Mr. Tony O'Brien:

To return to the nursing unit registration issue about which Deputy Healy asked, what I was referring was the fact that a long stop date has been put in place by HIQA for compliance with the registration requirements. Interim registration was granted on the basis that, over time, full compliance would have to be achieved. That date is mid-year. Some of the stock to which I am referring is actually original work house stock in terms of footprint and in terms of the fabric of the external buildings. The regulations are correct. It is appropriate that we move away from essentially ward-type accommodation to more suitable accommodation – single and double en suite rooms and so on. At present, we are not in a position to do what would be necessary in order to meet the requirements of compliance by mid-year. However, there are processes in place and under way designed to address that issue but, at present, we do not have that funding in place. That is what I was referring to there.

In regard to the registration of nurses and doctors returning from abroad, I think it may vary depending on whether the individuals continued to pay a retention fee. Where they did not, the regulator will go through a process of verifying qualifications and so on. That is not something in which we have a role but clearly it is important and we have seen recent incidences which have emphasised the importance of that checking process to ensure people are registered only on the basis of their strict entitlement to be registered. There can be variability, depending on where people have been in the meantime, the availability of records and their ability to demonstrate their practice and professional compliance in the meantime.

In regard to Hollybrook, the Deputy is right in that the facility has been used to facilitate the decant of what, I think, was called "hospital seven", which was a medium to long-term facility on the grounds of St. James's Hospital. During the redevelopment there and at present, it has not been available for the originally intended purpose. Against that, under the €25 million programme to which I referred to earlier where Dublin has been prioritised, in particular because of access issues, St. James's Hospital has been prioritised with 15 short-stay beds and 40 packages, which are designed to specifically address the issue of patients in that hospital who would be from its hinterland and catchment area. However, the Deputy is right the facility is not being used for the originally intended purpose.

In regard to the overall issue of budgeting, every western society which seeks to run a comprehensive health care system is facing the same issues as we are. Some people use inflammatory language, such as demographic time bomb and so on. There is a requirement for us to re-engineer our services in order to take account of the fact that an increasing proportion of us will be living longer. Hopefully, we will all achieve that status. Some of the things Dr. Colm Henry spoke about are necessary for the re-engineering of our pathways which take account of the fair deal scheme, home care, acute hospital systems and so on.

In response to Deputy Doherty's question on budgeting, we seek, with our colleagues in the Department of Health, to reach an intelligent view of what the future requirements will be and then we have to take account of what we get and how we can apply that. Those two things are not always the same. That is the reality.

In regard to the cancellation of elective procedures, which was Deputy Ó Caoláin's point, at present, I do not have a figure which I can give him. This is a real-time situation. It will obviously be influenced by how long current pressures exist and what the weather, which it is being unkind to half the country, in particular today, does to us and, indeed, what the influenza-like illness index produces. We are now in the 'flu season. We have seen our first spike and are, therefore, on particular alert for a period of about eight weeks, which is what we would expect the 'flu season to be.

An added complication is that the particular strain of 'flu, which has traversed the Atlantic, as it always does each year, is not the strain of 'flu predicted and, therefore, is not the strain of 'flu for which we have vaccinated our health workers and the general population. There are particular risks in that area, which means this could continue for a little bit longer than we would like but all of our measures are designed to prepare us for that. When we get to a point when we can recommence electives – this would be different in different hospitals and it will be calibrated - we will then be in a position to say, and we will do so publicly, what the impact of this has been on electives.

At present, however, it is not really possible to reschedule. We do not want to reschedule people into an early slot which is more than likely going to be cancelled. That would not be good for them or for the system, but we will be open about it when we have the full details.