Dr. Tony O'Connell:

At the moment, the level of bed occupancy in Ennis and Nenagh is slightly lower than the level in Limerick. I think that is a palpable reason to make more use of those hospitals. That would require a more aggressive approach to how we move patients. There is an opportunity for a kind of step-down, back-transfer way of approaching patients. After they have had their more complicated procedures in the largest hospital, they could move back to a hospital closer to home for the lower-acuity end of their stay in hospital. We have already started to provide for much more use of Ennis and Nenagh hospitals along these lines. I referred earlier to the increase in day cases and things like endoscopies, etc. The Deputy also raised the separate issue of how to make more appropriate use of the beds that are available. I am disinclined to promote use of the medical assessment unit because I think its advantage lies in its ability to churn patients through rapidly. It makes sure they are given a kind of holistic assessment with a level of clinical input. They are then moved to an appropriate place in the community, if that is reasonable, hopefully with minimal double handling.