Dr. Colm Henry:

A small hospital framework document was issued in 2014. It recognised exactly the point made, namely that we cannot provide for all the expectations people would reasonably have for all emergency departments. In modern healthcare in accident and emergency services, one would expect a full range of specialties, right up to and including intensive care, but the fact is that not only can we not staff that number of emergency departments but we cannot provide for the complexity and specialist support required, right up to and including intensive care. The intensive care personnel involved, particularly for those with more complex needs, will tell you that while there have of course been capacity issues associated with bypassing hospitals, it is simply not realistic to revert to opening emergency departments in model 2 hospitals and to create the expectation that one can provide the full range of care, up to and including intensive care.