Ms Eil?sh Hardiman:

I will take the first question. I understand this and I will have it verified, that the first technique referenced in the letter is an approved technique. However, I will have that verified. In regard to the issue of the clinical environment, we have excellent staff working in an inadequate environment. The difference in the theatre being put into Temple Street which is opening next month is of a higher standard than existing theatres. They are old. The hospital is 151 years old. There is only so much we can do within that. We were pleased to have that investment and we are making that change because our colleagues on the Boston team pointed out some safety equipment issues that would actually make the spinal services better. We were able to adapt that. We were only able to do it because the room being put in now is bigger than the existing rooms in the theatres. That is because technology and techniques have moved on and the hospital is not able to keep up. We have an excellent team. I would not like to think that we do not value and recognise that people are working extremely hard. We measure our outcomes in some of our services, in particular with cancer, and we are as good as anywhere in the world in that regard. The team is as important as the environment. We have constraints. This is why we went to the Boston Team. The Boston report says they have children who undergo surgery with a spinal curvature of more than 100 degrees, sometimes 120 degrees. They still do very complex spinal surgery but their outcomes were better than ours. That is why we looked at getting some examples of international comparators. It identified a technique that needed a longer rod than a shorter rod, particularly for a kyphectomy. That came from clinical expertise. We did it in a very collaborative way with the clinician, in a way of working together for the best. It was not done on two people. The clinician actually participated and welcomed the investigation. We want to do this together, to make the patient safer. I believe we have a lot of support across the hospitals to improve services. However, we are restricted in some of our facilities.