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'Outrageous': Over 75s face average wait of 20 hours in some Emergency Departments

PAC Chair Brian Stanley said wait times in emergency departments is an intolerable situation in a well funded health system.

LAST UPDATE | 26 May 2022

THE CHAIR OF the Public Accounts Committee (PAC) Brian Stanley has told the HSE boss Paul Reid to “knock heads together” in order to reduce the waiting times over 75s face in hospitals.

A recent parliamentary question by Sinn Féin’s David Cullinane revealed that the average waiting time for admission to hospital emergency departments last month was nearly 14 hours for people 75 years of age and over.

The data indicates that the waiting time was nearly twice that duration in two Cork hospitals.

Five hospitals – Naas General Hospital, St Vincent’s Hospital, Cork University Hospital, Mercy University Hospital and University Hospital Limerick – had an average wait time of more than 20 hours for patients aged over 75.

In 23 out of the 27 adult hospitals, this age cohort had a longer wait from registration to admission than those aged under 75.

The target for patient experience time (PET) – the time from Emergency Department registration to either admission to a hospital or discharge home -  for patients aged over 75 is 95% within six hours and 99% within nine hours.

The number of patients overall waiting more than 48 hours in an ED was 40% higher than April 2019, and for those aged 75 it was 70% higher.

One-third of patients overall had a wait time of less than six hours.

Commenting on the figures, Cullinane said it was “outrageous” that wait times in particular for those aged over 75 were so high.

“It should be a key priority for each hospital to reduce their ED wait times across the board but in particular for older people,” he said. 

He pointed out that the 20-hour average wait time for some hospitals meant that some people were waiting longer than that, in some cases for a number of days before they were admitted.

“These are people with acute needs, some in chronic pain, waiting for admission,” he said.

Cullinane said there is “no magic solution” to the issue, as it is due to a number of factors including inpatient bed capacity and a lack of resources in the community to facilitate discharges for older patients.

“Many find it difficult to get support packages in particular for older people who need a recovery bed or to go to a nursing home or to convalesce, the resources are not there,” he said.

“And while the funding is there for intensive home care packages, they don’t have enough staff to provide the service.

“To add to that we have a growing crisis in GP care, people are waiting to access GP services, out of hours services in many areas are patchy so in some areas people are left with no choice but to go to an ED.”

He said Emergency Departments are “picking up the slack for a failure to ensure” there is appropriate capacity in GP care, primary care and community care in general. 

In response to a query from The Journal, the HSE said reasons that result in longer wait times include volume of patients presenting to the Emergency Department and the requirement to prioritise, treat and care for the sickest and older cohort of patients and those with life threatening illnesses.

“This can mean that patients with less serious illnesses and conditions may need to wait longer for their treatment,” it said.

The HSE said a patient’s experience can include multiple steps and delays in any one of these events or services increase a patient’s wait time and can create bottlenecks in the ED. 

“Emergency Department wait times are also affected by what’s happening outside of the hospital Emergency Department, in both the hospital and the community,” the HSE said.

This includes such things as the availability of inpatient beds within acute hospitals for acute admissions, the availability of community beds and or home care support for those patients in acute settings who are medically for transfer or discharge to the community. These factors in turn slow down the transfer of patients from the ED.

‘Intolerable’

Committee members, including Stanley, said that substantial funding was going into the Irish health system, but it “seems we are not making any headway”, he said.

“What is HSE going to do to address that,” he asked. 

“Hopefully everyone in this room will see 75 years,” said Stanley, adding that “it is just an intolerable situation in a well-funded health system”.  

Reid said Irish hospitals were seeing increased levels in the presentation of over 75s to Accident and Emergency. He said the HSE is working with individual hospitals in a bid to get community healthcare networks in place to shift presentations away from the acute hospitals.

As the winter months approach, Reid said things will be done differently, stating that given the current situation with Covid, he would hope that dual pathways of access to hospital will reopen. 

Stanley urged the HSE to look at the work of Kilkenny Regional Hospital, whereby streaming has been introduced, which involves GPs directly referring people to A&E.

Reid said it was a “really good example”, stating that the HSE is aiming to “pick up the best practices”.

