Mr. Liam Woods:

Is there a policy to delay elective surgery in January-February? No. There is a cohort of surgery going through elective, planned or scheduled care which is urgent. Even what is referred to as non-urgent is still important. If one looks at our data, there are approximately 99,000 cases a year of elective surgery and it averages out evenly per month. When hospitals have a surge requirement, they do need to manage that and it can have an effect on elective caseloads.

On the proposed resolution with the INMO, we have a deferral of an action with a ballot to be completed by 5 January but there is still a potential strike notice for 12 January. We are in an interregnum at present. The intention of the agreement that is in place is that there would be in effect additional measures around the retention of nursing. The figure of 144 nurse vacancies in the emergency departments, quoted by the Deputy, is correct. These vacancies need to be filled, so we have targeted advertising taking place over this Christmas. This is a vital period for advertising, given the return of nurses from overseas. We should have advertisements going out this weekend. We are undertaking a campaign to seek to recruit. While we will do it on an ongoing basis, it will be in a targeted way over the Christmas period.

There are specific issues regarding the retention of nurses in services, particularly in emergency departments. This will be associated with supporting training after 12 months of stay within the services. We have 630 graduates within the service. Based on staying for an additional six months, there will be an incentive around training for the amount of €1,500 by a process to be agreed after the completion of the action. It is one of the feedbacks we get quite frequently, namely, that the capacity for career development and training is an important component of retention.

There are also some measures looking at the tasks undertaken by nursing generally within emergency departments and growing the total number of tasks to improve patient flow. That is another set of actions which will emerge from this dispute been resolved.

The escalation policy became an important part of dialogue. The deeper process we have worked out around escalation is one we have discussed in detail with the INMO. The latter was quite insistent that this policy would be included in the agreement. It sets out the steps and the escalations which are relevant when an emergency department comes under pressure. That is a document we can make available to the committee, if it would be helpful to do so.

Infection can prosper in mild weather during winter. It has done so in children services particularly. Hospitals such as Temple Street have been under a lot of pressure during the past several weeks. The respiratory syncytial virus, RSV, prospers quite well in this weather. In a strange way, cold weather would kill it off. We also monitor the influenza-like illnesses across several sentinel GP practices. At present, it has not escalated to a concerning level. However, the RSV rate in paediatrics has and has had a visible effect. We can graph and predict that and it is following a course we understand. It is set to peak in the coming week, so we are working on that. Paradoxically, bad weather has some positive benefit.

Access to radiology was raised. The eight-to-eight arrangement is in place. We are also investing in primary care and extended-day, over-the-weekend services to ensure access to diagnostics. When we look at what might cause slower flow than we might otherwise like in a hospital environment, access to diagnostics is one of those issues. If we look at some of the reasons why people are in hospital, access to diagnostics may be a contributory factor to that. We are investing in primary care and access to diagnostics outside hospitals, as well as an extended day.

I would like to come back to the committee on the question of every hospital every weekend, which is not necessarily required. There are 26 hospitals that will have emergency departments, EDs, and will primarily focus on the major areas of pressure. There is already an extended day and we are also looking to invest further in longer hours.

As the data in the director general's opening statement show, the 30-day moving average for St. Vincent's represents a disimprovement, which was associated with the change in the region as a result of St. Colmcille's going off call. It is a 30-day moving average which looks back over the past month. It has improved in recent days and St. Colmcille's is now taking more patients from St. Vincent's every day. The number is five over five days which the hospital is looking to grow to seven over seven days to ease pressure on St. Vincent's. The kind of cases that are going back are not the kind of cases that are coming in. There is work being undertaken around that at the moment. Access to Mount Carmel, which Mr. Healy can talk about more, also helps alleviate that because it provides transition care and quick step-down.

On the question of where the new beds are, I have a detailed sheet which shows where they are. I will leave it with the committee if it would be helpful. In summary, there are two components to those new beds. We are investing in 301 beds with a view to opening them in November, December and January. There were a further 150 beds that were closed but were available within hospitals. I will address those two cohorts at a summary level and I will leave the sheets which show the detail by hospital. By 18 December, we will have 206 of the 301 additionally funded beds open and the list will show where that is. It is across-----