Mr. Tony O'Brien:

We value the progress made at approximately €200 million. The challenge, however, is that extracting cash as a productivity gain, particularly in the area of roster changes and so forth in which consultants will engage, is a delicate and tricky manoeuvre. Their increased availability to treat patients, if managed correctly, will result in shorter lengths of stay and an ability to reduce the number of patients who require longer stays in hospital and so forth.

Extracting that cash will work well.

On the other hand, their increased availability can sometimes lead to increases in demand for services. A particular management challenge will arise as part of the implementation of this agreement. The overwhelming reality is that the implementation of this agreement will be very good for patient care, will enable us to provide more patient care within the decreased envelope and will present a particular challenge both for our clinical directors whose role will be strengthened as a result of this agreement, and for our managers in ensuring that we extract cost at the same time as we increase efficiency. Health systems are often challenged to do that.