Ms Eilísh Hardiman:

We fully support what those concerned are doing, but it means that the income line we had in the past will continue to decrease.

We have installed an electronic system to examine our income collection. I refer not only to private health care services, but also to road traffic accidents and ED cards. Going purely electronic has actually generated better income for us than in the past, certainly this year.

With regard to bed capacity, we have 17 beds at the moment that are not in operation but I heavily caveat that. Fourteen of them are of very limited use. They are in the basement in Temple Street and there is no lift. We tend to open them up on a temporary basis as a discharge lounge during the winter when have peaks in emergency department activity. We have three in Crumlin. These are very small, cubicle-type beds. We tend to use them. We have very little capacity to open up new beds within the children's hospital.

With regard to ICT, I have stated very clearly that the hospital is identified to be open as a digital hospital. It is planned that way, as are the workforce and patient flows. The hospital is designed that way. We have a burning platform as a health system to identify when we will make decisions about the electronic health care record, in particular, in addition to other electronic systems. That is coming very close because the business case identifies, for the children's hospital, the need to have the electronic health care system in place. It can take three to four years to implement that type of system.

It is critical for the network that we plan. Already, our consultants in Temple Street and Crumlin go to Cork, Limerick and Letterkenny with patients. It involves charts in cars and it is not the way to deliver services. We need to move to having one system, with data available in the right place so the right people can be supported to deliver the right care locally. That needs to go right out to GPs. As a strategic direction for the next ten years, it is a critical enabler to allow us to become more sustainable. There are huge inefficiencies in the system purely because of paper records.

With regard to working with community services, we work with all the community health care organisations in Dublin, but also nationally. Our long-stay issues pertain to children with complex care needs. We have very small numbers but they can remain in our hospitals for a really long period. One may have heard parents talking about this issue.

What we have developed with our community and social care personnel, and sometimes with Tusla, is a pathway for complex care needs children. Each time, it goes out to whatever community it is based in. It is usually about transferring children with tracheostomy and very complex care needs requiring 24-hour services care in the community. In recent years, it has not been a funding issue. It was perhaps two years ago but there seems to have been progress on this, which is positive. The community services do find it a challenge to get staff on a 24-hour basis to manage very complex care needs. We work closely with them and train them. We sent our nurses out to train them and to try, as much as possible, to move the children out of the acute hospitals in Dublin, mainly to locations outside Dublin.

On recruitment, I will give Dr. Martin an opportunity to talk about what we do from a consultant's perspective.