Dr. Colm Henry:

I might take some of that. On the reconfiguration of Ennis and Nenagh and the nine hospitals reconfigured under what was called the smaller hospital framework of 2014, it was the right thing to do for patient safety and outcomes. In 2022, and indeed when this was devised in 2014, we look at access to healthcare in terms of outcomes. Once a sign is put up that says "Emergency Department" people have a reasonable expectation the full range of services, the complexity of services and the expertise will be behind that sign to give them all the care they need. We know that with the expectations people rightly have these days we are not able to do that. That does not just apply to Ennis hospital. We have bypass now for myocardial infarctions and for stroke. We are introducing a trauma strategy that will centralise trauma into some hospitals. Generally speaking, what was replaced, largely successfully in my view, in the smaller hospital framework document was the concept of an emergency department that does everything with medical assessment units. These are operated during working hours during the week and people see defined, differentiated medical problems within the capacity and within the framework of expertise in that particular hospital. That has largely worked well in those nine hospitals.

What the Deputy said is also correct in that reconfiguration exposed a capacity issue that was perhaps especially marked in the mid-west. We had one model 4 hospital, a centre of excellence as you might put it, with all the complex range of services including a cancer centre, and then the rest of the hospitals are model 2 without a model 3 hospital in between like those in Cavan, Mullingar or Castlebar, which have 24-7 emergency departments. Since the smaller hospital framework was devised in 2014 that has been successfully implemented in those hospitals but capacity issues have come to the surface and are being identified through the additional 1,146 beds throughout the country as part of the successive winter plans.

On a safety and outcome basis I defend the reconfiguration in a general national sense. It was the right thing to do then and remains so to meet the expectations of the public around what they can expect when they do into an emergency department.