Sec Gen salary

Wexford Independent TD Verona Murphy robustly questioned the Secretary General of the Department of Health Robert Watt asking him: 

“Have you identified a problem and you don’t know what to do about it? Have you not identified the problem in which case it’s getting worse or are you paid a large salary which you get regardless and just don’t care?”

Screenshot - 2022-05-26T114147.097 Secretary General of the Department of Health Robert Watt

‘Third world service’

Murphy said for the money that was being invested into the health service, the public are getting a third world service. This was subsequently denied by Reid.

She acknowledged that the health service is a massive area to manage, but said the fact that over 75s are waiting more than 14 hours in emergency departments shows that the home care supports – and the Government’s pledge to deliver an additional one million hours – is not being delivered upon.

Murphy said Watt was the new “top dog” in the department, and asked what he was doing to ensure funding was being translated into services. 

Watt said the department’s priority is to ensure we are getting value for money 

He said he was dedicated to the delivery of Sláintecare and the new Regional Health Areas, which he said will “reform the way in which we fund the health service including a pathway to implement population based funding and multi-annual budgeting”.

In addition, the committee was also told that the HSE is set to record a deficit of more than €250 million for the first three months of 2022.

Additional reporting by Christina Finn.

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56 Comments
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    Mute Aileen Ryan
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    Jan 14th 2015, 11:05 PM

    Sex offenders should not be out on bail to begin with !!!!

    246
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    Mute Stephen Fitzpatrick
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    Jan 15th 2015, 9:35 AM

    When the question of bail arises, they have not yet been found guilty of being a sex offender.

    79
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    Mute Martin Bishop
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    Jan 15th 2015, 12:13 PM

    But everyone is innocent until proven guilty in a court of law,

    If you are going to assume all people accused of a sex offense are 100% guilty and should not be out on bail then the exact same must be applied to all other crimes.

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    Mute The Throwaway
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    Jan 15th 2015, 12:37 PM

    What needs to happen is a greater robustness to bail applications. As it stands, it is extremely difficult to have an accused persons bail rejected. Worse still is there is very very, very limited means with which the Gardai can object. If there was a robust, hearing-like procedure that the Gardai could argue freely that an accused should not be out on bail, then society as whole would benefit.

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    Mute Aileen Ryan
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    Jan 15th 2015, 1:03 PM

    If some body is charged with sexual offences there is obviously some evidence against them I for one would certainly sleep better at night knowing some body that has been charged with a sexual offence is behind bars and not walking the streets on bail to reoffend.

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    Mute The Throwaway
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    Jan 15th 2015, 1:22 PM

    For the most part the fact that you are before a court on a serious offence like a sexual offence means that the Gardai believe there is ample evidence to mount a prosecution, and in turn that the DPP have reviewed that same evidence and similarly believe that there is sufficient evidence to sustain an allegation of a sexual offence.

    The problem lies in the nature of bail applications; Gardai are practically hamstrung from saying anything incriminating. There are sever restrictions on what you can say to a judge in respect of objecting to bail of an accused. Even if you have previous convictions, only specific and certain previous convictions can be told to a court in respect to bail.
    Whether it is intended or not, a decision has been made in the legal system that the presumption of innocence (in respect to bail) is absolute, even where there might well be a crystal clear danger to society.
    I personally believe that a separate judge, and separate case is heard for bail. Gardai should be allowed to state to a court without prejudice to a case that a person is a risk to society and deserves to have their bail denied. Some will argue that is a step too far though.

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    Mute Paul Roche
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    Jan 14th 2015, 8:37 PM

    “He said that video links could be used to reduce the amount of time gardaí spend waiting in court.”

    I’d have thought it was obvious, but video links would reduce the amount of time everybody spends in court.
    As far as the law is concerned, if the Gardaí are not prosecuting, they are witnesses like any other in any case.

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    Mute AlanHarte
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    Jan 14th 2015, 10:42 PM

    Re the witnesses point, what relevance is that? Video link isn’t used for witnesses except in rare occasions where they can’t attend as, for example, they’re overseas. It’s not used as a matter of routine.

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    Mute Alien8
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    Jan 15th 2015, 8:57 AM

    Can we also use video links to avoid wasting the day in court on things like traffic violations? Had to go to court once to discuss why I got a summons for someone else’s car, spent the whole day there and the guard didn’t turn up – every one of his cases struck out. Joke system.

