Seán Kyne (Fine Gael)
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I welcome the Minister of State, Deputy Smyth. I thank the Cathaoirleach's office for choosing my Commencement matter. I am disappointed and it is not good enough that neither the Minister for Health nor one of his three Ministers of State at the Department of Health are here to debate this issue. However, I understand that the Minister of State, Deputy Rabbitte, is before an Oireachtas committee because she phoned me yesterday.

My Commencement matter concerns the provision of winter beds and permanent beds for Galway. Yesterday, at the meeting of the Oireachtas Joint Committee on Health we discussed the winter plan with Mr. Paul Reid, chief executive officer, and his senior officials in the HSE. I pointed out that we need a plan for each hospital so in this case University Hospital Galway or at least for the Saolta University Hospital Care Group. The national plan contains a promise or commitment to provide 205 acute beds over the period of this winter, also community beds, extra resources for GPs and the like. I asked a question based on the fact that the one in eight people who have been on trolleys over the last eight weeks were on trolleys in University Hospital Galway. I asked how many of the 205 acute beds that are proposed to be provided as part of the winter plan will be located in Galway and the answer I was given was zero. I find it unbelievable that no beds will be given to the hospital that has had the highest rate of people on trolleys over the last eight weeks. How does that make sense to anybody? The reason given was that there is no capacity to put beds in place, no wards have been closed and there is no space without major construction. They said they are considering community beds and private care. Obviously there is no capacity in other hospitals. Certainly I would not advocate that patients from Galway would be transferred elsewhere for care. They want and deserve to be looked after within their home area and within University Hospital Galway. The hospital is at breaking point and there is no capacity within the hospital or within Merlin Park.

The resourcing of GPs is an important area and I have previously raised the issue of Westdoc, which is an out-of-hours service in my region. Westdoc does not cover some parts of County Galway and it does not cover my own area of Moycullen, Rosscahill and Oughterard, which is close to Galway city. If one has an out-of-hours patient that cannot avail of Westdoc then where must he or she go? Such people must go to the emergency department. Yesterday at the committee meeting, Ms Anne O'Connor of the HSE said that the HSE would look at resourcing Westdoc to provide extra provision as part of the winter plan because there are resources available. I welcome that and urge the HSE to consider the matter.

In the meantime, the winter plan does not provide acute beds to Galway and we do not know what will happen long term. We have proposals from an elective hospital, which is likely to be Merlin Park, and an announcement is due to be made.There were commitments and promises regarding acute beds, but it now seems that none will be provided or the matter is still under discussion.

That is the situation in Galway. We have the most people on trolleys over an eight-week period and there are no short-term or medium-term plans to provide acute beds. There may be long-term plans to provide them depending on how long-term "long-term" is. That is the situation in the largest city in the west and the centre of excellence for hospital care in the west. It is a sorry state of affairs. There are many plans and a great deal of talk, yet the situation on the ground is dire. Nurses in the emergency department are leaving and there is no commitment from the HSE to provide acute beds for this winter.

Ossian Smyth (Dún Laoghaire, Green Party)
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I am answering questions on behalf of the Minister of State, Deputy Rabbitte, who is appearing before a committee. She sends her apologies.

I welcome the opportunity to address the House on the issue of additional beds in Galway university hospitals, GUH, raised by Senator Kyne. While additional beds are an important part of the solution to emergency department overcrowding and waiting lists at GUH, it is also important to acknowledge that our response must not be solely based on the provision of extra beds but also on the provision of alternative pathways of care outside the acute sector in line with Sláintecare's right care, right place, right time philosophy.

I acknowledge the scale of the challenge facing our acute hospitals as we head into what is expected to be a difficult winter with increasing levels of Covid-19. The Government is taking action to mitigate the challenges presented. The Minister for Health, Deputy Stephen Donnelly, published the 2021-22 winter plan on 15 November. The plan centres on three core objectives - emergency department avoidance, patient flow and hospital egress - to mitigate the expected challenges in providing emergency care this winter while also continuing to respond to Covid-19. This year's winter plan recognises that a whole-of-system response is required and outlines how the HSE proposes to manage winter challenges across primary, community and acute care, including measures to allow the public system to access private healthcare capacity.

