Dr. Peadar Gilligan:

First, I absolutely acknowledge that things have improved. We have gone from an average over that 14 years from 21 hours waiting for a bed to 14 hours waiting for a bed. It is a very significant improvement but it is not good enough. My colleagues in the RCSI hospital group have worked incredibly hard to achieve that reduction in length of stay for patients requiring admission from the emergency department and to introduce some of the initiatives Deputy Donnelly mentioned. We acknowledge that the ability to move patients from long-term care in the hospital to nursing home care has improved our access to bed availability.

It is fair to say we have gone from having 15% of our bed base occupied by long-stay patients at any given time to half that rate. That has involved a huge amount of work. We have a group in the hospital dedicated to ensuring patients are moved through the system and on to nursing home care, augmented home care packages or other such arrangements, as appropriate.

Considerable work was done on trying to reduce the length of stay of patients. That has included trying to accelerate the investigations done for patients. It has included trying to accelerate access to services such as MRI, CT and ultrasound scanning. There has been a huge input by the clinicians on call, who are now rounding two or three times per day to try to ensure patients get through in a timely manner. However, I have yet to meet a clinician in the RCSI group who tells me it is not a bed issue. We all know we do not have the capacity we need.

In Beaumont, there was an assessment some years ago by auditors from the NHS who advised that, given our current workload, that hospital alone needed 250 additional beds. That was just one hospital in the system. Therefore, we absolutely need hospital beds. I have patients for 14 hours. The 14 hours are usually a good seven or eight hours after the decision to admit has been made. The reason I have the patients for 14 hours is that there is no available bed at the time to put them into. That is because Beaumont Hospital runs at about 104% occupancy. Approximately 6% of that 104% is in the emergency department. Yesterday evening when I left our emergency department, which has 24 clinical spaces, there were over 60 patients there. Most of them were going to be going home, having undergone assessment, investigation and treatment. For the 24% who required admission, there was going to be a wait for more hours before getting a hospital bed. That is because we do not have enough beds in the system.

To be absolutely clear, the issue of crowding and overcrowding in Irish hospitals is significantly worse than in any other developed country in the world. It is worse because of our capacity issues in the system. Those are not just around the beds. The beds are a considerable issue, however. Until we get the beds right, we will really continue in the storm.

To answer Deputy O'Reilly's question on what this winter will be like, bearing in mind the fact that we need 1,500 beds now, unless there is a very significant increase in existing capacity by approximately 600 beds, it is likely that there will be considerable numbers of elderly patients in every emergency department in the country waiting for a significant period to gain access to a hospital bed. We will have staff traumatised by the compromised care they are having to deliver because they do not have the space in which to deliver it.

We have heard about the fiscal space many times. Space is something I would love to have in an emergency department to provide care, rather than having to wedge myself between trolleys when taking a history and trying to assess patients. We will get that space only when we have the beds, the medical and nursing staff and allied health professionals to help to move the patients through the system as quickly as possible.