Mr. Shaun Flanagan:

The National Centre for Pharmacoeconomics is a recommending organisation, which the HSE asks to commission a health technology assessment. This involves the HSE drugs group, a committee of which 50% to 60% are actually clinicians. It reviews and assesses the assessment and evidence synthesis Professor Barry has done. It also challenges my unit, which is responsible for the commercial negotiations, on whether we have done a good enough job. There are steps within the process. The HSE drugs group makes a recommendation to the HSE leadership team, which looks at everything de novoand challenges all of the assessments and judgments made throughout the process and comes to an ultimate decision. There are steps in the process where all of us are challenged internally in the HSE. Obviously we also have a significant amount of external challenge and viewpoints on which we must reflect. All the way through the steps no single person is responsible for the decision. Everyone is answerable, everyone's recommendations are challenged and my work on negotiations with pharmaceutical companies is challenged by the drugs group. I am frequently sent back to try harder and do better. This is part of the process.

Deputy Brassil asked an earlier question on the frequency of meetings. The HSE drugs group is scheduled, and when it was incorporated it was scheduled to meet four times a year. It has already met six times this year, so it meets monthly to try to get through as many products as it possibly can.