Dr. Sara Burke:

I will have a go at answering that. The issue of why some emergency departments are overcrowded and others are not is complex and often very context-specific. It depends on the demographics, the number of people in the area and the number of people seeking care. It depends on the availability of resources, for example, whether there is a minor injury clinic, there are other hospitals in the area that can take care, and whether there is good 24-hour GP cover. There are lots of components that influence why some hospitals do better than others. I cannot answer that specifically for the Deputy. The Deputy is right that there are some hospitals, Limerick being one of them, which have nearly perpetual long waiting times in the emergency department and difficulties with accessing elective care because the hospital is so overcrowded with emergency patients. However, if you speak to people like Professor Colette Cowan, who is responsible for running that hospital, she would make the argument that if the mid-west was an integrated care area and if she had access to the resources in the community, then she could free up 50 or 100 beds, with people either moving into rehab beds, nursing homes or home care packages. That is another reason for the reform. Our blocked up emergency departments and hundreds of thousands of people waiting for that first outpatient appointment is an indication of our failure to reform the system we have, which is connected to all our other previous discussions.