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    Mute The Throwaway
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    Jan 15th 2015, 12:39 PM

    Also to bear in mind: video link is only acceptable if the accused and the defence want it. If they don’t want a video link then everyone else has to turn up. Similarly, if the judge is amenable to video link there is more likelihood of it going ahead.
    The Garda in court only gets told where to go, they don’t get a say in whether video should be used or not.

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    Mute Glen
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    Jan 14th 2015, 8:42 PM

    They will probably bring in microchipping for sex offenders which would be met with very little resistance.

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    Mute Glen
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    Jan 15th 2015, 9:22 AM

    This was a half baited comment.
    Had I approached microchipping from a conspiracy view I would of been called a nut job. ” the chip” doesn’t exist, tin foil hat and all that
    Yes they will use sex offenders as a way of rolling them out further but the problem is there isn’t enough IPv4 address to accommodate everyone. When IPv6 completely takes over which will be at least another 10 years then you will see a chipped population to keep us safe from those terrorists.

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    Mute Sean Smith
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    Jan 15th 2015, 9:48 AM

    Glen they already track everything we do. Our phones tell them where we are, who we are calling. The internet tells them what we are buying, who we are talking to, what we are interested in, where we are etc.

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    Mute little jim
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    Jan 15th 2015, 9:49 AM

    Nut job.

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    Mute Glen
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    Jan 15th 2015, 9:51 AM

    I’m aware of that Sean.

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    Mute Eugene Walsh
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    Jan 14th 2015, 8:32 PM

    I’m tired of hearing about gardai.
    If they’d routinely and regularly enforce the laws we already have, well that would be just great.
    Ask em to sign for a passport and you’re met with a snarl! !

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    Mute Al Beebak
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    Jan 14th 2015, 8:58 PM

    If Gardai were to strictly enforce every single law available to them we would become a very unhappy nation very quickly.

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    Mute Eugene Walsh
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    Jan 14th 2015, 9:42 PM

    Discretion is to be applied certainly but for decades they let people off scot free for speeding and other road offences.
    That’s wholly unacceptable and too bad for the poor folk who are not “connected” to the system.

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    Mute youknowimright
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    Jan 15th 2015, 9:33 AM

    Did you know the person who snarled at you?? I’m sure it says on the passport application that you are supposed to. Did they sign it anyway once they were satisfied who you were?

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    Mute Colm Flaherty
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    Jan 15th 2015, 8:54 AM

    PULSE is what happens when you throw money at civil servants to become programmers.

    Plenty of good solutions in, (and Irish heads working for) the tech industry, both here & in California. Cheaper too!

    63
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    Mute RealCorkLanger
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    Jan 15th 2015, 9:38 AM

    It was actually made by Accenture I think, not by civil servants

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    Mute Mary Lyons
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    Jan 15th 2015, 9:38 AM

    They can stick all the Pulse computers in storage with the voting machines. They will get a good rate!

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    Mute SteoG
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    Jan 15th 2015, 9:38 AM

    PULSE is a secondhand system purchased from a US police force.

    24
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    Mute Col de Gal
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    Jan 15th 2015, 10:19 AM

    PULSE is the work of Anderson Consulting, nowadays known as Accenture. They are not public servants, not cheap, and have offices in California too if that’s the sort of thing that impresses you.

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    Mute Charles Mcdonald
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    Jan 15th 2015, 11:11 AM

    No other force had pulse. From what I believe police in NZ use a very simular type system. It’s not really outdated…… could probably use facelift to modernise a part of it. Don’t hear guards complaining about it being outdated. Oh facelift here slow speeds there I can see it being administered badly as it’s civil service run.

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    Mute John R
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    Jan 15th 2015, 12:03 PM

    Charles Pulse is not run by civil servants. The running is largely outsourced to the private sector. All garda ICT needs to be examined in the round in order to determine what the best solution. PULSE may be their biggest system but it is only one of their ICT systems. It’s also a large and complex system so replacement will not be a cheap option.

