Hildegarde Naughton (Fine Gael)
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I thank the Minister for attending. I recently had the opportunity to talk to a retired nurse of senior standing who qualified in what was then the regional hospital in Newcastle, Galway, in the early 1970s. She had been there from the mid to late 1960s. The hospital is now University Hospital Galway, UHG, which is located on University Road. It was a hugely informative discussion. She was able to tell me about the lack of specialisation back then and the handful of surgeons and consultants. She thought there were about ten in total. She spoke about the conditions that nowadays require a day case or perhaps an overnight procedure but from which one could have died 40 years ago. She was able to tell me about the much smaller hospital building in a much smaller town and the fact it was effectively run by a matron of fearsome repute. She was also able to list out on a piece of paper, floor by floor, ward by ward, as only a nursing sister can, the number of inpatient beds in University Hospital Galway in 1971. The number was 464, give or take a few. At the time the population of Galway was much smaller and there were a lot fewer surgeons and consultants. Back then the hospital was not a centre of excellence, attracting patients from all over the western seaboard for oncology, cardiothoracic surgery and cardiology, and when patients were not flown there daily from all over Connacht and beyond, from out at sea and the top of mountains for emergency treatment.

In the space of 45 years, University Hospital Galway has added just less than 100 inpatient beds to cope with the current need. I accept that medical science has advanced and many people can now be seen as a day case for conditions that previously would have required admission. I also accept that modern health and safety regulations dictate that the number of beds in a given space in the previous time would no longer be acceptable today. Additionally, some people no longer even need a procedure with the advent of new drugs. I will not argue with the nurse on whether her memory is correct on the numbers, but the fact remains and the Minister has seen it for himself that the hospital complex is simply bursting at the seams. It is not just the accident and emergency department, it is the entire complex. I am sure the Minister would acknowledge the staff at the hospital do a wonderful job. The simple issue is a lack of space. The chief operating officer, Tony Canavan, said so himself on Monday.

One could ask what is happening at the moment. To make space, the physiotherapy department and other sections are being moved across the city away from the acute hospital to Merlin Park. That is hardly ideal. Basically what is happening there is a daily patch job, a case of getting over the crisis and moving on to the next. For the avoidance of doubt, the blame for the situation cannot be laid at the Minister’s door. We inherited an economy that was broken. We had no money to invest in infrastructure and we still have very little. Even if we had the money, the infrastructure required would take some time to complete. The problem in UHG is a manifestation of years of under-investment and the fact that when investment was made, the result was past its sell-by date when the doors were opened. The current accident and emergency department is hardly in place for 20 years, yet it is completely unfit for purpose.

One could ask what we can do. The Government is in office and, money or no money, we simply must plan for the future. I ask the Minister two things: first, to recommit as a matter of priority to getting a new accident and emergency unit with the shell space for a new maternity department included in the capital development programme and, second, to order a comprehensive study of future bed needs, including bed capacity, at University Hospital Galway. The study should include the development potential of the Merlin Park site and also demographic changes that are forecast for the next 30 to 40 years. The development can be fed into the capital programme in the forthcoming years. It should be a long-term plan for the development of the major acute hospital in the west over the coming decades, a hospital that saves the lives of people from Donegal to Clare and Connemara to Athlone. Perhaps in that way we can avoid the fire-fighting that has been a feature of our health system for decades. I know the Minister. He is a straight talker and that is very much appreciated. It is in that spirit that I urge him to consider this request.

Leo Varadkar (Dublin West, Fine Gael)
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I thank Senator Naughton for raising this issue today. First, I recognise that University Hospital Galway is extremely busy, with approximately 66,000 emergency department attendances, 38,500 inpatient discharges and 76,000 day cases every year.

A number of construction and infrastructure projects are now under way at Galway University Hospitals, GUH, including the upgrade of the medical gas network and the commencement of enabling works for the new 50-bed acute mental health department. The transfer of acute mental health services to a new, purpose-built unit will facilitate construction of a new radiation oncology project, which is currently in design phase, at the old mental health services site.

