Dr. Emily O'Conor:

Deputy O'Reilly asked about the performance management unit. I understand that it is a continuation, or a remodelling, of the special delivery unit. The Irish Association for Emergency Medicine has not been invited formally and an invitation has not been discussed. I have heard the announcements the Deputy has heard but I do not have any further information.

Another question was on recruitment and on agency versus permanent staff. I have experience of both. Many nurses who came to us as agency nurses, and formed part of our number on a night shift, have been converted to permanent nursing staff following interviews. I am aware of some progress in providing funding for new posts, particularly on the medical side. In my own hospital we have had funding for an extra registrar on a temporary basis, which is an extra body on the payroll. Until very recently there was a ceiling on payroll numbers for new staff. Hospitals took any other means possible to get new staff on board without having to put them on the payroll and the only way we could do this was through agencies. I knew doctors who wanted to do shifts with us as locums but I could not take them on myself. They had to register with an agency and the hospital had to pay hugely inflated fees, both to them and the agency, to get them to come. It is very welcome that the ceiling has been lifted so that we can take on board our own staff and it is really important that the ceiling does not come in again.

I was asked if we were invited to the bed capacity review. No, I did not see a formal invitation and I am the president of the association. We feel that if there is to be a review there should be no delay in starting to make things better. We are not opposed to a review but we do not feel it is necessary before we get the ball rolling. We have a short window of opportunity, whether this involves doing modular builds in certain hospitals which do not have enough beds or recruiting staff to open beds in hospitals that have closed wards. We have a small window to get it started before it is too late to make any difference in time for next Christmas and new year. We will participate in any bed capacity review but not at the expense of starting to commission beds, which needs to happen urgently.

I was asked about the primary care budget being separate and moving money from acute to primary care. Both need funding. We are very interlinked and if we have less money in acute care GPs will not be able to access the service and it will put more pressure on them. Both areas need higher budgets and I am glad I do not have the job of allocating them. The question on special measures was directed at ICTU.

Senator Burke asked about emergency departments. My department saw an increase of approximately 8% last year but I have not seen the HSE increases. I would say the increased attendance at emergency departments will be between 5% and 10% and between 25% and 28% of those patients go on to need an acute hospital bed. I wanted to demonstrate how, based on the numbers alone and not taking into account increasing frailty and the higher complexity of conditions, we will need more hospital beds. He also asked about the number of Departments where there was not a consultant in emergency medicine on call at night. We have 29 departments and 80 consultants, an average of over two consultants per departments. I cannot name them all but we have nine or ten emergency departments which do not have consultants in emergency medicine on call at night, though there may be a consultant surgeon or physician. How would members feel if we ran obstetric units without a consultant obstetrician on call at night? We do not feel this is acceptable.

We do GP working sessions in local hospitals and several GPs work on a sessional basis in our hospital. It is a model that seems to have gone under the radar a little bit but it is in many departments around the country. We have GPs contributing to our minor injuries stream and our ambulatory stream. We cannot, however, give them security. They are not permanent members of staff but come out of our special budget and I cannot say that budget will not be rearranged in the future. Lots of GPs like to get their hands dirty, so to speak, by working in emergency departments but I cannot give them permanent contracts, even those who have been with us for many years. It is extra income for them but is not a source of security.

I was asked about excessive drinking. As an physician, I am entirely non-judgmental as to why patients need to come to an emergency department. There are many societal bad habits that mean people end up in crisis and excessive drinking is one of them, as are drug use and lifestyle and behavioural issues. I have no role in telling people what they should and should not do before they come to the emergency department. I just want to be able to deal with them when they come. I have heard of bad experiences of drunk people being kept in prison cells or Garda stations overnight. If a young person, or an older person, is drunk to the extent that they are not fully conscious they cannot protect their own airway and they need to be in an emergency department. We need to be resourced to look after them so that they do not compromise the care of other patients but it is the right place for them to be.

I was also asked about the type and number of new beds and the community care model. I agree with Senator Swanick about our public care model for beds, not just the private nursing home sector. There has been success in freeing up acute hospital care beds, including such measures as the winter initiative, and in reducing delayed discharges. These people have completed their acute episode of care and need to move on to another type of bed. We may have further improvement as the years go by but I do not know if we can change things for patients on trolleys between now and next Christmas. We need to start opening acute hospital beds because, while process change should continue and there should be a continual improvement in step-down beds, transitional beds, community and nursing home beds, this will not be fast enough for patients lying on trolleys in our department. We need current beds, opened and adequately staffed. Where there is not enough physical bed space new beds need to be commissioned, in whatever form that can be done.

I fully agree with Senator Swanick and would like to see long-term care in community hospitals as well as in private nursing homes. GPs can admit to community hospitals but I do not have much experience of this. I fully agree that GPs should have a role in post-admission and transition care. Transitional-type beds already exist in the system and for patients applying for fair deal there is a system whereby we get funding for these beds while they are waiting for fair deal to come through. I hope the community care hospitals are involved in that.

With regard to busy GP practices, I am well aware that our GP colleagues have been absolutely overrun this Christmas. They have felt the pressures as much as the acute hospital sector.