Professor Brian Lenehan:

To speak to the here and now, capacity will not come on stream, as Deputy Quinlivan said, for 24 months. What, then, are we doing now to improve the situation with trolleys and overcrowding in our ED? There has been incremental improvement in recent weeks, which has been sustained. That is being achieved in a number of ways. The appointment of a head of service is key because the focus there is on patient flow, on decompressing the ED and on ensuring that all potential discharges are facilitated. We have put in the patient flow co-ordinators, who are working on the ground at ward level identifying patients who can be discharged because once a patient is discharged, that bed has to be cleaned and turned around for a patient to come from the ED. We have enhanced triage in the ED now, with additional nurses in triage and consultant-assisted triage, so the triage times are coming down. Our patient experience times, PETs, are coming down. The number of patients discharged daily has increased, the utilisation of our community beds and contracted beds has increased, the referral rate to rehab has increased, and the number of patients experiencing a delayed transfer of care has come down significantly.

All those small pieces, incrementally, speak to patient flow. They generate capacity within the system, and that is why we see today the number of trolleys that are there compared with the number this day last year. We need to build on that, use the funding we have been provided with to sustain that, use the additional consultants and NCHDs in the emergency department to improve the time it takes to see a doctor and the time it takes to get a test, and look at building on the work that has been done with frailty to the fore and OPTI-MEND, which are two areas that focus on the over-75s and admit fewer patients because there is an alternative whereby they have access to the OPTI-MEND team and the frailty team and can be referred to the ICPOP services in the community. It is therefore a joined-up effort and it is probably ten or 15 small things that will lead to the incremental change.

We need to sustain and drive that. We are doing that with the support of the HSE, its performance management and improvement unit and the staff on the ground supported by the executive management team. We will have people on trolleys but I hope the number will be far less than heretofore. Winter is coming and I do not know what will happen with Covid or flu. All we can do is respond and redouble our efforts. As with Professor Cowan, as chief clinical director, I too want to apologise to patients who have a negative experience in our emergency department. It is not the standard of care we aspire to provide and we will do everything in our power to improve that situation, as we are resourced and facilitated to do.