Stephen Donnelly (Wicklow, Fianna Fail) | Oireachtas source

It is absolutely being taken on board. In terms of operational principles for regionalisation, it is exactly what we need to do. I passionately believe that the only way we will get the level of performance and change we need, on behalf of patients, is to empower our front-line workers to do the job they know how to do. I will give a very quick example of where it goes wrong and what we need to change. I was talking to an emergency medicine consultant before I was in office who told me that they were trying to set up a triage room in their emergency department, which is an absolutely basic operational procedure for emergency medicine. She told me that it took five years to get it in place. At the time her colleagues told her she was wasting her time and that she would be exhausted by the end of it. They got it after five years but she said to me it was the last time they were going to embark on that kind of local reform programme. That is a case of the system being stuck and buried in red tape and failing on behalf of patients. What we have to do is trust our front-line staff, our clinicians and our front-line management teams as well. In fairness, there are many parts of the system that are already doing this. We have to trust them to do the right thing in their local environment.

However, the flip side to that is that we need to know how it is going. One of the big problems we have in the system right now is that we do not know. We do not know, for example, how many procedures are being run per operating theatre in each hospital. We do not know how many scans are being run per diagnostic suite. We are not able to compare and contrast one hospital with another and say that it looks like hospital A is getting an awful lot more for the capacity it has than hospital B, for example.

There is wonderful change happening. I will give an example just from last week. I was in one of our model 4 hospitals and they brought me to the ophthalmology suite where they do cataracts. They have basically applied engineering principles and lean process design to get the patients moving through quicker. Believe it or not, they are going from an average of four and a half cataract procedures per session to 15. No one in the centre, be it politically, in the Department or in Dr. Steevens' Hospital can solve those local problems and spot those local opportunities. The only people who can do that are the people working in the community or in acute settings. We have to make sure they are free to do it but at the same time we need to be able to hold them to account and make sure that reform, change and improvement are happening.