Mr. Liam Doran:

I can only echo Dr. O'Conor's point about integrated care. Everybody is for integrated care, with GP access to diagnostics and so on. I will give a figure for Kilkenny, although I do not mean to be smart because I come from Kilkenny. It does not please me to have to say this. In 2010, there were 140 people on trolleys there for the whole year. Last year, there were 3,144 people on trolleys. That is in a unit that has really worked hard and that has great people in the clinical arena, including Dr. Garry Courtney. They are just overwhelmed by a lack of beds and so on.

I can give some figures about the level of overcrowding. In Dublin in 2007 we had 27,000 people measured on trolleys and last year we also had approximately 27,000 people measured on trolleys. That number stood still with a growing population. Looking at the hospitals outside Dublin, in 2007 there were 23,000 people on trolleys but last year there were 66,000 people on trolleys. It has become three times worse outside Dublin because of the growth in the population, demographics, demand for services and so on. Even when we have tremendous integrated care and collaboration with the general practitioners, practice nurses, primary care teams and the acute hospital, if we do not have enough beds, the end game is overcrowding because the accident and emergency door can never close.

With regard to clinicians in management, I do not have to choose my words quite as carefully as my colleague, Dr. O'Conor. I do not have to go back to any hospital. We have heard the phrase "clinicians in management" for years and two issues arise, with respect. One is that general management do not like it; for example, they do not like putting nurses and doctors into management roles. It is a case of nurses nursing and managers managing. The other difficulty, with respect, is that clinicians at times find it difficult to move into the arena of the difficult job of management, where one must make choices. Nobody is in any way downsizing the challenges facing a senior general manager, who has not got enough resources to respond to need. It is very difficult. There is a clinical director who is supposed to co-ordinate the work of all consultants and, if we are brutally honest, that can be a difficult job for that consultant, as his brothers and sisters do not always like him or her because of what they are required to do arising from that management component. Clinicians have a clinical focus and they do not really want to do the management component. Clinicians in management sounds very good but it often does not happen as well and it does not make the material difference as one might expect.