Dr. Colin Doherty:

Neither of us is a neurosurgeon. I am wearing my management hat for the HSE, but to my right and left are people who are speaking in a very personal capacity. Their points are well made. I got involved in this because I think the most complex thing we do is deliver health care, and it must be delivered. People are crying out for process and data. When I started this programme we were a group of experts who were all providing care. If a person in Galway had epilepsy, their chance of getting the same type of care as a person in Dublin was minimal. It was all very different. Now, we are starting to standardise everything we do. I acknowledge the hurt of Mr. Lawless and the points he makes. He is crying out for a process to be put in place for what happens to people. That might be what HIQA meant to happen in 2010. It is a question of whether we, as a profession of consultants, have delivered on that process. That is where the concern lies. If I talk about what I am delivering on a daily basis, I should point out that the people I work with on a daily basis are crying out for process. Unless we put a process around it, it will not be fixed.

With regard to neurosurgery, there are numbers, resourcing and bed issues. However, one must put a process around this complex delivery of care. For example, I do not believe that one cannot safely manage a patient who has some neurosurgical issues in a distant centre, but unless one gets the governance right and somebody takes responsibility at the neurosurgical centre for managing a patient who is in a distant centre, they will never be looked after properly. There must be a set of trigger points for the movement of the patient. The patient must be moved according to a set of protocols. If the patient runs into A, B or C trouble, the ambulance service must deal with that as an emergency, like a 999 call. They are all process issues, not resourcing issues.