Mr. John Hennessy:

I would be happy to do that.

Dr. Hanlon might deal with the diagnostics and minor surgery initiatives currently under way. If there are opportunities to cluster those in isolated areas in the west that would sustain that in a more efficient manner, we would be very pleased to examine that.

Mr. Pat O'Dowd might address the question on the rural practice allowance but there is a published rules set in regard to qualifying for a rural practice allowance so I would be surprised if anybody would be surprised by the outcome of an application for that. The new rules set put in place this year is intended to make the scheme more transparent and ensure that there is consistency throughout the country.

The issue about distance coding is interesting. I am sure issues such as that will be put on the table in the current round of contract negotiations.

My understanding is that was part of the financial emergency measures in the public interest, FEMPI, reductions in 2008. In terms of targeting rural practice, there are questions around how much targeting there should be. I understand all GPs benefited from the distance coding.

On Deputy Healy-Rae's questions, I do not accept that the health service is a shambles. In fact, the evidence shows the vast majority who encounter the health service come away with a positive experience. However, I readily acknowledge that is not everybody. We have significant pressures in emergency departments and elsewhere, and constant problems and emerging needs have to be addressed all the time.

On the St. Mary of the Angels point, there is, as the Deputy will be aware, a policy relating to decongregated settings and the expert advice is that we need to move patients out of congregated settings and into normal domestic environments. I appreciate that involves change and that is always difficult. It has to be done in a sensitive manner, with good engagement and consultation with relatives and families, and over time in order that people make the adjustment, but the advice certainly is that in the long run it is the better option for the patients. I take the Deputy's point that it has to be done carefully and sensitively.

On graduate GPs going abroad, we have always had a certain proportion of newly qualified medical staff and other health professionals going abroad to get experience in other jurisdictions which has always been regarded as a positive development. Thankfully, we see a flow back as well in that, in time, a substantial proportion of those will come back. I expect that will be the case in the future, particularly as we make it more attractive for people to come and work in the Irish health service.

The point about the wards in University Hospital Kerry could apply to any hospital around the country. Capacity issues are a pressure point there. I repeat the point that our policy and plan would be to move as much care out of the acute hospital system as is possible and provide more comprehensive routine care in the primary setting, and with the support of general practitioners.

The Deputy's point about home help expansion is acknowledged. It is a crucial need and will be for some time.

On the Deputy's last point about ambulance services, most would readily accept that the ambulance service and the transport system for inter-hospital transfers is a crucial part of the change agenda relating to the health service of the future. We are seeing a significant modernisation programme in the ambulance and transport service where emergency response is now being defined in a much different way where we have early responder programmes and support for those, especially in rural areas. Together with inter-hospital transfer, routine transport and probably the further development of the air ambulance service for real emergency cover, it will be a significant feature in the future. I will ask Mr. Hayes to answer a couple of the points raised by members, if that is okay.