Dr. Rónán Collins:

Very briefly, I agree with Deputy O'Connell. It may interest her to know that the Australians carried out a large atrial fibrillation screening study using pharmacists as the screening interventionists. They came up with a very acceptable result of about $3,400 per stroke saved in terms of using the pharmacist. However, there are national issues about indemnity. Our pharmacists are very integrated into our atrial fibrillation clinic in our hospital. They have done the MSc in cardiovascular prescribing so there are extended roles there. Those roles are changing. As the committee has heard from every witness here, we are into multidisciplinary and interdisciplinary approaches. We see roles for people but obviously there are issues regarding contracts, indemnity and so forth that would need to be teased out.

Specifically with regard to thrombectomy and thrombolysis, we have modelled this recently in Ireland. The important thing is to get the Domestos in as quickly as possible while also trying to carry out thrombectomy, which is the mechanical removal. There will be different models depending on where one lives. We certainly want to get the drug in quickly because most of the thrombectomy trials occurred on top of the fact that patients already had the blood thinner on board, preventing further sludging. It is key to get the drug in quickly but if the door-to-needle time is going to be prolonged in an individual hospital, then maybe one is better bypassing that.

Deputy O'Connell spoke about Mullingar and Tullamore. I do not know if she is from-----