Mr. Damien McCallion:

I will add to what Mr. Watt said. There is the performance piece. We do have a number of sites to which he referred where there has been an escalation. We look at what supports can be used to try and help those sites, as well as the general performance piece. We have national programmes rolling out for enhanced community care and making sure it is consistently applied across the country. As the Deputy said, if it is working in one geographical area, we can apply it to another.

There are different factors sometimes between the hospitals in terms of access to primary care, capacity, staff, the mix, and so on and so forth. The age profile, demography and tradition, for example, can be very different between certain areas. There are factors like that.

In addition, last year we set up an academy for all the people who are involved in urgent emergency care to try to make sure there are opportunities for people to learn from each other, see what is there and to look at the things that can travel. It is almost on three levels. There is a performance level. There is a piece then related to national deployment. The Deputy suggested that programmes should be consistently applied across the country. Then there is a learning piece as well for people in terms of making sure it is shared. There were more than 500 people at a recent learning event - nurses, doctors, therapists, and radiologists all came online during their lunchtime to listen to talks on a number of issues. We bring in international people as well as domestic speakers.

The Secretary General referred to places such as Beaumont. In the past three years Tullamore, for example, has seen significant changes and improvement. That is alongside places like Waterford that have commonly been highlighted. We are seeing a growing number. We have seen a reduction, but we recognise there are sites that are not as they should be.

We do not want to have people on trolleys, as I mentioned earlier, so that is why the focus is on performance improvement, a consistent roll-out and then trying to make sure that learning is shared with people. There is no one in our system in any hospital today that is under pressure who does not want it to work better. It is about working with people to try to make sure we support them to allow that to happen. Mr. Canavan might want to comment. He is the regional executive officer in the west. He is on the ground.