Mr. Nicholas Jermyn:

The various questions are interchangeable so I will try to deal with all of them. We have a liaison committee that meets with the Cystic Fibrosis Association representatives, some of the patients and the medical and nursing staff at a local level on a regular basis. That meeting will take place tomorrow. The meeting to which Mr. O'Dwyer referred is the national meeting with the HSE, the hospital, Professor Gallagher and Dr. Edward McKone of St. Vincent's Hospital.

In respect of the ward block, St. Vincent's Hospital was opened in the 1970s and the old-type wards were in existence. The concept of the ward block was that we would create 100 single-room en-suites to cater for a number of patients. Senator Crown referred to various specialties and patients who require isolation in bathroom suites. This unit was opened and two of those floors were dedicated to CF patients. We have 45 different specialties, 550 beds and 126 single-bathroom en-suites in the hospital. There is a concentration in the Nutley wing and, obviously, CF patients have a dedicated 20-bed unit into which nobody else goes. We have not put other patients into it even if the beds are vacant. The day facility below that unit has ten en-suite single rooms and is used for day care and patients for whom we are trying to find beds.

An issue related to the statement issued and to which we are committed was the flexible use of those beds. We do not need the 34 beds all year round but there are certain times, particularly coming into the winter, when there is a need to increase the number of beds. In respect of the one to two emergency beds, we are guaranteeing and working with the Cystic Fibrosis Association to ensure that at least one of the beds in the CF unit in the Nutley wing will be made available and kept for emergencies. When certain types of CF patients are admitted, they cannot be put with other CF patients. When we refer to the one emergency bed that is guaranteed in the Nutley wing, there are situations when, although we always try to admit the most sick CF patients to the actual ward itself, we cannot always put them into that unit for clinical reasons so we must find the other most appropriate place to put them. As Senator Crown said, we want to ensure that they are placed in an area where the nurses and staff are familiar with treating these patients and that is what we have in the overall hospital situation. There are other areas where we cannot accommodate certain CF patients in the dedicated unit and we then look to the acute respiratory unit. There are one or two other areas in the hospital we have designated. We have not been able to guarantee single-room en-suites in all areas because of the design of the hospital and we are working to escalate our policies.

We are devising our current practices. We have been in the new unit since July and we have developed the day care unit. I know it was referred to as the register of patients. Over 60% of all adult CF patients attend St. Vincent's Hospital but there are other centres around the country that have been developed and have evolved. What we need to do is flex and work with the specialists. There are other cystic fibrosis consultants appointed in other centres around the country. As the hub centre, we will try to ensure we can accommodate the most sick patients and maximise the efficient use of the day centre in St. Vincent's Hospital and the other centres around the country. I understand that 315 patients are registered with us, of whom about 20% come from outside Dublin. We need to see whether we can maximise the facilities.

We are challenged at times with many of the other specialties we have. We are the lead centre for many cancers and other specialties. As indicated, we need single rooms for these patients as well. We have allocated 26% of the 126 cubicle en-suite bathrooms for dedicated use by the CF patients. The hospital admits over 100,000 patients per year and 400 of them are CF patients. We are doing our best and sometimes it does not always meet the requirements. The purpose of looking at international standards is also to look at developments in care, drugs and medicines. There have been significant developments in the way we care for CF patients, including identifying them at a younger age and treating them earlier, and we should learn from them. We have found different ways of dealing with different types of patients coming in with CF. There are different levels of emergency. Some patients need to be admitted immediately, while others need to be admitted soon. We are working on that and will discuss it with the Cystic Fibrosis Association so that when we do have-----