety arising from the HIQA report rather than one of cost. There will be other potential benefits arising from full implementation of the small hospitals framework and the groupings, which has a direct bearing on the subject matter discussed by the committee at its meeting on Tuesday, including compliance with the European working time directive, cross-covering in various disciplines and ensuring that the overall resource in a given area, including staff and so on, is used to provide the maximum possible range of services. For example, in Roscommon General Hospital, which is now part of the Galway-Roscommon University Hospital Group, there have been significant performance and operational benefits arising from the creation of this group. We have also seen a significant increase in the level of activity at that hospital following the changes which occurred there the year before last. The hospital is busier in terms of day cases and so on. These are the types of changes we expect to emerge. There are dependencies but these are not service plan financial dependencies. We keenly await the outcome of the deliberations so that we can give effect to these proposals before the end of the year.

On medical cards, I will ask my colleague to address the detailed mechanics of that process. The target is 40,000. There are some policy determinations yet to be made and provided to us, which will cover the detail in that regard. We expect to have those relatively soon.