The Brennan report highlights the absence of organisational responsibility for the management of the health service as a unified national system and notes that there are no incentives to manage costs effectively, with inadequate investment in information systems. This may surprise some people but, considering the performance of the service, perhaps not. The report is critical of aspects of the role of consultants in the service. That role and the parameters of the influence of consultants in the hospitals will not be easily or quickly grappled with because they are historic in nature. The Minister faces considerable opposition from consultants who will be key to making health reforms work.