Mr. Tony O'Brien:

If we break the demographic profile down between immediate and longer-term issues, Deputy Kelleher was correct to say that the changing demographic profile presents a long-term challenge for the entirety of the spectrum of health and social care services. The needs and intensity of our population will change. The challenge of providing the right resources in the right place, in particular for the increasing cohort of older people, is enormous. We will have to face up to it in the coming years.

What has happened in the recent flu season is not unique to Ireland. It is true for the whole island of Ireland, our nearest neighbour and European countries. The relatively late onset of the flu season and its sustained nature had a particular impact on elderly people. When flu season happens later in the year the potency of the vaccine programme is lessened. There is, therefore, more incidence and often people are much sicker. One of the characteristics we experienced was the substantial number of people presenting in the elderly age range, a much greater percentage of whom needed hospital admission. Many needed intensive care and respiratory assistance, which led us, in a phased way, to step back on elective admissions, to accelerate 400 additional places in the fair deal and, ultimately, to temporarily step away from chronological management. As the first step in the fair deal was to accelerate the number of places by 400, at no point in time did anybody who would otherwise have been in receipt of funding approval for the fair deal get one later than he or she otherwise would have done.

When one takes the two measures together, persons who would ordinarily have received their approval during the period when chronology was suspended had already received their approvals by virtue of the accelerated 400 places. There is no instance of an individual having been directly disadvantaged by the temporary pause in chronology. Interestingly, during the chronology pause periods we instituted a procedure whereby anyone in the community who was experiencing a particular need could be accelerated, which would not normally happen. A number of persons whose personal situations were deteriorating were accelerated on medical grounds.

On geography, the reality is that those who were treated and in need of long-term care in the six major hospitals in Dublin and Cork University Hospital, which is a major academic teaching hospital providing tertiary and quaternary services, do not come from those regions alone, rather, they come from around the country. In the best interests of the totality of care we can provide to older persons, because many of those would otherwise have been waiting on trolleys and would have arrived into emergency departments from long-term care, it was the appropriate thing to do.

With regard to the ambulance service, I will ask Ms McGuinness to speak to the non-emergency patient transport issue and the Hollybrook Inchicore issue. The Deputy referred to two tragedies. In the first case, the issue was not ambulance response times. The newspaper that reported that it was subsequently retracted it and apologised for the story. I recognise, however, that it gives rise to a generality of concern. Some people saw the story but not the apology.

To be clear, the ambulance response in that tragic situation in which a child sadly died as a result of the initial drowning incident was appropriate. In the case of the second, we have questions and I have outlined what they are. The review will proceed. This year significant investment in the ambulance service is taking place, in terms of additional intermediate care vehicles and personnel, in order that emergency ambulances are freed up and reserved for that purpose. We are also bringing our ambulance control system into line with international standards. There will be a significant investment with a progressive centralisation of ambulance control functions that will enable the totality of our emergency ambulance fleet to be used much more effectively and in a much more controlled way.

I will briefly address one of the issues raised by Deputy Byrne. She did not name an individual, but by telling us what he does and where he does it she has identified him fairly comprehensively. It is important that I speak up on his behalf. He is a distinguished and committed public servant. Like many of us, we often find ourselves being photographed with delegations of various kinds from all parties and none and various groups. Where those photographs subsequently end up is something over which we have limited control.

While I can see from what she described that it would not seem to be the most appropriate use of his image, I suspect he had no control over it whatsoever. I recall when I was director of BreastCheck that every time a mobile unit rolled into a place for the first time many stories would appear in the name of various local politicians, councillors or mayors, explaining in great detail the meetings they had with me and the extent to which they had lobbied me, but frankly I had never heard of them. The rush to claim credit for various things is a particular phenomenon and I do not think the individual should or can be held accountable for it. I understand the concern the Deputy had.