GUH provides regional services for a wide range of specialties and is also a designated centre for cancer and cardiac services. It has a total of 712 inpatient beds across the specialties - 639 in University Hospital Galway, UHG, and 73 in Merlin Park University Hospital - and approximately 3,500 whole-time equivalent staff.

We continue to invest in UHG to improve services to patients. Six additional critical care beds have recently been opened in GUH. The number of beds open on any particular day is subject to fluctuation as a result of variety of factors. Building works have commenced on the cardiothoracic ward in UHG to provide 12 cardiothoracic beds and are scheduled for completion in the second quarter of 2022. The new radiation oncology unit is under way and is scheduled for completion in the fourth quarter of 2022. GUH also has access to additional beds in the private hospitals in Galway under the safety net arrangements. Work is progressing to complete a temporary extension to the emergency department to provide additional accommodation. The phased handover is scheduled for the end of April 2022. Merlin Park saw the commencement of building work to deliver two orthopaedic theatres with ancillary accommodation for the provision of elective procedures, which are expected to become operational in January 2022. Finally, the Sláintecare Implementation Strategy and Action Plan 2021-2023, approved in May, commits to progressing an elective-only hospital in Galway. The Department of Health is engaged in the preparatory work necessary to seek Government approval to proceed with this project.

Seán Kyne (Fine Gael)
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I thank the Minister of State for his response on behalf of the Department. He stated: "While additional beds are an important part of the solution to emergency department overcrowding and waiting lists at GUH, it is also important to acknowledge that our response must not be solely based on the provision of extra beds". They should be part of the solution, but they are not in Galway, given that none will be provided despite the fact that it is top of the list in terms of the number of people on trolleys over the past eight weeks. Clearly, the Minister of State's speech should have read, "They are not part of the solution for GUH and we have to look at private care". That is the only solution based on what I heard yesterday from HSE officials at the Joint Committee on Health and today from the Minister of State. We must look to private hospitals in Galway. Thankfully, they are there because they were built and financed, but it is not good enough that there is no physical space to put anything due to bad planning by the HSE and the Saolta University Health Care Group, which have a diversity of opinions about the UHG campus and Merlin Park. Some want to move everything to Merlin Park, some want to move parts to Merlin Park. We are caught in a situation where there are on both sides of the city medium-term, long-term and grandiose plans of €3 billion to €4 billion but there are no medium-term plans to provide extra beds for an area that the national planning framework has identified will see a population increase over the coming years.

Ossian Smyth (Dún Laoghaire, Green Party)
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The safety net arrangements are being used to utilise capacity within the private hospitals in Galway and a number of other beds are in train for next year. The health service capacity review was clear on the need for major investment in additional capacity in acute and community hospitals combined with a widescale reform of the manner and location of where health services were provided. The current winter plan builds on significant investment in last year's plan, which committed to delivering 1,146 additional beds over the number at the start of 2020. Of those additional beds, 800 are now in place and a further 50 are expected to be delivered by the end of December. Six additional critical care beds have opened in Galway and 12 cardiothoracic beds are due to open early next year.

The health sector is expected to face significant challenges this winter in dealing with Covid-19, the presence of which places additional and unpredictable demands on our hospital systems, including staffing pressures. The Senator accepts and understands that it is not all about beds. Reducing pressure on acute hospitals also requires providing egress arrangements such as additional nursing home places, step-down care and, as he mentioned, providing pathways for people to avoid going into emergency departments because that is their only choice. The Senator stated that Westdoc was under pressure. If people cannot access primary care and their only option is to attend the emergency department and wait for hours, that is not something that they want to do or that the health service wants to happen. The Senator is right that there needs to be a focus, not just on the hospitals themselves, but also on the reasons people are attending hospital and cannot leave hospital.