John Crown (Independent) | Oireachtas source

I also wish to welcome our guests. As somebody who has been a consumer of the ambulance service on the medical side for a long time, I would like to ask the witnesses to address two specific operational questions, one of which is Dublin specific. The situation is common in Dublin whereby the emergency ambulance will be called to somebody who has got an existing relationship with a hospital for a specialist problem. My own perspective in this is that it is often for oncology or cancer, but it could just as easily be for cardiology or diabetes. It seems to me that there is not any discretionary authority resting with the ambulance crew to bring a person to the hospital where their records are and the specialists who know them.

I can understand how organisational questions can determine where someone must be brought, but there is a downstream consequence to that as well. The quality of care a person receives will obviously be better if they go to the place where their relationship exists. Very often, however, in the course of that admission they will be transferred back to the original hospital in the cold light of day when a decision is made that it makes sense to go to that institution for their care. It is one area of policy that could be examined. Without having a free-for-all where everybody goes to a particular institution because it may be popular, could people produce their outpatient cards to show where they have previously attended for treatment?

My second question concerns part of a bigger problem that I worry about a lot, which is the treatment of head injuries. In Dublin and most of the rest of the country, head trauma is concentrated in a very small number of units. Effectively, for most of the country it is in Beaumont Hospital and also in Cork. Really great people work in Beaumont Hospital under difficult circumstances. Without going into my usual song about the shortage of specialists, we have an absurdly small number of neuro-surgeons. As a result, I have come to the opinion - I am sorry if this will make me unpopular, but I have to say it - that we have put together a number of band-aid solutions to try to work the best kind of emergency head injury care we can into the small number of resources we have made available for it. This causes problems because for the kind of head injury for which a surgical remedy is appropriate, necessary and potentially successful, the last thing one wants is delay.

With the best will in the world and no matter how people try to work it, an instant problem is built into a system whereby people are not discretionarily brought to an institution that does not have on-site neuro-surgery for something which is clearly a serious head injury. We need some kind of triage system for emergencies - such as burns, head injuries or penetrating chest injuries - so that they will go to the place which is most suitable to deal with them. We do not have one hospital in Dublin city that could deal with all these problems, including a very complicated trauma involving penetrating heart injury, a head injury plus a burn. That kind of thing can happen. The reason we do not have such a hospital is that we have disbursed our resources across a somewhat unusual number of hospital sites.

As part of that process, there needs to be some better system of getting people with head injuries to the place where they can be looked after. It troubles me a lot because over the years I have personally seen such problems.