Mary Harney (Dublin Mid West, Progressive Democrats)

It has begun and many patients have been moved out. The plan captures many of the actions that must be taken to address the problems. We have allocated priority funding of €80 million this year, clearly not as a total investment in accident and emergency solutions but on top of substantial funding for hospitals, long-term care, home help, primary care, GP co-operatives and so on. Our actions are also being implemented in conjunction with our capital investment plan of nearly €3 billion up to 2009. Additional actions are needed that are not about funding but more about management, work practices and processes in hospitals, which the Health Service Executive will address.

No plan can work without people implementing it. Health is all about people, about the patients, their needs and the people who have the expertise, training and commitment to deliver services. We cannot achieve improvements in accident and emergency services without change. More of the same, even a lot more of the same, will not work. More beds, hospitals, nurses, consultants, resources and pay on their own are not the solution. When the IMO and others rightly say we need a whole system approach, this means whole system change, not just a wholly bigger system. Would any of us tell patients that the existing system is fine, it just needs to get bigger?

I am urging all of us involved to embrace change to make things better for patients. Doctors, nurses, politicians, administrators, hospital managers, cleaners and caterers are all involved. We can each play our part in delivering that change. The health system is not an anonymous machine to which we are all subservient. It amounts to the way we work together, the rules, processes and procedures that have grown up and are perpetuated. The system is ultimately under our control, not just mine as Minister, not just this consultant or that nurse, this manager or that chief executive, but all of us working together.

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