Dr. Tony O'Connell:

It is a long time and it is a slow process. We are attempting to convince individual surgeons that they need to improve their rates, but ultimately they will make the decisions. Over a period of time we hope there will be a number of prominent clinical champions for these new ways of doing business who will drive a change in behaviour. There will be an opportunity to incentivise through different funding arrangements. We could quite artificially alter the reimbursements in the new activity-based funding arrangements, for example, by preferentially rewarding hospitals for doing day cases. In other words, we would pay them above cost to carry out a procedure as a day case, and below cost for in-patient care of equivalent procedures. There would then be much more local pressure from the hospital managers, who have to deal with the budget, on people they bump into every day in the hospital.