Enda Kenny (Mayo, Fine Gael)

The Deputy is aware that 1,433 staff left the health service in 2011. Transition teams are not going to turn up in Beaumont Hospital or any other hospital in the middle of the night and do what he suggests. There are local managers in each hospital who know who will leave the service by the end of the month and they will make arrangements with the HSE, working with staff and the unions, to see to it that cover is provided.

The has Minister stated it may be necessary to delay some elective surgery cases. That may well be the case. There has been a 10% increase in general admissions to hospitals. This may well be because of the change in the weather or respiratory problems in older people. As the Deputy is aware, the numbers fluctuate from time to time, depending on what the issue might be, but I want him to understand it is virtually impossible to know what situation might apply in an individual hospital at any one time. The important thing we need to do is to manage the system in the best interests of patients. That is why there is a need for very clear lines of command and responses from the Department of Health, the HSE, regional directors and hospital managers who have responsibility at the end of the line for their hospital. This takes into account the co-operation of staff and trade unions in order that patients who need attention will receive it. That is why there will be a continuous focus and intensity on the part of all of the teams between here and the end of the month in order that there will not be the crisis or catastrophe that some predict. We are all interested in matters of health, which are about patient care and patients receiving attention.

It is not possible to do what the Deputy says, given the extent of the reduction in numbers, but it is possible to see the benefits of having very strong primary care and community care systems. In Deputy Dara Calleary's town I had the privilege of opening a modern primary care centre that takes many people away from the necessity of having to go to an accident and emergency department in the first place to have minor ailments treated. This eases the pressure on accident and emergency departments.

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