Mr. Bernard Gloster:

I thank the Senator for that and his kind words. It is lovely to connect with him again. As he said, we have worked together over many years.

On the emphasis of the issue of people with a disability, I cannot emphasise enough the importance of us changing our approach and our response to that. Recognising many good people are doing good work today, we need to make a step change in that.

On the management process change from 1 April and how that will benefit UHL, it will benefit UHL in the same way that it will benefit the totality of the healthcare system. When I look at regions, geography and counties, I do not just look at the individual hospital, rather, I look at the totality of the health service within that. The totality of the health service in the mid-west, where UHL has its footprint, is UHL, mid west community healthcare, the National Ambulance Service based in that area and all of our functions, estates and so on. It is a totality of a health system. To be fair to the people leading the hospital there, we have to represent and push the entire system as an entire system. That is the first thing.

On delayed transfers of care, I met the senior leaders of the mid-west last Wednesday night with the INMO as it happened. It was my first service meeting in the job. It was not because I happen to be from Limerick – I emphasise that. It is just the way it emerged – I promise, Deputy Durkan. I am a CEO from the mid-west but I am not a mid-west CEO. In seriousness, they have made improvements around things such as delayed transfer of care. To be honest, I have been relentless in the past few days in pushing the entire system. The day before yesterday, we had some 440 people waiting for a bed in hospitals on trolleys in emergency departments across the country. That was only achieved because of a huge pressure coming into the weekend to get discharges and other things done.

On the same day we had 440 people waiting for a bed, we had 600 delayed transfers of care. I cannot accept that this requires buildings, new beds or additional other things. Some of those cases are very complex and there is not always an easy solution. There might be major rehab or a major impact of drugs on the life of somebody. There might be horrendous social circumstances, such as homelessness. However, I cannot and will not accept that. I have told both the hospital chiefs and the community healthcare chiefs that I will not accept it is reasonable even today to have 600 delayed transfers of care. For every one of those delayed transfers of care that we can move more speedily and take solid, quick decisions about, that is one fewer person admitted to hospital waiting on a trolley. I am focused on that.

The process I initiated that will potentially benefit the mid-west the same as other areas is exactly what I said to Deputy Cullinane. It is a way of performance managing the totality of the system. Rather than saying what works in Waterford or Dublin – and there are many good things that work in Limerick that other parts of the country could learn from too, to be fair to my colleagues there – I have to go to a position very quickly whereby if something is working in a particular area of the country, particularly a management process, there is very little room for every other area of the country to say why they are not adopting that same approach. Mandating and performance managing that is probably the piece that might help a little bit. However, it is a long way to go. The experience of the mid-west, as the Senator know, is challenged.

On the configuration of the model 3 hospital and the blue light position, it is a difficult question. I have heard questions and calls about reopening Nenagh, Ennis and St. John’s and so on. Those might appear easy solutions to people in the short term, and I can understand where people might default to that position because of their dreadful experience. The reopening of a blue light entry to a hospital requires not just an emergency department and emergency department consultants, it requires intensive care capacity, advanced life support capacity and all of those things that go with it. We know that if you do not have all of those to that standard, it is difficult. There is not an easy answer to that. I could not give the Senator a simple answer and say “Yes” or “No”. There are other things we can do first and that is where my focus has to be.

In the case of UHL, which already has planned 96-bed additional capacity, my job is to see how I can drive the entire system that builds, staffs and configures that to shorten the time.