Dr. Colm Henry:

We have two models of care which have been referred to at this morning's committee meeting - pathfinder and EDITH, both of which are essentially part of the same spectrum of care. The pathfinder involves, along with the National Ambulance Service staff, a therapist going to visit the patient on-site with a view to enabling him or her on-site and avoiding unnecessary conveyance to hospital and an unnecessary stay in an emergency department. The second is EDITH, which was referred to earlier, where a physician visits the patient on-site and may include review of the medications. The committee will have heard earlier about our integrated care programme for older people, ICPOP. Twenty-three of the 30 centres open have seen over 60,000 patients to date. This again pushes care out into the community involving earlier review of older, frailer people. About 60% of the patients reviewed score high in the frailty scale. These are exactly the kinds of patients we are seeing increasingly in emergency departments. The idea again is to bring care away from hospital.

While saying this, it is important to emphasise what we are trying to do is to avoid unnecessary conveyance to hospital. However, if people need to be conveyed to hospital, whether it is from ICPOP, pathfinder or EDITH, they will be referred to hospital if that is what is deemed to be appropriate and clinically necessary. The purpose of all these different elements of enhanced community care and bringing expertise to the community is to bring as much care as possible to the patient's home when he or she is unwell and to avoid conveyance to hospital if that is not necessary.