Éamon Ó Cuív (Galway West, Fianna Fail) | Oireachtas source

I am sure the Minister of State is absolutely amazed that it is nearly five years since her party entered government and that so little has been achieved. I know from experience that time flies and one suddenly looks back and wonders what was going on. I have believed for a long time that we are great people for changing structures but that we are not great at making the structures that are already in place work. We now have the Saolta group and various other arrangements in place. Ultimately, however, the people who go into hospital, who require day care or who need access to another service do not really care what is the logo of the entity providing the care. What they are interested in is the service. I believe, and most of us have this experience, that when one starts changing the structures and moving people around, what happens is that the real change being sought is delayed. The question we must ask is whether the changes introduced in recent years have actually had an impact. Unfortunately, the figures suggest that the answer is "No". Certain high-level ideas that were attached to getting rid of the health board approach were good. The idea of uniform national services, irrespective of where one lives, within reason is good. However, the old concept whereby every health board had its own standards, etc., was not good, particularly in view of the fact that ours is a small country. I have always been a great proponent of taking a strategic national approach, whether for ambulance call-out times or waiting list times. I have not, however, been a great proponent of changing management and board structures because much of this tends to be very disruptive in terms of solving the problems that exist.

I have often wondered if we should take a more scientific approach, such as that taken by somebody running a manufacturing industry, when dealing with the flow of people in and out of hospitals. Rather than changing the management, perhaps we should examine whether all the logjams are necessary. I often described the accident and emergency department process in a hospital as equivalent to a hotel owner insisting that everybody who entered the premises, whether they wanted a meal, a pint or a bedroom, should register first at the front desk. If that happened, there would always be a queue at the front desk waiting to register. In my humble view and as any analysis would prove, many people end up in accident and emergency departments who need either a patch-up clinic, involving X-ray and appropriate outpatient treatment before going out the door, or who should be admitted directly to the hospital rather than through the accident and emergency department. We should ask ourselves if there should be a minor injury clinic that would operate separately from the accident and emergency department. There should be a separate process for incidents that would very likely require admittance, meaning people with a condition that inevitably requires a hospital stay in a known department would not have to go next or near the accident and emergency department.

When I was a Minister I was fascinated by the fact that one hospital in Kilkenny never seemed to have a queue in the accident and emergency department. We never got an answer on why that was so. I do not know if it is still the case. I had an interesting experience of that when I attended a football match in Kilkenny. Five minutes into the second half of the match, one of the London players came down very heavily and was carted off to hospital. The match continued for another 25 minutes of play and the lads togged off before coming out to get on the team bus. They found that their comrade had been to the hospital, had his foot X-rayed to find it was not broken and was bandaged and strapped. He was sitting on the bus waiting for the others. Does the Minister of State know of many hospitals, even in their quiet periods, that would deliver such a service? It is absolutely vital that we start looking at the systems we have rather than all the time playing around with the top structures.

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