Professor David Keegan:

I will try to answer this one briefly. Yes it is common. On the co-ordinated effort, it is part of lean and what we call the "just do its", when one gets a group of people together the stuff is so obvious we wonder why we did not do it. Deputy Shortall alluded to this earlier when we spoke about integrated care. One of the early things we did was a gap analysis. We considered our four key bits of equipment: a colour camera; an optical coherence tomography, OCT machine; a biometry machine; and an visual fields machine. These are the four core bits of kit. We then considered the staff to run it. This is in the primary eye care review under the heading of staff and includes a consultant ophthalmologists, orthoptists, optometrists and nurses. Then, when we looked around the region, some were very well staffed but had no equipment. They were in a very basic room with only so much they could do. Then the patient was sent on somewhere else in the system for that. Likewise, other areas had the bells and whistles equipment but only had a consultant in two days a week. The equipment was sitting fallow for the rest of the time. Mark Jeffrey and the office have done that gap analysis. The equipment ask in our budget submission is very targeted. For example, we need a particular piece of equipment in Beaumont Hospital. We do the cataract surgeries based out of Beaumont Hospital. We see some 300 patients per year who have to come to the Mater Hospital be seen in the clinic there, have tests done in the Mater and the surgery done in the Mater but then must go back to Beaumont Hospital for their follow-up. With the purchase of a machine the costs €70,000 those patients could get their tests in Beaumont Hospital and they would not have to come to the Mater hospital for anything other than their surgery and then go back. We are looking to recreate that across the hospitals in Beaumont, Blanchardstown, Cavan and hopefully Navan. We only need to lift up 7% to 10% in all of these areas. It is a cumulative effect. There is a gap. We have identified the gap. The request in our budget submission is that the gap be closed.