Dr. Colm Henry:

I thank the Deputy. There has been a huge shift to the left in the past years in response. The most expensive commodities and scarce commodities in healthcare are inpatient beds, and theatre. Looking at the surgical models of care, we have seen a huge shift in the past ten years that has accelerated recently from inpatient admission, to day of case surgery, to day case and, in some cases, this involves moving those cases from theatres to outpatients. For example, one of the modernised care pathways we are reporting now is a one-stop shop for haematuria. Previously that would have involved multiple visits with cystoscopy, scheduling and revisits and so on. We are working with the Royal College of Surgeons in Ireland, RCSI, and other partners on this who have designed and are implementing models of care that are shifting away from expensive inpatient protracted unnecessary stays to day of surgery admission, through to day case, to outpatients and out into the community. In some cases, for example the Ballincollig eye care centre. which we visited recently, we see a shift of macular cases away from what used to be in day theatres in the South Infirmary Victoria University Hospital Cork, to these patients being dealt with in the community. There has been a response from the clinical community even before we look at what has happened at policy level in response to an increasingly congested and valuable space, that is, acute hospital beds and theatres, to devise models of care and standards that could be applied to different procedures, different conditions, that move away from inpatient consumption of beds out to the outpatients.