Dr. Pat Nash:

There was consultation about the hospitals strategy and the Higgins report, but the announcement of it and the roll-out of Saolta group happened within a few months. It was the first group formed in August 2013. There was no time to do the strategic planning to be able to effect that. We are back to what Deputy Naughton highlighted. The Galway hospital site is currently overwhelmed. There is no additional capacity that can be turned on as all beds are open. I agree with Maurice Power that Galway needs a new emergency department but, ultimately, it needs a planned new hospital to be able to serve the six counties of the west and north west.

Integration with the community is a critical issue. Saolta has two community health organisations, CHO one and CHO two. The geographical boundaries are not the same. That is a big issue because we are looking after the same people and patients and we have different accountabilities. Regarding the proper and full integration of services, I fully agree with everybody who says that the key to addressing part of the overcrowding in hospitals is looking at chronic disease and elderly patients. However, that requires integrated governance to be able to manage them because they are separate governance structures. I agree that we need an integrated structure, but I would not necessarily agree to it in the short term. If one tries to move funding from the acute settings to the community without having a single governance, that will have a huge adverse effect on the acute hospital sector.

The other comment was about private ambulance use. Yes, it is a necessity. Given the geography there is a four-hour transfer between Letterkenny and Galway. To transfer a single patient and cardiologist from Letterkenny to Galway for an angiogram requires an ambulance for a full day. From Letterkenny to Galway and back is a four-hour round trip and that happens every day of the week. There is no capacity in the national ambulance service to be able to provide that in a timely fashion so, unfortunately, we end up being dependent on the private ambulance services for the non-emergency but urgent inter-hospital transfers.