Leo Varadkar (Dublin West, Fine Gael) | Oireachtas source

What the Vice Chairman says is only partly true. An alternative access point is the day hospitals. I previously worked in a day hospital which provided in-house services for the elderly. The Smithfield unit has a dedicated frail elderly service. There are proposals under the national clinical programmes to do something significant around streaming frail elderly services separate from the rest of the emergency department population. Mr. O'Brien will elaborate on that issue later.

On Our Lady of Lourdes Hospital, on which Deputy Fitzpatrick made a very good contribution, that hospital is under a lot of pressure. It now deals with as many presentations as St. James's Hospital. It is a very busy hospital, which arises in part because of the changes made in Monaghan and Dundalk and a failure to provide it with adequate resourcing. We need to help out that hospital. Some of the suggestions made, including in relation to bed capacity, ambulance bypass and extension of the opening hours of the minor injuries unit, are valid. I do not think, however, that we should start re-opening emergency departments that were closed. Emergency medicine is not what it used to be. Some 20 or 30 years ago, a person went to the emergency department and saw a doctor who could do anything from taking out one's gall bladder to treating a heart attack, but that is no longer the case. To run a quality emergency department requires a critical mass of patients and access to many specialties. There is much talk about patient safety. It would not be in the interests of patient safety for us to re-open closed emergency departments. If anything, we need to continue reconfiguring our services in order that everyone has access to a level of specialised care. Doctors, nurses and midwives need to be seeing a critical mass of patients or they lose their skills. This is evident the world over.