The report is being presented against the background of an accepted myth that big is better and that big hospitals deliver better services. The Minister asserted this just a week or so ago in Limerick before the publication of the Hanly report. He said that evidence shows that patients receive better treatment in hospitals that have the required numbers of specialist staff, high volumes of activity and access to appropriate diagnostic and treatment facilities. I put it to the Minister that big is not always better. For example, there is only one hospital which has conducted a study and published data on survival rates following acute myocardial infraction. The figures compared favourably with a relevant international trial. That study was conducted by Nenagh Hospital. I have heard it asserted, particularly from medical people, that one could not possibly get good service from Nenagh Hospital. The opposite is the case. The quality of care, delivery of service and value for money in that hospital are exceptionally high. Figures published by the Department of Health and Children prove this. The case I am making is not only that big is not always better, but that in this country "big" has become "worse". Looking at the larger hospitals such as the Mater and Beaumont, it is clear, particularly at accident and emergency level and at acute level, that the care is not as good as one would get in the small hospitals.