Mr. Liam Woods:

In terms of ambulance and intermediate community care vehicle, ICV, cover, there has been an increase in that and it continues. It also remains under pressure. As the Deputy rightly says, the demand for increased bypass facilities to more major centres is a demand the ambulance service faces as well as the growth in calls. In the mid-west region there is a pressure which Colette Cowan can speak further on around patient transport. There is an advantage in having Nenagh and Ennis which allows for the movement to a more appropriate setting. Sometimes the challenge in that is transport. There has been a growth in expenditure on private transport at times to support that, which we would prefer to run through the public system if the national ambulance service can support it. It has done so, but it remains under strain.

On GP relationships, there is work ongoing with GPs in terms of their referral practices and protocols around referral in some specialties as part of our outpatient planning.

There is a very good example in neurology where effectively a consultant, clinical leads and GPs have agreed protocols and the effect in practice has been to reduce outpatient numbers significantly and reduce waiting very substantially. That is being expanded to other areas both in terms of specialty and across the country.

On the issue of a seven day working week pattern, there clearly is already some seven day working in terms of waiting list work. Some of the proposals we are receiving are about running clinics on weekends and at night time. Consultant contracts allow for seven day working patterns as do some other clinical contracts. Not all contracts provide for this and there is work to be done in that area in the system overall. The best capacity we can access most quickly is our own that is used most intensively. I take the point Deputy Kelly makes and there is some work taking place on the issue.

On the issue of modular units across the country and whether a modular unit in Limerick and the University of Limerick hospitals group will be supported, there is a proposal from the UL hospitals group on a modular unit, as the Deputy is aware. The HSE has submitted that, with other proposals, to the Department and would be supportive of it, subject to deliberations at Government level around increasing capacity in Limerick. Underlying part of Deputy Kelly's question is the capacity constraint in the UL hospital groups, which we understand. It has been well researched and clinically validated and we need to invest. We would be supportive of growing capacity in Limerick, and that would include modular units. I should add that we are in discussions with the Government which, with the Minister, will need to make decisions in the coming weeks to determine the outcome of that. We are supportive of capacity as we know it is needed. To be fair to colleagues in the Department, they are equally aware of it.

The Deputy raises a specific case of an individual child and an issue between Crumlin and Tallaght hospitals. If I can, I would like to answer the Deputy directly on that individual case. I do not have the details with me but I can do that. The more general question the Deputy asks is about co-operation between the facilities and the pathway of care. I get that and I will revert to the Deputy on that if I can.

The Deputy's final question was on staffing ratios and staff funding. I am aware of the piece of work to which the Deputy referred but this is connected to the general point around capacity. I have already acknowledged there is a capacity issue in the mid-west region. I might ask my colleague, Ms Colette Cowen, to address the specifics relating to the report.