Mr. Bernard Gloster:

I do not think its advocacy for the welfare of patients is any less than that of the Irish Society of Physicians in Geriatric Medicine. I do not think it is just a case of, of course the Irish Association for Emergency Medicine would say that. I have also had an unequivocal unwelcome for the policy from Sage Advocacy, which is one of the strongest advocacy partners in the country. There are different views and I respect both perspectives. That is the first point.

The second point I want to make is that I come from the absolute premise that we should at all times do the best we can to give effect to the will, determination, rights and wishes of people in everything we do. I am a firm believer in that and in how the assisted decision-making process modernises what was a very paternalistic system. However, we can only do it to the extent that it is pragmatic and practical to do so. The simple reality is that, first, as I have made clear to people, nobody is being sent anywhere, forced to go anywhere or sent 100 miles away. I have heard all of that type of commentary. The simple reality is that I have expert evidence telling me that when people, particularly older people, are discharged from hospital but stay in hospital, they decondition at a very significant rate and it is very bad for them to be there. That is the second point.

The other point, separately, is rightly raised repeatedly by members of this committee. We have made improvements in this regard in the past few weeks but we have a long way to go. I refer to the incidence of the most abhorrent situations in which frail people are on trolleys in emergency departments or parked on corridors where they have no dignity and where their life chances are greatly compromised the longer that goes on. On both ends of that spectrum, it makes sense from my perspective that where a person's genuine choice is not immediately available, we at least do everything to move to a second-choice or best-choice position and thereafter to allow that individual, after he or she has moved to a place that is not his or her first choice, to exercise his or her first choice as soon as it becomes available. The fair deal scheme allows for that.