Mr. Tony O'Brien:

Obviously the culture on this has to be influenced by top-down behaviour. At present, I am carrying out performance meetings with a number of hospitals on their financial performance and I am specifically excluding from this the issue of health insurance generated income. I am certainly not putting any pressure on any hospitals in relation to this particular question, even though there are variances on that income against original budgets. Our performance dialogue is much more on the expenditure side, specifically because of this issue. In our performance process we are not pressuring the hospitals to do better or to do more on this. With regard to the traditional levying of insurance charges for elective treatment, we do pressure them to make sure they do not allow forms to go out of date. It is a discussion we have had here many times.

This is obviously a new component. There is no pressure within the organisation, undue pressure or pressure to maximise this form of income. It is a reality that it is a line in the budget because that is the way the budget is received.