Mr. Stephen Mulvany:

I will make a couple of comments. Before the Senator asked her four questions, she mentioned people were going to accident and emergency departments just to access basic services, such as diagnostics. That can be an issue. She may be aware - it was mentioned in our opening statement - in respect of GP direct access to diagnostics, which is one of the investments under enhanced community care, that in 2022, 250,000 patients were able to access MRI scans, CT scans and X-rays through that scheme. That is ahead of the target of 240,000. That is one element of us trying to make sure that the reasons people might be inappropriately referred for care into EDs are dealt with and that alternatives are made available. There is more work to be done in those cases.

Senator Hoey mentioned the 50 patients per week dying because of hospital overcrowding. As we said earlier, we cannot speak with certainty about this. That number is based on a particular NHS study, a large one of more than 5 million patients, which indicated that for every 82 delays in admission beyond five to 12 hours there was one associated excess death. Whether it was causative or correlative I am not clear. We know there is in every health system a level of preventable and avoidable harm but we cannot be sure of that actual figure.

What can one say to anyone whose loved ones are caught up in this? What else could one say other than that it is just completely unacceptable? Our words, however, will be meaningless to anyone in that situation.

As for bed capacity, and this is not just about hospital beds or capacity, but as for acute hospital beds, yes, as one of my colleagues here said, beds have been lost over the past 40 years. As I have said, the past three years have seen more beds put into the system - about 970, with another 209 to go - than in any three-year period I could see over the past 40 years. Are there a whole load of hospital beds lying empty? No, at this stage there simply are not. There will always be some beds closed for reasons of infection, staffing or refurbishment but, no, there are not a whole load of beds sitting there waiting to be opened. It is about building them where they need to be built and, again, not just about hospital beds or capacity. There is also a process piece and an integrated care piece, which is where Sláintecare comes in.

A public inquiry is a matter for the Government, not us, to comment on, to be frank.

We completely respect the fact that the INMO is going through a consultation process with its members. It exists to serve its members, and that is what it is seeking to do. We share and acknowledge the efforts of our nursing colleagues and other colleagues. We know that some of them are doing really difficult jobs in difficult circumstances. The consultation process will bring whatever it brings. Obviously, we engage regularly and will continue to engage with the INMO on all sorts of matters affecting its members, who are our staff, and the patients in whom we jointly have an interest.

Workforce planning, as we said, is one of the key issues in plotting the course out of this. We need to retain more as well as train more. While we do retain a large percentage of nurses - we have offered every single nurse graduate this year a job - we know that in a year or so a number of them will leave and they will not all come back. Workforce planning therefore remains a big priority area and one we have not fully cracked yet.