Professor Deirdre Heenan:

It depends how we frame what we are trying to do. If the public listen and hear "closure", "removal of services" and "things being taken from us", we cannot expect them to be happy. We cannot expect people from south Down, the rural area I am from, to say it is how great it is and offer their congratulations on more things going to Belfast, etc. These are the conversations we have.

In healthcare more than any other area of policy, this is about communicating with the public and working with them. It is not about the closure of hospitals. I am old enough to remember when Banbridge Hospital closed. The people of Banbridge thought it was the end of the world. Now, they cannot imagine that hospital being there because they have something that replaced it, namely, a multidisciplinary healthcare centre that serves their needs. The difficulty - I can only really speak about the North - is we do not have an overall plan for healthcare. If we had that plan, people would have confidence that it was not just about removing, removing, removing. Going back to my Tony Blair analogy, it is part of a grand plan. We would have evidence to say that people would have better outcomes. The question for the public is whether they want this service on their doorstep where they turn up in the middle of the night for gastrointestinal surgery with someone working on their own as a locum who perhaps has not carried out this operation before and the member of the public ends up with a colostomy bag, etc., or do they want to travel 20 minutes down the road to a team where they will walk out the next day as though it had never happened.

It is not just about saying, "I want this on my doorstep"; it is about saying the reality is that most medicine now happens in teams. We cannot have a team in every hospital. It is not physically or economically possible. Within those conversations we also need to ask what the role of Daisy Hill Hospital is. Will it be the specialist for orthopaedics such that it is kept open, it becomes a flagship hospital and everyone knows that if orthopaedics are needed that is where to go? What are we doing in the SWA Hospital? Why are those theatres not open? That is a public-private finance initiative we are paying for. There are big questions to which the public need answers. I think that if the public were convinced that in the end this would lead to sustainable, better health outcomes for them, their children and their grandchildren, we may not see as much resistance as we might think.

Finally, this goes alongside saying that if someone says to you it is 10 miles away and you are travelling 10 miles up the motorway, it is very different from travelling around Hilltown, Kilkeel or Rostrevor on roads with potholes and poor conditions in the winter, so we have to be cognisant that we often do not compare like with like.