Mr. Bernard Gloster:

There are a couple of parts to that. First, if people are going to present to a place other than an emergency department they have to have a place to present to and the primary care system has to make that available. I said in my opening remarks that more than 2,000 new staff have gone into the primary care system in the past two years. I have set very clear targets and expect to see evidence of a direct connection between that activity and reductions in people attending hospital and increase speed of people getting out of hospital. That is the first thing. To be fair to those 2,400 staff, they are not GPs. A lot of progress is being made on GP training places and recruiting of GPs but general practice has fundamentally altered. It is not as available to people at short notice as it might have been in the past. That is something on which we keep working with the Irish Medical Organisation and others to improve that access.

The final thing is when people themselves, regardless of what is available, present at an emergency department because they believe that is where they need to go. We know from much of the evidence that many of them are presenting with flare ups of chronic disease that can be managed elsewhere. There is a GP part, a HSE part and a public part. It is about building confidence. More beds and more capacity is important but that is not the only thing. I made the point to the Senator last week that while Limerick requires support - of course it does and I know that perhaps better than most - there is also the question of when you put in more what do you get for the more you put in. In other words, is the problem reducing? That is a serious challenge and part of the engagement I have been having this week. Late last night I spoke to the head of the Irish Nurses and Midwives Organisation, INMO, and I am due to meet her again tomorrow. I take the problem very seriously. Waiting to produce a written plan sometime in the summer is not the best place for my energy right now.