Mr. Robert Morton:

That is basically it. Delivery of targets is a feature of a match between capacity and demand. Demand far exceeds capacity and, therefore, we are not able to meet the targets. On the 19-minute target, there is a growing question mark about the relativity of those targets.

Professor O'Donnell is developing the realm of clinical key performance indicators, KPIs - in other words patient outcomes. I will give a brief example to articulate that point, then hand over to Professor O'Donnell. For a patient in Dingle who experiences a stroke, the nearest ambulance is Dingle ambulance station but that ambulance might be dropping off a patient or en route to Tralee, as the main receiving hospital. The ambulance will not get there in 19 minutes because it is at the end of a peninsula but, in real terms, that will not change the outcome for that patient. The target is 19 minutes but the key target for that patient is to get to a hyperacute stroke unit within four and a half hours of the onset of symptoms. We are moving to a clinical, rather than response-time, way of thinking about it. That is not just in Ireland, but in a general global setting. I ask Professor O'Donnell to comment on the development of alternative KPIs.