Ms Phil Ní Sheaghdha:

My point in respect of clinical governance is not directed at Limerick; it is in general. We know that the 24-7 nature of healthcare delivery means that clinical teams must be led by senior clinicians. We note that admissions, and the ratio of attendance versus admission, are higher in some hospitals than in others. We looked further into that and asked the HSE for statistics. We are disappointed that the emergency department task force meeting has not been held, despite our seeking it, because it would give us a lot of this information and, from that, we could determine how matters might be improved. For example, if the attendance to admission ratio is higher in some hospitals, we have to look at why that is so. If it happens between 6 p.m. and 2 a.m., which it does in some hospitals, we must look then at the seniority of the admitting doctor. If consultants are on duty during that period, we find, in many instances, that the admission rate reduces because they have the clinical confidence to say to a patient that he or she can go home and come back to the outpatients department tomorrow or be sent for further referrals, if necessary. It is about clinical confidence and the seniority of the clinician making the decisions. When we see increased admission rates between 6 p.m. and 2 a.m., we must ask that question.

Furthermore, we see many patients attending who have not been seen in the community by GPs, largely, the latter tell us, because they do not have that capacity. We are seeing an increase in children being admitted and attending hospital emergency departments, particularly in the out-of-hours period, whose parents say they have not been able to access GPs. There is a whole load of issues and the nub of it is there is no one problem that can be fixed at a site like Limerick. There is history there whereby reconfiguration left it with a lot of problems. The independent review must take into account the availability of beds in Nenagh and Ennis and how they are being used, as well as what services are being curtailed because of the lack of beds on the site in Dooradoyle and whether services for older people could be supported. The most recent statistics we have seen show there is a higher number of over-75s attending there. The independent review should and must take all of that into account and we also need to look at how patient flow happens through a region as opposed to just concentrating on a particular site. Last week, there were four discharges from one of our major acute hospitals between Friday and Monday.