Kate O'Connell (Dublin Bay South, Fine Gael) | Oireachtas source

I thank the delegations for coming before us. I almost feel I am friends with them at this stage as I see them at so many committee meetings. I will try to be as quick as possible and I will have to excuse myself immediately because I am supposed to be attending the water committee meeting as well. I must show my face but I will look back at the replies here.

The figures for overcrowding are increasing outside Dublin but in Dublin they have basically remained the same but demand has increased. Could one say things have improved? Is that taking it a bit too far? If capacity has not increased and demand has increased, are people just making this work? Are there efficiencies? I just want to tease out the issue in Dublin. If we had not used private hospitals in the past eight weeks, what would we have been faced with? Is there data on that? Could Mr. Doran say from experience what sort of mess we would have been in if we did not have that capacity or the "valve" to release pressure?

The success of the winter initiative would be a reduction in delayed discharges. Has there been any other success or anything else that was positive? Could we learn something for next year? I worked as a community pharmacist for the Christmas period and I do not think I have ever dealt with as many people in an awful state in that time. I was working until after 8 p.m. on Christmas Eve dealing with people. Is there anything we could do in the view of any of the witnesses to try to improve matters next year? Do we need to examine buffers? This year we had a strain of flu that was particularly difficult for older people so how could we predict that? Taking that to a natural conclusion, what would happen if there was a massive disaster? How would it leave trained clinicians like Dr. O'Conor with what they deal with already?

The comment that illness is a 24-hour phenomenon as opposed to something that happens from 9 a.m. to 5 p.m. is quite interesting. I remember speaking with an accident and emergency consultant one night who explained that a farmer had come in one night with a massive gash on his arm. Instead of being able to deal with it at that point, remedial treatment was given and the fellow was kept stable. There was no capacity to deal with it fully and the doctor had to make a decision based on what was available. There were three or four subsequent operations with multiple doses of intravenous drugs to try to deal with it. I think there were maggots in his arm by the end. When something is not dealt with properly in accident and emergency departments, in the experience of the witnesses, what sort of knock-on effect is there? I realise it is difficult to get metrics on that. Are we constantly in this cycle of causing ourselves more problems?

In a health committee meeting this morning we had an economist who told us there were 3,000 beds taken out of the system in the 1990s. It went from 18,000 to 15,000 beds. Despite demographics and people expecting greater access to health care, are the witnesses saying the imbalance has never been addressed?

There is a plus three figure for public health nurses. My mother is a public health nurse who retired last year or the year before that. Is that a pure plus three or does it take into account senior nurses who have been made retire at 65 years of age, even if they do not wish to? Obviously, if they wish to retire it is fine, but I know a number of people who do not wish to retire at 65 years of age.

To return to the management, Ms O'Connor mentioned her experience. I do not wish to get her in trouble at work but could it be said, perhaps, that prioritising of patient need is not being done by clinicians but by management? Is it fair for me to say that? If that is the case, it must be exceptionally challenging for people bound by codes of ethics and registered with the Irish Medical Council and the like.

Finally, if there were three realistic things the witnesses could do tomorrow - I know that Dr. O'Conor's first would be more beds - or that they think could be done to try to fix things, will they say what they are?

I thank the witnesses. I am sorry but I must excuse myself. I will watch the rest of the committee's proceedings tomorrow.