Dr. Grace O'Malley:

We would look to international best practice in this field. A hub-and-spoke model is usually recommended. Under this model, there would be a tertiary centre that can provide bariatric procedures in the most severe cases and spokes coming out from that hub. Thankfully, the UK's clinical excellence institute has already developed a whole framework. The Deputy referred to data. As part of the audit we do every year, we check how close to the standard we are and work with the business intelligence unit in the hospital in looking at the annual figures. When we look at non-attendances, for example, we try to see how we can change the communication on the letters we write to parents to ensure they feel welcome to come to the hospital. There is often an idea in health care that we should say "Tough - you are out the door" to those who do not attend. We have a duty of care to the child. If a parent is finding it difficult to attend, we must find out why that is the case and try to address those reasons.