Professor Garry Courtney:

Yes. In the past three years there has been an increase of approximately 30% in emergency department attendances. The famous day on which we had 27 beds in the corridor was in 1999. I actually felt we were losing control of the hospital. We went to the Lord Bagenal Inn in Leighlinbridge and met many general practitioners and agreed with them that they should give up their direct admission rights to beds in the corridor and that we should set up the acute medical assessment unit. For the following six or seven years, we abolished all beds in the corridor. That was wonderful, but then the recession hit and we closed 40 beds in the hospital. There was a reduction in the number of beds from 300 to 260. We closed 80 beds in the community. Therefore, we took 120 beds out of the system at the same time as we were ramping up services for care of the elderly, chronic disease care services, etc. An acute ward floor has been opened and it has exposed a little of what one might call health tourism. In Nenagh hospital, in the Deputy's area, we are seeing patients from Borrisoleigh, Templemore and Templetuohy, which is unusual. We are seeing patients from Ballylinan, Abbeyleix and Durrow and also from places down towards Clonmel and up towards Portlaoise. We are exposing a capacity problem, but the way to deal with it is to ensure one cannot say "capacity problem" without having data to back it up. I do not like to hear people saying we need 200 beds. Rather, I want them to give evidence that we need beds for stroke or stroke rehabilitation patients, but they will be provided in the community. I want them to give evidence that we really are short of intensive care unit beds and probably need some, or that we need beds in the acute medical assessment unit. However, to make a blanket statement that we need beds is not sufficient. It costs €500,000 to provide a bed and the necessary staff. I believe between 500 and 1,000 beds have been provided with the necessary staff in acute hospitals with patients that general practitioners should be looking after in the community. It would take ten years to provide 1,000 beds and we do not have the money to provide them in any case. If we did, we would not have the necessary staff. Why not discharge between 500 and 1,000 patients to general practitioners who are very willing and able to look after them? We should fill the freed-up beds with patients who are being treated in the corridor on trolleys.