Ms Mary Dunnion:

Changes have since been introduced. Emergency medicine consultant numbers have increased. Towards the latter end of our investigation, the group hospitals were developed and, while I acknowledge the groups are still in their infancy, the group CEO has formally streamlined the governance arrangements to ensure those who work in the emergency department are reporting to the clinical director in Portlaoise hospital. The bigger issue pertained to the nature and volume of patients passing through the emergency department. There was no evidence in the context of managing and planning a service that anyone was examining the data on patients coming through to find out the nature and extent of their conditions and the types of services they really needed. The hospital told us that 40,000 people attended but the HSE had a different number. We know the hospital was not critically investigating the types of patients and nature of services best provided. For example, it would be consistent with the recommendations on Ennis and Mallow to ask whether it operate a 24 hour emergency department or a different type of service.