We have three good reports. However, all will be for nothing if we do not implement them. Implementation is key and it must be a planned and clear process of change with clear accountability for making it all happen. Last June the Government promised to establish the new health service executive and the national steering implementation group, but these two important bodies have not yet been established. I am aware that senior management in the Department of Health and Children and the health boards are progressing certain aspects of the reports. However, we need an independent body to drive the reform agenda. Difficult decisions will have to be made. Current members of senior management of the health system would not be appropriate decision makers as they clearly would have a conflict of interest. We are talking about designing and implementing a new health delivery system, a mammoth task. The change must be centrally driven but with local ownership.