Mr. Tony O'Brien:

There are probably one or two but the key difference between some hospitals and others which have been able to improve performance has not arisen through sanctions but through help and support.

When a consultant gets to a position where he or she has such an outstanding amount, getting back into good order requires a huge effort and work on their part while we are also pressurising them to treat patients. It is often about providing the individuals concerned with supports to enable them to get their files in order so they can sign them off. The experience in hospitals which have been successful is that the support works. However, there have been instances, and will be in the future, where despite all of that if people really are not co-operating then the issue of whether a disciplinary offence has arisen has to be considered. Primarily the situation is one of support.