Mr. Maurice Power:

Our current governance structure is a hybrid of hospital site based management teams and cross-site clinical based teams. To enhance our governance structures, we are developing a clinically led cross-site governance structure which will improve patient care and outcomes. A non-statutory board, which had been in place for the past four years, has recently come to the end of its term. A process is ongoing to appoint a new chairman and board. Although non-statutory, the board took responsibility for ensuring that the group was achieving its objectives and effectively managing its resources and maintained a strong emphasis on patient care and safety.

As a group, we face a number of key and inter-related challenges. Access is the single biggest challenge in our group, especially in UHG where our emergency department is not fit for purpose. It is too small and outdated and it is an ongoing challenge to manage the large numbers attending daily. Attendance at the department averages 180 per day and up to 240 on some days, making it one of the two busiest emergency departments in the country. This results in unacceptable delays for patients.

The development of the hospital group has added to capacity challenges in Galway due to the change in the referral flow patterns from other hospitals in the group to Galway. A key element of our clinical strategy will be ensuring the bidirectional flow of patients. This will involve the transfer of non-tertiary care from the Galway site to other sites in the group which will free up capacity on the Galway site. This is currently happening in plastic surgery and endoscopy in Roscommon and in other surgery services at Portiuncula. We are also actively working to implement the clinical care programme pathways and have seen significant benefits from an investment earlier this year in a new acute medical unit in Galway. There are also developments required in other sites particularly in Sligo, Mayo and Portiuncula. Further investment in infrastructure will ensure that we can sustainably address the unacceptable delays in access to urgent inpatient and outpatient care.

Galway also requires additional inpatient bed capacity to meet its dual requirement to provide timely access to tertiary services for the group while providing secondary care to the people of Galway and Roscommon. A new 75 bed ward block is due to open in 2017. This comprises mostly much needed modern replacement beds, but will provide 15 new beds and additional surge capacity in the vacated older wards. Galway urgently needs a new emergency department but there is also a requirement to look at a long-term solution for acute hospital services in Galway and consider the future development of the hospital. Ultimately, the physical constraints presented by the UHG site mean that plans for developments into the future must include a new hospital on a site such as Merlin Park.

Our inpatient, day case and outpatient waiting lists present an ongoing significant challenge for the group across a number of specialties and sites. Galway University Hospital, GUH, accounts for approximately half of the group’s waiting lists. We are implementing a variety of measures to reduce the numbers of patients waiting and the length of time they wait, including validating existing lists, moving activity between hospitals, running additional clinics, new appointments to key specialties and the development of health and social care professionals and nurse-led clinics.

The recruitment and retention of skilled nurses, particularly theatre nurses, remains a challenge for all our hospitals and is currently significantly reducing our theatre capacity, especially in Galway. The recruitment of consultants and non-consultant hospital doctors, NCHDs, remains a challenge mainly in Letterkenny and to a lesser extent in Sligo and Portiuncula. We face a number of information technology, IT, challenges and we currently do not have an integrated patient administration system, PAS, or integrated patient care record across our hospitals. This is key to facilitating safe and effective care. We have developed an IT strategy to address this which will require significant investment.

To conclude, the Saolta group is well established with a strong governance structure. Our hospitals work closely together and there is an eagerness to fully integrate our services. Our clinical strategy will help facilitate this together with the implementation of our integrated clinical governance structure and an integrated IT platform.