Mr. Damien McCallion:

To deal with the point about existing resources, I was referring to moving from old buildings to new buildings which in itself is not what brings the resources. Clinical programmes are being run nationally that are setting out alternatives in terms of how primary care can develop, so there is a roadmap but it will require resourcing. To give some examples, community intervention teams are one part of it. Other areas include the development of injury units and trying to promote and encourage people to utilise those rather than emergency departments. In terms of general practice and primary care, this is also about chronic disease management. That is one of the national programmes, which is looking at putting resources in around chronic obstructive pulmonary disease, COPD, diabetes and so on. For example, for the first time there is now a full register of those with diabetes. We are trying to develop and sustain it so that services can be planned around it.

There is a fairly clear roadmap. Some of it is developing and some of it is still in the early stages, but there are resources following it. In terms of the sort of things we are talking about today, the pressures the system is under, the growth in the population and the points Dr. Colm Henry referred to earlier, the level of investment will have to be enhanced significantly to make those centres work better. A key issue will be the GP contract. GPs are one of the key resources in primary care. It is clear that all of those things will have to come together.

To clarify, a number of projects are running. As I stated, we have four more community intervention teams so they now total 15. In terms of chronic disease management, resources are being deployed around diabetes and in other chronic diseases as well. Another area that is being examined and which has been mentioned a couple of times is an integrated care pathway, that is, we are examining how the system works for patients both going into hospital and coming out of hospital, and the process side. There are clinical programmes set up around all of those and they are also starting to identify the resources that are required. Some of them take time to come to fruition in the sense of providing the evidence that they function.

The other one I will mention is the frail elderly programme which is working in six areas in the country at the moment. One of those is in Sligo. It is in the hospital and is examining how frail and elderly patients are managed within the system when they require admission. The programme would cite that as being one of the key factors in their ability to manage the trolleys down to a lower level this year given all the things we spoke about earlier. Some of those take time to come through but they are looking at all aspects, both resources and process in-hospital and out-of-hospital.