Ms Colette Cowan:

In UL Hospitals Group, we have a chief clinical director and four clinical directors working as part of my executive team. The clinical directors review the hospital in-patient enquiry, HIPE, data every month and meet every Tuesday morning at 7.30 a.m. to review a number of performance items on my behalf and report to me at performance meetings. We have seen skewed data at times. We have met consultants one to one about matters relating to the public-private mix across the hospital group and we are unique in the sense that we have clinical directors managing six hospitals within the hospital group setting. We do not have a private hospital and we do not have co-location; therefore, it is quite seamless and we know where doctors are working. We do not have to be concerned about people being off-site or working for 13 hours a week. The clinical directors look at the HIPE data. They meet individuals but there is a balancing act for us as an executive team. If we enforce the rules too tightly, people will leave the service and leave us with a situation where our service disimproves because a person has resigned or left the system. I mentioned Croom Hospital earlier. We have five orthopaedic consultants in the region, serving 380,000 patients. They do not just work in Croom elective hospital. They provide a five-day fracture clinic for me at a UL Hospitals, ULH, site, and 100 patients a day could attend those clinics. They also provide a seven-day trauma service. These people work for extensive hours across the sites and when the public-private mix changes or moves, those people are met and spoken to. I assure the public service and my colleagues in the Oireachtas and at this committee that we have a process in place.