Mr. Paul Bell:

I will ask my colleague, Ms Marie Butler, to comment on Deputy Donnelly's question regarding what is happening in accident and emergency departments. We have issues in community care where patients are going to hospital who should be cared for in the community.

On the ambulance service, members may not know that when an ambulance is dispatched to a location the ambulance crew must take that patient to an emergency department. We have highly skilled advanced paramedics and emergency medical technicians. By "highly skilled", I mean they can issue up to 44 different types of medication at the scene but they have no power to discharge. The ambulance crew must bring the patient to the accident and emergency department unless that patient discharges himself or herself. That issue has been overcome in the Scottish ambulance service which has two distinct services. One is a hear-and-treat service where the people in the control room involved in planning services for the ambulance dispatch can determine if the patient needs to go to his or her GP or pharmacy and does not require the use of an emergency vehicle. The other scenario is where an ambulance crew arrives in a community or an incident has occurred. Much of the care of the elderly could be considered from the perspective of how ambulance personnel treat those people. They cannot recommend anything other than taking the person to hospital unless that person decides not to travel and in such cases, he or she must sign off on that. My colleague, Ms Marie Butler, will explain how some people in the community care area are ending up in emergency departments unnecessarily.