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    Mute Charles Mcdonald
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    Jan 15th 2015, 12:11 PM

    Well then why replace. Why not earmark improvements and release and updated system. Cheap and ticks the boxes

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    Mute The Throwaway
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    Jan 15th 2015, 12:46 PM

    PULSE is outdated and outmoded. At least that’s one of the newer technologies in use. The dispatch system in use for Dublin is from the early 1970′s. Those who know DOS would be well able to use it.

    Gardai have long asked for better IT infrastructure, it’s one of the main causes of the widespread use of mobile phones by Gardai: the phones do more than the equipment given. Only in the last 5 years has an actual purpose built radio communication system been put in place (and even still, TETRA is an 1989 technology, prevalent in police use by 1995-2000, and only relatively new in Ireland).

    8
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    Mute Snorre N Skalagrimmerson
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    Jan 14th 2015, 9:40 PM

    Anomolies in the penalty points system…..bent cops fire them that simple!

    47
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    Mute Kerry Blake
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    Jan 14th 2015, 8:32 PM

    Scrap “Pulse” some one remind me just what that system cost? Can we recover the cost from those who recommend the system?

    44
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    Mute Jane Travers
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    Jan 14th 2015, 10:08 PM

    In fairness it’s what, 20 years old? No-one expects tech to stay current for that long.

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    Mute Kerry Blake
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    Jan 14th 2015, 10:51 PM

    Jane it was never current part of it’s problem.

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    Mute Jane Travers
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    Jan 14th 2015, 10:59 PM

    I’ll give you that, Kerry.

    31
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    Mute Kerry Blake
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    Jan 14th 2015, 11:32 PM

    And we the “tax payers” paid for a system that was not current or could be upgraded. Who approved that purchase I wonder?

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    Mute Charles Mcdonald
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    Jan 15th 2015, 11:16 AM

    Jenny I was using windows xp till last year. I upgraded because software was no longer supported for dx11 applications I run.

    Now olif I could run what I want in the quality I want I’d still be using xp. Just because something is old does not mean it’s bad. I’m sure many would take xp over windows 8.

    That’s the same with pulse system. If it ain’t broke don’t fix. If there is something then address that in a new update.

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    Mute Charles Mcdonald
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    Jan 15th 2015, 11:22 AM

    Now if *****

    Sorry stubby fingers small touchscreen :)

    1
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    Mute John R
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    Jan 15th 2015, 12:09 PM

    Kerry get a grip. You don’t replace large complex corporate systems because the are “not current” (whatever the hell that means in ICT terms). You replace them because they no longer meet your evolving business needs. As I read it that is what is being said in the article. Large business systems are not equivalent to home users. If they work you use the system and you upgrade it as needed. That is what they did with Pulse and rightly so. The cost of replacing very large business systems to keep them “current” would be phenomenal and incredibly complex. Nobody in the public or private sector replaces ICT systems and enters into such a massive project lightly. It is very expensive and very resource intensive and the projects frequently go wrong!. If it ain’t broke don’t fix it. Pulse is not broken but it may not longer be suitable for the business needs of the Garda Síochána. If so a new system will have to be considered.

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    Mute Snorre N Skalagrimmerson
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    Jan 14th 2015, 9:42 PM

    Subpeona Gemma O’Dogherty…..and ask why she was sacked……then open can of worms.

    44
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    Mute Charles Mcdonald
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    Jan 15th 2015, 12:12 PM

    Ya wha?

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    Mute Ger
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    Jan 15th 2015, 6:19 AM

    Sex offenders are monitored by the Garda whilst on bail. When they are convicted of a sex offence they are required to sign on at their local station, providing they are not immediately jailed for the offence. Sometimes the judge will defer sentencing until he/she has probation or victim impact reports to hand. But the offender is required to be subjected to the sex offenders act while waiting on bail to be sentenced.
    People who are going through the courts procedure and are on bail but have not yet convicted are not required to be monitored as per the sex offenders act because “innocent until proven guilty”. So im not sure what changes they are requesting…..

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    Mute Jonathan Bambury
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    Jan 15th 2015, 9:17 AM

    If you belive that system works you my friend have blinkers and ear muffs on

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    Mute Ger
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    Jan 15th 2015, 3:53 PM

    I never said what I believe regarding whether or not it works…..I just said that monitoring does happen while on bail, the article said it doesn’t.

