Dr. Cathal O'Donnell:

I thank Deputy Colm Burke for raising this important issue. It is probably our single biggest patient safety issue. It is a huge problem. I have been in this job for 11 years and it is getting worse. I have to say that I fear for the winter ahead. I was looking at some figures before the meeting started. Last month alone, 17,000 ambulance calls had delays at emergency departments. The agreed handover time is 30 minutes. Of this, 20 minutes is for clinical handover and there are ten minutes to allow the crew to maintain the vehicle or restock. In October we failed to meet this key performance indicator 17,000 times. Every day, we lose between 5% and 10% of our capacity. Today we have 180 ambulances on duty. Roughly speaking, between nine and 18 of them are not available because they are held up at an emergency department. When we get a concentration in a particular hospital, which we do see because it is uneven, it can have a huge impact on our availability to respond in a timely manner to a call in the area with the hospital offload delay issue. As Mr. Morton said, we work closely with our hospital colleagues nationally and locally. At my level, I link in with clinical directors. There are no easy answers to this. It is a hospital-----