Mr. Tony O'Brien:

We have put in place a number of measures and the Minister has been central to this. The first is chronological waiting list management and the other is ensuring waiting lists are properly validated. One of the features of a system which has long waiting lists in multiple locations is that patients are often referred multiply for the same referral so they need to validate to make sure patients are not on their waiting list as well as that of other hospitals. Where they can identify that they simply cannot provide the treatment, whether it be with an outpatient or inpatient appointment or day case treatment, within the time required, they have to declare it to us centrally and we will then make appropriate arrangements, either for insourcing somewhere else within our system or outsourcing. The penalty comes from doing none of those things and allowing patients to go beyond the maximum waiting times without having taken appropriate action to enable the hospital itself or somebody else to ensure that does not happen. Solutions are available and the penalty applies where those solutions are not available. That is something to which the Minister has committed and to that extent, it is a policy issue. He has been very keen to ensure we implement it.