Dr. Emily O'Conor:

It is a geriatrician and there is a clinical nurse specialist who works with her. It was started off by Siobháin Kennelly, a geriatrician in Connolly hospital. If we could expand that service it would be wonderful. Currently, we cannot give intravenous antibiotics in nursing homes. We need to be able to do that to prevent patients coming in to us with infections.

Geriatricians also introduce good practice for end-of-life planning. They are difficult conversations to have with patients and relatives, but they are bringing in good practice on that. I can only support that model.

As regards the predictability of surges, I could not have said it better myself. We know when the surges happen. Why do they happen on Mondays and Tuesdays? It is because we have peaks in attendance at emergency departments on those days, generated significantly by GP referrals on Mondays because the clinics re-open and, thus, GP referrals increase. In addition, theatre lists for elective surgery open up on Mondays and Tuesdays, so there is a surge from both sides on beds. We are therefore always going to have difficulties on Mondays and Tuesdays. Should we have elective theatre lists on Saturdays and Sundays, and all weekdays? There is a lot of medical literature to say that evening out elective surgery across the seven-day week would improve one's ability to deal with surges through the emergency system.

As a society, we close down for six or seven days over Christmas. We all want to do that, yet people still get sick. How can we expect the system to cope? This year there was a Saturday and Sunday, and the bank holiday, so the system re-opened for three days before it shut down again for four days. Are we surprised therefore that things back up? When I say "shut down" I do not just mean the acute hospital sector. I also mean that it is very hard to get someone out into the community on Christmas Day or St. Stephen's Day. It is hard to arrange for a public health nurse to visit a patient on Christmas Day. Society makes these decisions. We all want Christmas Day off to be with our families. If we want people to work on these highly valued days in the year, we need to staff them enough and incentivise people to work then.

Weekend discharges are not as good as we want. It has definitely improved in some hospitals, particularly on Saturdays, although it is still not great on Sundays. That is not just because consultants are not doing ward rounds, it is because access to community follow up is difficult at weekends.

This committee is not about emergency medicine. I would love to sit here and tell members of the committee all the good things about emergency medicine, but I am not allowed to do so because this is about overcrowding. So do not confuse both - emergency medicine is not simply overcrowding.

The transitional space or annexe for patients is not safe. We used to have models where we shoved all the admitted patients out into a room and they could not be seen. They were having cardiac arrests out there and no one could get to them. Patients need to have nursing and medical care, even while they are waiting on trolleys. They are easiest to nurse when they are visible and they are visible on the corridors. Not all departments nurse on the corridors. We do not nurse on the corridors in my department, but that means that I do not have cubicles to bring patients in the waiting room into. Therefore, nursing staff have to balance where the biggest risk is going to be. If we do not have enough nurses to nurse patients the best thing we can do is to put them into a visible space where we can see them. That is why they are on the corridors. I am sorry if it is undignified, but clinically it is the safest place for them to be if we have no beds for them. If we have money to build annexes for them, we have money to build beds, so I would not support building annexes.