Some patients who have been in serious accidents and suffered major injury are being brought by ambulances to the wrong hospital where they can only be stabilised, Health Minister Leo Varadkar has admitted.
"We have a huge place to go when it comes to improving our ambulance services over the next couple of years," he told the Seanad.
Senators had earlier described the long delays endured by patients in counties such as Kerry.
People who have suffered a heart attack or stroke can wait an hour before getting an ambulance.
Mr Varadkar said some seriously injured patients end up in local hospital emergency units, where they are stabilised.
But there can be "huge difficulty involving lots of phone calls" to get them to a hospital which can properly treat them.
Just adding more ambulances to a service which is not designed in the right way would not achieve the results needed, he added.
Referring to proposed changes in the medical card scheme, he said it is planned to make it easier for people without a medical card to get access to therapies and expensive appliances.
However, he indicated this will face delay because primary legislation is needed to allow it to proceed. "We may need two or three steps in doing what we are trying to do," he added.
He also revealed:
• It will be the end of next year before Breastcheck starts rolling out to older women.
• Medical cards for the terminally ill will no longer be subject to formal review.
• Despite changes to the discretionary card scheme, it will still have difficulty dealing with cases of people who are in the middle ground of medical need.
He said it will continue to be difficult to know where to draw the line but the hope is to refine it.
The minister was urged by several senators to visit the overcrowded A&E departments of their local hospitals.
However, he said it will be more useful for him to spend 80pc of his time in the Oireachtas and his department.
The other 20pc will be spent in his constituency and seeing facilities.
"Some ministers spend their time touring the country but "not getting down to their desks," he claimed.