Dr. Ronan Fawsitt:

With regard to the Chairman's third question about the structures of the CHO, there seems to be a misalignment at one level but we work on finding solutions to that. People can be creative. It is not an ideal start that they are not aligned but, at the end of the day, if there is a willingness to work with people, we can work with different CHOs and hospital groups. We can get around that if the relationships are right.

What is different about Carlow-Kilkenny is last night we had our LICC meeting, which was attended by 25 doctors, our manager, pharmacist, mental health psychiatrist, hospital manager and the CHO. We discussed issues such as transport of laboratory samples from a rural practice to the hospital in order that the rural practice can survive, communication, and the increasing number of scopes.

As a group, we came to share a similar view on many issues and on the fact that change was needed in some areas in respect of which we needed to improve. When one gets people in a room and breaks bread with them, one begins to trust, get ideas and scale solutions. That is what we have done over a number of years. There is no magic to it; it is about getting people together who have a shared vision and who make things happen. The projects that we mentioned in the submission are real, tangible and actually happening. When one sees a product like that year after year, one begins to realise that this process works. If I was looking forward, I would say that we need to develop those kinds of relationships everywhere in Ireland and that every acute hospital and CHO should be involved in this. It is already supported by the college.

The third point is about planning and costing. We are not health economists but what we have done is change things incrementally. We have come from a situation in which we had beds in corridors 20 years ago. We had admissions rights to the hospital and we used to admit our patients to the hospital corridor, which was not good. We sat down and asked, "Look, how do we fix this?". The idea of the acute medical assessment unit came up, again, from contact, trust and time. The costing model comes when one gets the work right. Once we have a sense of the right way to flow the work, it is then a job for a health economist.

I believe that people should have access to health care as a fundamental right. There is no question about that and I think we are all agreed on it.