Mr. Paul Reid:

I will make a few comments. I might ask the chief clinical officer, Dr. Henry, to come in on a couple of them.

The first point the Chairman mentioned relates to the challenge of delivering the service plan in light of increased service pressures. That is a matter on which we are working through with the team. In terms of the processes that have kicked off, I will get a review back from all areas. That review will include proposals to come in on budget but within an overall framework of quality and safety. When I get all of that information, we will be in a position to review and assess the overall commitments on the plan that we will set out to deliver, which areas of the service are under significant pressure and what choices we must make. It is a process that we are working through. The Chairman summarised it well. It is a challenging process because of the upward pressures that exist.

On the overall perspective of the service plan, moving to new models and innovation, I referred earlier to the community health networks that are being set up across the nine areas. That is the start of the process to examine the issue of acute hospital services and community and primary services working closer together. It is a pilot programme across the nine sites. Ultimately, it is at a micro level and the model that we are moving towards will be at the macro level. We will assess the benefits as we move forward.

The Chairman summarised where matters currently stand, namely, we have an acute service under pressure in terms of capacity and demand and a community service that is under pressure in terms of the availability of step-down facilities, etc. Those are some of the areas we want to look at in greater detail in the context of facilitating better alignment and with regard to the working relationship between the acute facilities and the community side. Overall, it is, as the Chairman described, very challenging.

On elective care, earlier I summarised that there has been some progress. The NTPF has been part of the solution, but so have our own services and the work of consultants. Dr. Henry may want to add to that overall.

In summary, it is a very challenging process. We will be working through it over the next few weeks in the context of looking at the outturn for the year, providing a safe quality framework and making judgments in terms of how we prioritise within the budget for this year. Notwithstanding the challenges we face, we have significant extra finances available this year as a result of uplift we have been given by the Government. We want to ensure that we use this money in the most focused way possible.