A significant and welcome construction project, which commenced in May of this year, is the new ward block which will provide 75 beds in single room accommodation. Some of that capacity will replace older wards and some will be additional, to address the inherent bed capacity deficit that exists in Galway. It is anticipated that work will be completed by the end of 2016.

Recognising that the loss of 17 beds to commence this building work was unavoidable, 14 additional rehabilitation beds were opened in Merlin Park. In addition, emergency capital funding was approved by the HSE on 30 June to create 30 bed spaces in temporary ward accommodation as an interim measure. The additional accommodation will provide additional capacity and enable more effective streamlining of patients through the acute medical and acute surgical assessment units. The HSE is undertaking all actions possible to expedite the procurement of this accommodation without undue delay.

The completion of the hospital's clinical research facility and translational research facility building, which is now operational, is another significant development, facilitating clinical research, while allowing patients access to state-of-the-art treatment. That is a major advancement for the hospital as it has been internationally proven that clinical care provided in a research-intensive environment results in the best patient outcomes.

I referred at the outset to the high level of activity which takes place at the emergency department in Galway. As well as working closely with the special delivery unit, SDU, to better manage patient flow through the hospital, GUH has also recruited and allocated experienced general and paediatric nurses and advanced nurse practitioners to the emergency department. When we examine the pattern of patients on trolleys each week, however, it is clear that changes in working practices and better liaison with primary and social care services will help make better use of our facilities and smooth out activity in hospitals. In particular, the provision of short-stay beds in the community, transitional beds, additional intensive home care packages and medical care provided by community intervention teams in patients' homes are essential and welcome changes in activity which mean acute hospital facilities are used by those who specifically require acute medical or surgical care and the use of a hospital bed is less frequently required.

I acknowledge that the current physical infrastructure of the emergency department is not fit for purpose and requires investment. The HSE is concentrating on applying the limited funding available for infrastructure development in the most effective way possible to meet current and future needs across the overall acute hospital sector. Limited funding is available for new projects over the next multi-annual period which runs from 2015 to 2019, but I am advised by the HSE that some funding is available to advance the development of the plans to upgrade the emergency department at GUH. I will seek to have further funding for this project included in the 2016 to 2022 capital plan.

Hildegarde Naughton (Fine Gael)
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I thank the Minister for his comprehensive reply. My reason for raising the matter this morning was to emphasise the importance of forward planning in University Hospital Galway. Over decades we have had add-ons in dribs and drabs and the hospital is still not capable of dealing with the demands placed on it. We must also consider a plan for the future, taking into account the congested city centre location of the hospital, and examine the potential of a site such as that in Merlin Park, which is under-utilised. A long-term plan is required. People accept that the Minister has no magic wand but it is important we carry out a review and examine the long-term plan not only for Galway but the western seaboard and how the facility can meet the demands of citizens.The Senator's points are well made in that we are often running to catch up in health care. We are doing exactly the same now with the additional 30 beds for the existing physiotherapy department in Galway which I hope will make the patient experience much better this winter. The additional 75 beds in the ward block currently under construction will be a significant benefit to the area. These beds will be in individual rooms which means the risk of infection such as MRSA and C.diff is dramatically reduced.

The hospital group may wish to examine where it sees the hospital in 20 years time and to engage in long-term planning, as the Senator suggests. That work is being done for the Cork hospitals and we have done that work for the maternity hospitals in Dublin, so perhaps there is a case for the hospital group to do some work on where it would see the hospital and what sort of hospital it would have in 20 or 30 years time. The story related by that retired nurse is very true and it shows how much things have changed. More hospital beds were needed in the past because day cases were not the norm and people stayed in hospital for procedures which are performed as day cases now. Also, people could not get home as quickly. Over time, we have needed fewer hospital beds rather than more. However, it is very difficult to predict future trends. American experts who come here say we have too many beds and that we use them inappropriately. For example, cancer centres in America may often have no inpatients because patients stay in a hotel on the campus of the hospital and are treated every day. The number of patients who need to be horizontal in a bed on a ward and nursed 24-7 is actually very low. We may yet find in the future that we do not need as many additional beds as we think.