Mr. Stephen Mulvany:

If we take the numbers awaiting admission - the trolley count - as the measure of how a hospital is doing in unscheduled care, which is just one part of its business, I will not be able to list them all off from memory, but the obvious examples are University Hospital Waterford, Midland Regional Hospital Tullamore, Beaumont Hospital and Drogheda. Any trolley wait is unacceptable, but we have a list of hospitals with us that have a low level of trolley waits, if that is the measure of performance in this instance.

In some cases, the level of trolley waits is due to the overall imbalance between capacity and demand. Some hospitals have less of an imbalance. For example, some have been able to get additional beds. Others may have got additional beds but been unable to use them as a catalyst to make change. The hospitals that do the best tend to have a combination of capacity and a better grip on process flows, although this is not always the case. I was in Clonmel hospital recently. It is a medium-sized model 3 hospital that has a strong operational grip. It has 209 beds, so it is not overly resourced in that respect. It has a relatively low level of trolley waits, although this has increased recently, with the hospital being unable to keep up. As in Waterford, it has a strong grip on its processes, given its capacity.

Therefore, there is no one factor. We have to be careful not to be simplistic. That said, we accept the point – and I certainly, as CEO, accept the point – that we need to help all of the sites make ongoing systems process improvement. There is not a process anywhere that cannot be improved.