Hildegarde Naughton (Galway West, Fine Gael) | Oireachtas source

I thank Mr. O'Brien for his opening statement. I will come back to some of the themes raised by my colleagues.

The restructuring fatigue issue was highlighted by Mr. O'Brien. That matter has come up a number of times with other witnesses who appeared before the committee. When the hospital groups came before us, they said although they are not perfect, they have changed patient pathways for the better but that issues arise with regard to resources, a lack of capacity and inpatient beds. Will Mr. O'Brien outline the steps the committee would need to take to ensure that we have a functioning group system throughout the country? All of the hospitals in the Saolta hospital group in the west are HSE-run hospitals, which is a completely different scenario to what is happening in the east, which has voluntary hospitals. There are challenges in this regard. For us to come forward with a report that works for the health service in Ireland over the next ten years and to have the most effective health system in the short, medium and long term, we need to be able to deal with these challenges if we are seriously looking at a non-restructuring solution or, at least, trying to minimise restructuring. Will Mr. O'Brien go through the steps that need to happen for an effective group system?

Will Mr. O'Brien spell out the link between the acute hospital system and community care? Who will be responsible for oversight of the step-down facilities required when someone needs to leave hospital when their care comes to an end and they need to go to a step-down facility or a nursing home? What is the governance structure between the hospitals and our primary care centres? Mr. O'Brien needs to elaborate on this.

Mr. O'Brien made reference to acute hospital beds and said that simply increasing their number is not the easy solution. He made reference to the importance of community care and step-down facilities. We are all in agreement that if we had properly functioning community care and primary care centres it would alleviate bed capacity issues in our hospital system. The clinical director of the Saolta group, Dr. Pat Nash, came before the committee. The group stated University Hospital Galway, which is a centre of excellence model 4 hospital for seven counties, is not fit for purpose and cannot expand due to physical space issues. Even if we had functioning community care, we would still need extra bed capacity. The group made reference to the need for a new hospital at Merlin Park on State-owned land. What are Mr. O'Brien's views on this? Improvements in the ability to treat people and medicines mean that we will have an ageing population and that there will be a great need for acute hospitals. We will still have very sick people who will need to go into hospital. Does Mr. O'Brien agree that we need an independent assessment of bed capacity in Ireland? By this I mean independent of the HSE.