Professor Frank Keane:

That is a much more difficult matter with which to deal. What we are talking about here is someone coming in with an injury, such as a fractured arm, and being taken to theatre to be operated on under general anaesthetic or to have a cast put on. That is happening in many places. We have not reached the stage of adopting a programmatic approach to identifying specific common conditions which should go through a day case process. Again, it is a difficult one because people are often running their elective practices and dealing with acute admissions concurrently. So it comes down to the availability of staff. If a person comes in with a condition which could be dealt with on an acute day patient basis, it is a matter of having an individual of sufficient seniority available to carry out the relevant procedure. We are moving forward very quickly in this regard and we have written a model of care for elective surgery, which is mainly what we have been discussing at this meeting, and a model of care for acute surgery. What we are recommending is that we try to create situations in hospitals where there will be a surgeon on call to deal specifically with emergencies. Such surgeons will be taken away from their duties relating to their elective practices in order that they will be available to both assess and treat patients. We refer to them as senior decision-makers and patients will be seen sooner by them and given appropriate treatment.