Dr. Mick Molloy:

All of those hospitals have a function to fulfil right now because they are decompressing the public emergency departments. If they did not exist, one can imagine how much worse the problem would be. Granted, they only operate at a limited time during the day. With some of them it is ten hours and with others it is 12 hours a day. If that volume was taken from them and placed back into the public system, it would mean it would be even worse.

To be honest, those hospitals are very much concentrated in the Dublin area. I do not work in that area but work in a smaller model 3 hospital in the country. We have a critical need to recognise the importance of future-proofing these model 3 hospitals. Just because patients in these areas live remotely from Dublin, it does not mean they deserve a lesser form of healthcare. Unfortunately, the majority of the resources seem to be directed towards the large model 4 hospitals. If one is in a smaller hospital without all of the services on site, the patients who come to the emergency department are the same types of patients who go to the larger teaching hospitals in Dublin. When someone with a fracture presents to a hospital without on-site orthopaedic treatment, one has to get involved in phone calls and remote consultations to get him or her referred onwards. In the case of somebody with a brain haemorrhage, one tries to refer him or her to Beaumont Hospital. If the patient has a myocardial infarction, one tries to get him or her into a percutaneous coronary intervention, PCI, lab. All of this requires more resources in the smaller hospital and not less.

I would like to mention a particular issue that arises. The Deputy started talking about community healthcare. Community healthcare is available 39 hours a week but is not available 129 hours a week, which is the majority of the time. When someone has an acute need outside of normal hours, he or she rings an ambulance and is brought to a hospital. There are four hospitals in the country that do not have on-site psychiatric services. I work in one of them. When a person calls an ambulance, that is where he or she will be brought. When I have dealt with that patient and have tried to get him or her into the next part of the care system, which involves referring to a hospital 50 miles away, I might call the ambulance service only to be told it will not take the patient. It will say that the patient is voluntary, not involuntary, and should transport himself or herself the 50 miles to the next hospital. There are standardised bypass protocols in the National Ambulance Service to protect and bypass the large Dublin hospitals. For example, paediatric patients or labouring obstetric patients are not brought to the adult hospitals in Dublin. We receive those patients in the hospital I work in because we have those services on-site, but we do not have psychiatric services on-site. There should be a similar bypass protocol for people with acute psychiatric emergencies to go to the places which have those services so that they are not brought to a smaller hospital which does not and cannot provide a service for those patients' needs.