Mr. Paul Reid:

I will try to be brief and will call on some of my colleagues to comment as well. First, I thank the Senator for his opening comments, which are appreciated by all our teams.

Second, in terms of what will be different in the first couple of weeks in January, it is particularly about what will be different as part of the overall approach to the winter plan and the significant extra investment, which Ms O'Connor can comment on briefly. There is our community investment, community investment teams, integrated teams and multidisciplinary teams working with our acute teams and with our community. There is a particular focus on home first and keeping people at home, but there is also investment in our hospitals in terms of emergency departments and having key decision makers available to make decisions. Separately, we have established this year much stronger working processes and pathways with GPs in primary care. The significant difference is our particular and strong focus on the investment in communities, especially on home first for elderly care. There are many new integrated processes between the acute system and the community system. However, I will call on Ms O'Connor shortly to comment on it.

Regarding the role of private hospitals, they will play a role. We have carried out a procurement process for private hospital groups. It is different from the first phase. There are two aspects to it. First, we already have a budget of €25 million, which some of the hospitals are drawing down for both diagnostics and services. Second, we have concluded a procurement process for a number of private hospitals to engage with us on, and we are finalising those in terms of some mini tenders which will be local, operated between the public hospitals and private hospitals for certain diagnostics and services. Part of that would include diagnostics access for GPs in the community. Again, that will be very different.

On the screening processes, in July we launched our outline plan for the relaunch of our four key screening services. That is mapped out and all of those have recommenced. At various levels they will start to call on people on a priority basis. I will not go through each of the programmes, but our winter plan has approximately €2.7 million to invest, particularly in the rapid access clinic. Our clinics have always been open but we are concerned to ensure that people who are symptomatic and need care come through. There is an extra investment in resources. There is also an extra investment in infection control processes for our screening services.

I will ask Dr. Henry or Mr. Woods to comment on the endoscopy clinics, but some of it is referenced in our winter plan. There are some new innovations in terms of endoscopy clinics and, indeed, endoscopy capsules that will be spread out to further hospitals as part of an acceleration plan for endoscopy clinics.

On community assessment hubs, the plan facilitates a scale up from the current seven to approximately 20. We will monitor this closely. It is a process with good buy-in from GPs. The principle is to assess respiratory illness and try to filter out people who may need to go to a hospital, people who do not and people who can referred to other pathways. It worked very well for us during the Covid pandemic. The demand is not very high at present, so we will assess and monitor the best use of those clinics. However, there is good buy-in from GPs so far.

To deal briefly with vaccines, Dr. Henry was talking about this earlier this morning. We have now distributed almost 1.3 million vaccinations. We have distributed more as of this week than we did for all of the flu season last year. It is about 20% up on our total delivery and order. There is significant demand and we want to make sure it is prioritised. That was the principle of Dr. Henry's letter earlier this week, that it is prioritised for the groups who are defined as priority.

There is, however, very significant demand for private capacity for flu vaccine injections, and while that is under great pressure too, we are nonetheless significantly up on our volumes compared with last year. There are no missing vaccines. There is always a lag of GPs registering with the primary care reimbursement service, PCRS, for reimbursement but we want to see where the allocation is and how to prioritise the final distribution.

Recruitment will be a big challenge. We have recruited a net increase on our workforce this year of more than 5,000 resources, 1,600 of whom are nurses and 150 of whom are consultants. There are significant recruitment campaigns for each grade, although it will be a very significant challenge because there is a worldwide demand for healthcare workers. We have started that process and about 600 nurses from an international recruitment campaign are part of the process. As graduates come through this year, that will provide another 1,200 whole-time equivalents in the system.

With the Chairman's agreement, I might ask Ms O'Connor to make a brief comment, followed by Dr. Henry.