Mr. Stephen Mulvany:

We fully accept what the Senator has said in respect of the conditions for staff and, in particular, patients, and that they were unacceptable for a period. In fairness to the management team and the clinical director, they did the right thing in declaring a major internal incident. That and the actions that have flowed from it have had a positive impact from a health and safety point of view.

As the Senator said, the normal number of average attendances in the UHL emergency department, which is approximately 270 per day, is beyond the capacity that the ED was built for, albeit that these are 270 attendances over a 24-hour period. It is probably our most modern ED.

As I understand it, there is no current plan for the development of a model 3 hospital in the Limerick region because creating a model 3 hospital from any one of the current hospitals would effectively hit all of the same issues that were experienced when the decision was first made to effectively concentrate emergency department services in one hospital. There is simply not the population to enable us to have sufficient staff to be recruited and retained. If one divided up the recruitment capacity of Limerick over two hospitals, rather than one, in respect of ED staff, one would have even greater difficulties. The issue is one of addressing the capacity and process issues in the hospital itself and supporting it with the community in respect of what the community can do around the egress side, albeit, as we have said, the community team works quite well in the hospital and the level of delayed discharges is relatively low.

The new investment in specialist community teams should assist over time on the hospital avoidance side. I do not believe it is practical to construct another model 3 hospital. If you did, it would lead to all the problems that were there when the decision was made across the country to try to centralise emergency departments in a lower number of sites.