Mr. Paul Reid:

I will give a few components of the solution as I see it. Both the Minister and the Deputy have spoken about what they have seen in emergency departments. My experience of visiting nearly all the 24-7 emergency departments around the country is that a significant cohort of patients should be treated in a different way and in a different setting. A significant proportion of people who attend emergency departments are members of our aged population. These people have chronic illnesses and multiple illnesses. This is not a criticism because people are not attending emergency departments when they should not be. We must create new routes for their treatment. We need more GPs. I have met people from the training college to discuss the matter and it is positive that is looks as if more GPs are coming on stream. We need to invest in that and that is a part of our Sláintecare solution. Pharmacies can play a much better role in the context of treatment and care in the future. The contract for pharmacists will be negotiated next year and that will give us an opportunity to look at what levels of care can take place in a pharmacy setting. The first thing we need to do is to reduce the entry points into acute settings.

I listed a number of good, innovative triage processes, including advanced medical assessment units, having emergency department consultants in the emergency department all the time and having GPs in the emergency department. There is really good innovation and the challenge is to scale that up across the country. It is an issue of capacity in hospitals and the Minister has outlined some relief that will be part of the solution. We also need more egress points, as the Minister touched on, which means more community and step-down beds and more investment in nursing home support schemes, which we will have in 2020 when we launch the service plan.

We would be misleading the public if we were to say that we will make matters better in a few weeks or months by doing this or that. We have a key performance indicator in respect of trolleys. I have worked in capacity and workflow management all my career and we have what is called a lag indicator which looks at the measure at the end of a congestion point. We must develop a way of looking at our setting that looks at the whole workflow management process. That is about entry points and how to reduce pressure on them at capacity, how in-house flow can be improved and the need for more settings for patients who are egressing. This will not be solved in weeks or months and I did not convince anybody that it would be solved in that timescale when I took this job. This is a relentless process in which we must invest for the coming years through Sláintecare. We must stick to the plan. That is the longer-term solution and that is when we will be doing justice to the public.