Dr. Ronan Fawsitt:

Deputy Brassil's question is apt. To respond to the question on how we will manage change, we must involve everybody and everybody must be at the table. This means creating the table and resourcing it. We have done this pro bonofor years but if it is to scale nationally, the State must invest in integrated care and integrated care committees. The amount of money required is very small but it would deliver significant change. This is a strategic issue which the committee could recognise.

As regards rolling out local integrated care committees, LICCs, nationally, this could be done very quickly. It should be recalled that LICCs have the support of the Irish College of General Practitioners, the primary care division and one of the hospital groups and there is no reason they could not expand further. What is needed is a decisive political push and a small amount of resources. I believe the LICC process could be fully engaged within 18 months and two years at the outside. There is no reason we could not achieve that. I speak to general practitioners the length and breadth of the country and they want to engage almost to a man or woman.

As Deputy Harty correctly stated, people want a forum to engage with their consultant colleagues. They do not regard their colleagues or management as enemies. However, they do not have any mechanism for engaging, which leads to frustration and arguments. We no longer fight, although we disagree and have robust disagreements, including last night when we disagreed on communication. However, we left the meeting as colleagues and friends, having thought about how we will fix the matter. The issue is one of culture but one also needs a structure. The 25 people in the room last night were disenfranchised medics from across counties Carlow and Kilkenny who are not getting anything done and are becoming peed off with everybody. The State must invest in this process.