Dr. Colm Henry:

We have done an analysis of the appropriateness and presentation and have looked at sample case histories that have been analysed by a panel of experts - both GPs and emergency department, ED, consultants. This in no way takes away from the experience observed by the Deputy of the abuse of staff but we have found that the great majority of patients who present themselves to emergency departments are deemed to be appropriate even Looking retrospectively at their views. There is some difference and ED consultants might feel that a higher proportion are not appropriate. To answer the point that was made, even in the case of those people who may conduct themselves poorly, it may be, in some cases, that there are toxicity issues or issues that have to be dealt with medically within the emergency department. It is something that is a huge challenge to our ED staff that they are used to dealing with day in and day out. It is not a simple issue of defining at the outset somebody for whom it is not appropriate to be there. In our winter plan we are trying to identify the proportion, perhaps between 15% and 20%, of people who could go somewhere else such as local injury units, their GPs or out-of-hours GPs and ramp up those out-of-hospital services so that we can leave emergency department staff to deal with the core issue of urgent and emergency cases, which is what they are trained to do.