Mr. Liam Woods:

From our point of view, there are two dimensions. The first is about capacity and ensuring that we are planning and making available sufficient capacity. In the current winter plan, we are growing capacity in the community and there is a small growth in the hospital environment capacity. This year, we were initially putting in 55 beds, but it has increased to 98 beds on the hospital side. Last year, the number was 300. I understand the underlying demographic would require us to put in 300 to 400 beds on an annual basis. There is a challenge in that regard for us.

On the capacity required in the community, the fair deal scheme is running well at present in the sense that it is able to provide space, as required, to hospitals. It is doing that within its current funding limit and it is working well for us right now. The home care community intervention team capacity that has gone in as part of the winter initiative, some of which was there already, is also vital because it enables people to stay at home or return home and be treated there. Some of the committee's earlier conversations about the work of community intervention teams and the outpatient anti-biotic programme are relevant in that regard.

On the idea of a surge in capacity, the critical point is that hospitals are full all the time. At this time of the year, they are more full with work related to admissions from emergency departments. The price of that is that there is less capacity to do elective work and the staffing requirements relating to running the hospital are reasonably consistent.

There is a need to grow staff numbers, as Deputy Durkan referenced. We see that in terms both of the wider demographic but also in providing additional targeted capacity right now. In the acute system, the service plan this year provides for approximately 100 more nursing staff. Our staff numbers have been rising. If one looks back, between 2008 and now, there was a clear reduction through austerity and the number has been rising again over the past two to three years. This year, overall nursing numbers are up by over 200 and doctor numbers are also up, but we recognise that is coming from a low base. The impact of austerity on the global recruitment and maintenance of staff in the health system is still being washed through. If one looks at the demographic over that period, clearly we have a lot to do. We take the point about staff.

The hiring and retaining of staff is a significant issue. The rate varies to some extent across the country but the capacity to hire and retain staff in what is an internationally competitive market for medical and nursing skills is a challenge for us. We have to adopt as best we can strategies that are both friendly to staff work requirements and which invest in facilities that give rise to good working conditions. Clearly, the stresses and pressures of operating in emergency departments as they are at present are a significant challenge for staff.

On elective surgery and waiting times for elective surgery, we put in resources last year to address wait times beyond 18 months. We fully accept that is only the tail and that there is an underlying growth in demand. Hospitals in the past year have grown their service provision by approximately 33,000 cases. What is happening within the hospital environment is that throughput is growing but the demand is growing quicker, and we have to address that through providing extra capacity and also looking in some instances at the model through which care is delivered. There are opportunities within hospitals. For example, since 2009 the surgical programme is effectively using less bed space and is doing more work more efficiently with more patients being seen. That kind of opportunity exists within the hospital system. I agree with Deputy Durkan that our elective targets are not where we would want them to be. I fully accept there is a capacity requirement around delivering those targets. There is a requirement for both staff and beds.