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    Mute #Wynner
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    Jan 15th 2015, 8:15 AM

    Compulsory ankle tags ? Or do we even have them ?

    23
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    Mute Mike Brennan
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    Jan 15th 2015, 10:47 AM

    Software and technology dates. So what? Look at the evolvement of Microsoft Windows and Office since the nineties for example. There’s only so much future proofing one can do and there’s always something better down the tracks. I’m sure Pulse must have been a huge leap for the Gardai, at least compared to what technology they had at the time.

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    Mute WibblyWobblyWonder
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    Jan 15th 2015, 9:15 AM

    They should download the New Garda App. It’s free on Google Play!

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    Mute Conor Power
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    Jan 15th 2015, 11:26 AM

    Pulse is just a database at the end of the day. Ideally a new database can be devised and the data lifted and shifted, happens all the time in industry. The cost of hardware is also much reduced now and thin client tech with encrypted connections are in common use. IF properly planned by competent contractors it could be done in a short space of time. Can’t see it happening though.

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    Mute John R
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    Jan 15th 2015, 12:22 PM

    Conor, it can’t be done in a short space of time. Pulse is not just a database. There are databases and there are databases! Pulse is one of the largest and most complex databases in the state. If you wish to replace Pulse then you will have to determine what are your current and emerging business needs and what system design,architecture and software may be suitable to deliver those needs. Then you have to design and run a public tender competition under EU law (minimum realistically of one year from start to award from the time the completed tender is placed in the public domain). Pulse is also linked to other Garda ICT systems and all these will have to be factored into the new design. The design of the database will also be dependent on the business users (the Garda Síochána) determining what are their current and emerging business needs. This can be assisted by competent ICT professionals but it cannot be done by contractors unless you want to be “captured” by those contractors who will design something that they can deliver. Hardware is not the issue. The design and software is the issue. This takes time. I know of nobody in the ICT domain who embarks on a major nation wide ICT project of this nature acting on the presumption that it is easy and can be done in a short space of time. It is complex and it will take time. That time scale from design to award to implementation would probably be at least three years if you want to do this correctly and recognising the complexity of Pulse, a database that has been constantly amended with numerous other add ons over a long period of time.

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    Mute The Throwaway
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    Jan 15th 2015, 12:50 PM

    I agree with everything you said there, but I’d add that hardware is an issue. One of the reasons why the PULSE system is so secure is that it is so rudimentary primitive in its hardware. I’d say a modern tech company would be very hard pushed to have the expertise of yeateryear around to deal with it. Never mind upgrading it!

    Still no reason not to upgrade it though!

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    Mute Conor Power
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    Jan 15th 2015, 1:32 PM

    There are data models and information exchange models available from national and international law enforcement agencies. Sure there will be an element of localisation and interaction design specific to AGS but they they have plenty of existing models to work with.

    Revising the system would be a good opportunity to have seamless Interoperability with Interpol:

    http://www.interpol.int/INTERPOL-expertise/Databases

    You would not be upgrading Pulse at this stage – you would devise a completely new system and migrate the data.

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    Mute Paul Ó Duḃṫaiġ
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    Jan 17th 2015, 8:44 AM

    They can always virtualise the hardware, the bulk of the Pulse system from what I recall is based around Windows NT4. Do a p2v (physical to virtual) conversion of backend infrastructure and if needs be virtualise the terminals.

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    Mute Kal Ipers
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    Jan 15th 2015, 12:18 PM

    IT systems do what they designed to do. Consulting firms will do what they are asked to. The ultimate goal of such consultancies is to make money not solve your problems.
    They start off with a tender with a cheap price knowing you haven’t scoped the product correctly. Then the charge a lot for all the extra work they knew you would need.
    The people who make the decisions on which tender to accept generally have no knowledge of IT and don’t understand their own experts recommendations. They tend to take the cheapest from a well known firm. Then costs spiral as modification has to happen.
    It isn’t just civil service this happens in RBS did the same which caused their system to crash. I have seen this happen in lots of companies and one consultancy is notorious for this and I have watched them do it. What is worse is it is predictable.
    Pulse could have been future proofed but was old from the start

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    Mute Michael Sands
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    Jan 16th 2015, 6:13 PM

    It has no pulse then???

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