Mr. Stephen Mulvany:

Public confidence is really important and it is easily lost, which we totally accept. On the frustration point, the people at this table, in the crisis management team and at all levels of the HSE, including front-line staff, have that same sense of frustration. We will be asking if we should have done more earlier and if there was anything more we could have done earlier, particularly on those items that are not sustainable. We do not think it is sustainable to ask people to work longer hours in the long term, beyond their normal contracted level. It is something that can be done for a period, and while there is the working time directive, it is a staff welfare issue as well. It was done in the interest of patient safety when that was the paramount concern. We also get the point that it is very frustrating for people to hear us encouraging them to consider other options, which we only do at times of significant patient safety concern. We know if a person cannot access a GP and hears us saying, "Go and access your GP," that is frustrating for both patients and, in fairness, our GP colleagues, who have also worked very hard and are under pressure. The message is only given when we look at what is happening in emergency departments and decide we have to spread the load across the whole system. We cannot have the problem occurring entirely inside emergency departments because that brings its own risks, either of delaying assessment or delaying admission. We have had potential examples of both.

Capacity is a huge part of the solution, but as I think the Chairman and some of his colleagues said, it is not the only part of the solution. It is a significant part of the solution, be it hospital or capacity. It takes time. We and the Department agree that the time it takes to turn over capital projects needs further improvement. It takes too long to go from planning to actually having patients in beds, be they community or hospital beds. It also takes time to recruit staff, although that time has been substantially reduced. The issue is that the entire solution is not just about more staff or more beds. For the next 12 months, it will not be about those things because very little can be delivered in terms of extra beds or even staff in a 12-month period. While that may get a lot of focus, we need, with the support of the Chair as well, to hear people talk about improving what we can in terms of processes. As I said, it is not about asking staff to work longer, harder or faster but about trying to remove steps from processes that do not add anything for patients or staff. That, investment, implementing Sláintecare and changing the structures are all parts of the overall jigsaw. It is a problem that is solvable. The issue is that we will not fully get past this until we catch up and exceed the pace of demographic change and the ageing of the population and the increasing pressure that creates, which will take sustained support, investment and change. That means the whole system, including the political system, needs to be supportive of that, including the Sláintecare programme.