Dr. Emily O'Conor:

The Chairman referred to the medical assessment unit, MAU, model in County Kilkenny. No matter how many doors one puts into the acute bed pool, one still needs the same acute bed pool. Whether patients come via GPs directly to wards, via the MAU or through an ED, MAUs are not the solution to overcrowded emergency departments. They offer an alternative process to getting to the acute bed but they will not solve trolley waits. Kilkenny is experiencing significant trolley waits despite having an MAU at the moment. If one only has 20 chairs, and one has 50 patients trying to get into them, it does not matter how many doors one puts into the room; they will not all get a seat. We must remember that when we are talking about processes.

I can only speak for myself and I must be careful because the meeting is in public and my hospital manager probably has access to it. What I experience is a tiered level of management. I may have a good relationship with my local hospital manager but I work in a HSE hospital and much of the real decision making seems to be happening at group level and I have no access to the group CEO. I depend on my voice being transmitted through the management executive team up to where the power and the money seem to be, which is at group level.

I am only one of many problems faced by my hospital manager. She is trying to do the impossible task of managing elective bed capacity versus emergency bed capacity. On some days, the elective care waiting lists are more of a priority for her boss and sometimes the number of patients on ED trolleys are more of a priority in terms of the pressure coming down from her boss. Sometimes, no matter how loud I shout, the elective care cannot all be accommodated in the same acute bed pool. Sometimes my voice seems to get through and at other times the voice of my surgical colleagues seems to be heard best because the emphasis is on waiting lists. I would love to be more involved in management locally and I would love to have access to the real decision makers who seem to be the CEOs of hospital groups.