Mr. Ian Carter:

While it is important or useful to be able to talk to one CHO rather than two or three - this is simple mathematics - the most important piece that is probably missing is not singularity in terms of engagement but the fact that we still do not have an agreed chronic disease pathway and set of objectives for how we move services to the community. While there can be changes in control - there are enough international models that have multiple or senior - the main piece that needs to be moved forward is an agreed pathway for how we manage patients nationally and locally.

In respect of moving funding from the hospitals to the community, 85% of what comes to our hospital is an exacerbation of chronic disease, ergo, in the majority of cases, the treatment should happen at an earlier stage with the hospital being the last bastion as opposed to the first. The key problem is the fact that whether we like it or not, if one is going to build a new house, one must leave the roof on the old house while one builds the new one. If we are going to develop community services capacity capability, we must maintain the existing system. If we just move things in the space of a year, we will automatically have immediate problems. It will take time to develop community services and during that time, we will still need to continue funding the hospital system.

Reference was made to private hospitals helping out. Again, the issue is that the majority of patients in our emergency departments are medical patients with acute exacerbation of disease. The majority of the private hospitals are treating elective surgical patients. Therefore, while they are of some use to maintain elective treatment capacity, they are not the main solution. The main thing for our group, specifically, is the ability to successfully discharge patients to the community. As it stands across our group, 151 patients are waiting for community placement. The greatest capacity gain for us in the winter would be the ability to move those patients successfully to the community.

Information technology is another issue. It is well recognised nationally that we have limited isolated poorly developed IT systems. The two key requirements from a hospital dinosaur perspective are the electronic patient record coupled with the national patient identifier. The benefits are significant. There are small isolated models in small isolated hospitals, but we are well behind and we do not have a national scheme either and consequently, our ability to talk across hospitals is further limited.

I was asked a specific question about targets and what I would cut if I did not achieve them. I have no plans to cut services this year. The targets are what we are aiming to achieve. We are comfortable that we will achieve them and there are no plans to cut services at the moment.