Ms Angela Fitzgerald:

I will make a general comment and ask Mr. Egan to come in. Our task was to set out the advice for the Minister and the Government to make a policy decision. In setting out the three options, we felt it was incumbent on us to look at the benefits of the three options but also the implementation challenges.

The advices, I think, set those out. We are also saying there is a need to act now in terms of the safety concern. The Senator's opening comments are testament to that. That was the lens we were looking at it though.

In terms of our expertise, we are not planning experts. That is not why we were asked. We were asked because we are good at producing an evidence base for doing something. On the earlier comments, what this does provide is a clear evidence base for where Limerick sits relative to its peer hospitals, and where the gap is. The ESRI is providing the expertise it has to bring forward projections so I hope the two will provide the Government with a safe basis.

None of the options is without challenge. In looking at option A, we did ask capital estates in the HSE for its assessment, because they are engineers and technical staff, to look at what the site can support. That is set out in the advice. It does say that, on paper at least, it can support the additional capacity that is identified in the ESRI projection. It also suggests that it can support a maternity hospital. We have suggested that requires more detailed analysis because we know there are planning issues and then, as Deputy Crowe said, you have to run a hospital alongside that. Those are some of the operational challenges.

Option B was designed to recognise some of those challenges. You are running a living, breathing hospital. I worked in St. James's Hospital. I know what that is like. A building programme has a displacement effect. How do we minimise that displacement effect? The benefits of option B are that we continue to enjoy investment in option A but look at some additional investment in option B where it provides some decant possibilities which means we can move services off and that allows us to run the hospital more safely. It also provides the opportunity for future-proofing some of those options, as Mr. Egan said. Option B has some of those but seeks to look at benefits in its own right while also addressing some of the challenges of option A.

We were asked specifically to look at the requirements for a model 3 hospital and Dr. Ryan's evidence base looked at what is the international evidence in respect of how to stand up a model 3 hospital. The building of it is what everybody thinks about when we think about CHI, and the capital cost is a significant consideration. The other requirements, however, are that to build it safely and not create a new set of safety concerns we have to have clinical capability across anaesthetics, critical care, radiology, diagnostics and emergency medicine in order that we can run a hospital that is capable of taking that level of acuity.

That is one of the considerations the Government will have t look at, in addition to Limerick - whether we can support the clinical staffing as well as the capital build. Each of the options have clear merit. They also have challenges. The benefits of options A and B are that, in terms of the current capacity deficit Deputies Quinlivan, Crowe and others have spoken about so eloquently, it allows us to deal with those more quickly. Option C needs to be considered in the context of longer-term planning and planning for elsewhere in the country and that is outside our remit. That is a policy decision.