Dr. Matthew Sadlier:

The number of hospital beds is related to the population. The population is expanding so our need for beds is expanding.

I wish to come back to the core issue about vocation. I would not consider myself old but there has been considerable change from the time I graduated in 1999 to now. If a person had a stroke and came into a hospital 20 years ago, when I graduated, things were different compared to now. The possibilities now include thrombolysis or trying to melt the clot and restore the blood supply to the affected part of the brain so that the patient has a limited deficit from the stroke. If a person had a heart attack when I qualified the management of those procedures was markedly different. In the first days, it was pain relief and then into cardiac care and hope for the best. Nowadays, a patient can have angioplasty or have the clot removed. The damage to a patient's heart muscle can be minimised.

I am unsure whether the county manager job in the past 20 years has moved with the technical changes we have seen in medicine during the past 20 years. That has led to a difference. I agree 100% that this has had to lead to a difference in how doctors work. We have had to become a little more specialised. We have had to become more specialised towards individual skills and procedures. If I was a patient and had someone sticking a needle into my groin that would go all the way into one of the arteries in my heart, I certainly would want someone who was doing that procedure every day of the week, and not a general county physician who was doing it every third Tuesday. The difference in medicine in recent years has been phenomenal in terms of the benefits we can give to patients. The treatment survival rates in cancer care, cardiovascular disease and stroke have been phenomenal. We want everyone in the country to benefit from those technical changes. They should be available not based on where a person lives but available to everyone in the country.