Mr. Stephen Mulvany:

It is fine. As the Senator's question suggests, building a bigger emergency department so people can wait is not the solution, although in some cases where departments are very small it may be a necessary measure. It is about taking all those options the Senator identified, many of which are already in play, including pharmacists, who in fairness have provided huge capacity in terms of vaccinations, and maximising the opportunity to get as much as possible done outside of an emergency department and avoiding people needing to go to an emergency department. Our message is not that people should not go to an emergency department; it is that they should consider options where they exist. If the options are not there, we cannot consider them. We need to be doing more work on primary care units, giving GPs opportunities to refer directly to diagnostics and avoiding having to refer to the hospital or emergency department. That is absolutely the case.

With regard to the local injury units the Senator mentioned, the hours have been expanded. More and more, whatever the measure is, such as chronic disease being dealt with more in the community, including in those primary care units, every opportunity needs to be taken so the emergency departments, which are specialised units with staff who are there for complex care or urgent care, can do what they do and do it well. The Senator is absolutely right that we need to invest more in those model 2 hospitals so more and more can be done in them. Even that recent pilot in Mallow, which has now transferred to Ennis and Roscommon and will go to other hospitals, makes absolute sense. Again, that is about doing it safely. It is about the paramedic being able to call ahead using a protocol, get the patient accepted and avoiding having to go to a crowded emergency department. All those options are part of what is already being looked at in detail and many of them have come to fruition, in fairness.