Changes are taking place and new patterns have emerged in the way medicine is delivered. If one is to have a consultant led service, one must employ a sufficient number of consultants to have proper rotas. They must also have a sufficient workload to enable them to maintain their skills, and interaction must take place between different places. These requirements drive one towards centres. Other developments, notably in telemedicine, will allow one to decentralise a considerable amount of diagnosis and after care. Changes are also taking place in the pattern of disease. Chronic and degenerative conditions are associated with ageing and, as the Minister stated, those affected by them are entitled to the highest quality of care at local level.