Mr. Liam Woods:

At any time we would be aware of the number of beds they have available for us and we constantly try to place patients in those bed. I would need to get a comment from my social care colleagues on the specific point, but I hear the point the Senator is making.

Regarding the 500 to 600 people who are clinically fit for discharge, one of the successes of the winter plan has been that the number has dropped to the mid-400s. We would still like to see that come down further, but that is as low as it has been for some years. The Senator made a point about transition care availability. Under the winter initiative we have specifically sought to accelerate access to transition care to facilitate quicker movement from hospitals to care settings which may result in people moving to nursing home environments or home with support depending on the particular individual's needs. We have invested in additional spaces, but the Senator is right to highlight that for the future, access to that kind of space and indeed rehabilitation space will be very important.

The point the Senator made about recruitment of nurses and flexibility is absolutely right. The hospital system has approximately 8,000 nurses who work shorter hours. We need to support flexibility or else, as he rightly has said, we end up paying a premium for agency staff. It is always better for us to have staff who are on our own books, permanent and working in the facilities on an ongoing basis. To the extent that this is happening even in individual cases, it would concern me. It is certainly something I would like to follow up on. We have specific targets to reduce agency nursing where we can and employ nurses directly. We have a project team, co-operatively including the INMO, working on trying to achieve a target of 1,000 nurses in this current year in that way.

Deputy Murphy O'Mahony asked if there is communication between GPs and hospitals. There are discharge letters. That would be very much a part of the norm in terms of patients being discharged. Clearly, there can be communication inward to the hospital from GPs, in terms of outpatient referrals or specific comments in a letter. Half of all those who come to an emergency department have letters from their GP stating something about their particular conditions.

On the European Working Time Directive, EWTD, and compliance for junior doctors, we monitor and report on this monthly. Indeed, we occasionally report to Brussels in terms of our requirements under the directive. Our compliance has greatly improved and is 98% regarding the 24-hour requirement while 81% is the last figure I saw regarding the 48-hour requirement. We are looking to increase that, but the figure has come from well below that level. There are challenges in some specialties. There are small numbers of doctors in our national specialties and we are still pursuing that aspect.

It can happen on occasion that GPs work in emergency departments. Where it happens, the reports I have received are that it works well. Contractual issues in that context have not arisen. It could be part of a wider dialogue with GPs in terms of a GP contract for the future but it has not been presented to me as an obstacle at any point. Not all GPs favour working in emergency departments but where they do, as it is reported, it works well.

In response to Deputy Durkan's point, the structural comments are really a matter for policy. I heard the Deputy articulate them at the Committee on the Future of Healthcare also and they are noted. On the question of whether we have studied capacity-----