Commencement Matters

As Senator Rónán Mullen is not present, we will proceed to the second Commencement matter in the name of Senator Martin Conway.

Aquaculture Licence Applications

Go raibh maith agat, a Chathaoirligh, and thank you for allowing the Commencement matter to go ahead. I welcome the Minister of State, Deputy Nash, to the House. This issue is simple. Ballyvaughan in County Clare as well as Fanore and the Burren are among the most unique areas of landscape in the world. The Burren certainly has a unique style in terms of its rock, limestone, mountainous terrain, flora and fauna. Some of the flowers there only grow in the Burren and nowhere else in the world.

The Burrenbeo and Burren Geopark projects have had major success. They have won international awards and they are going to win many more awards. These, coupled with the Cliffs of Moher visitor experience and the panoramic coastline that extends all along the coast of County Clare, in particular from the Cliffs of Moher up as far as Ballyvaughan, are our natural resources. They are creating and sustaining jobs in the northern part of County Clare. Meanwhile, a fish farm is being proposed.

I do not know very much about fish farms but I have been talking to many people who know a great deal about them and I do not like what I hear. It is the same among the people of north Clare. I do not believe we need this type of investment in County Clare to create jobs. We have ample opportunity to create jobs in the county by promoting and investing in tourism and in promoting our natural resources. We do not need fish farms.

It would be more in the line of the Department of Agriculture, Food and the Marine to negotiate properly for access to sea waters for the fishermen who go to sea for a living, instead of indirectly encouraging these types of fish farms which, ultimately, will compromise the natural resources we have. I wish to put on the record of this House clearly that I am not in favour of the fish farm, either as it is proposed or as it will be alternatively proposed following downsizing. What we have we need to protect rather than compromise.

I thank Senator Conway for raising this issue which I am taking on behalf of the Minister for Agriculture, Food and the Marine. In 2012 Bord Iascaigh Mhara submitted an application to the Department for an aquaculture licence for the cultivation of fin fish near Inis Oírr in Galway Bay. The application and its accompanying environmental impact statement are being considered under the provisions of the 1997 Fisheries (Amendment) Act and the 1933 Foreshore Act which provide for extensive consultation with stakeholders and for a period of general public consultation as well. The public consultation stage of the assessment process in respect of the application is now closed and a total of 410 valid submissions were received by the Department.

BIM has estimated that one of these production areas could generate over €100 million in exports per annum and create 350 direct jobs. A further 150 jobs would be created indirectly in the service sector, supplying fish feed, netting, transportation and other services. There is always a strict separation between the ministerial duty to promote sustainable development of the industry and the ministerial role as a decision-maker in respect of aquaculture licence applications. This separation of duties is serious and is strictly observed at all times.

All aspects of the Galway Bay application are currently being examined by the Department in conjunction with its scientific, engineering, technical and legal advisors. All submissions received as part of the statutory consultation stage of the process and the general public consultation stage will form an integral part of the Department's consideration of the application. The legislation provides for extensive consultation with stakeholders, including Inland Fisheries Ireland, which has responsibility for wild salmon stocks.

It is important for all parties to understand that as the application is under active consideration as part of the statutory process it would not be appropriate to comment on the merits or otherwise of the application pending the completion of the formal assessment process by the Department. The application process is governed by legislation and must not be subject to parallel discussions by the Minister or his Department that could be misconstrued in any way as indicating a predisposition by the Department in respect of the application. Of course, no such predisposition exists and the formal assessment process will take into account and evaluate all of the observations received from stakeholders and the general public in respect of the application. Any person submitting a licence application to the Department has an entitlement, in accordance with fair procedures, to have the application fully considered in accordance with legislation. The legislation provides for a possible appeal of the ministerial decision to the Aquaculture Licences Appeals Board, the independent authority for the determination of appeals against decisions of the Minister.

A draft national strategic plan for sustainable aquaculture development has been published by the Department and is currently the subject of public consultation. It would not be appropriate for anyone to seek to prejudge the outcome of the consultation process or any actions, legislative or otherwise, that might follow from that process. In the meantime, and in the normal way, applications on hand and all new applications will continue to be assessed under the provisions of the existing legislation and licence determinations made in accordance with the legislation.

Senators can be assured that the public interest is well protected under the provisions of the relevant legislation and the Minister is mindful of the importance of proceeding fully in line with statutory requirements.

I thank the Minister of State for coming to the House to take this Commencement Debate matter on behalf of the Minister for Agriculture, Food and the Marine. Of course we have to respect the separation of decision-making and so forth as well as the appropriateness of ministerial involvement. However, as I said at the outset the Minister also has responsibility to protect our environment as well as a responsibility to protect our natural resources and tourism industry. His responsibilities lie not only in terms of creating jobs but in terms of sustaining the jobs already in place. I would appreciate if the Minister of State brought these observations to the Minister. We will watch the process with interest.

Hospital Services

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.

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.

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.

Care of the Elderly Provision

I thank the Minister for coming to the House to deal with this matter relating to Kenmare hospital. This €7 million project was constructed and completed more than two years ago. The official opening was performed one year ago by his predecessor. It is a fantastic new facility for the community. The campaign had been carried on since 1974 when the first of many promises were made about the hospital. Unfortunately, over four decades, many of those promises were not fulfilled. However, the community and the Kenmare hospital action group are delighted that their sustained efforts over those decades have reached fulfilment. Unfortunately, despite the fact we have a 40-bed hospital, not all beds are in use and there is a huge demand for them. We have been in contact with the HSE to ask for the remainder of the beds to be opened but staffing has not been allocated. Will the Minister look into this situation?

I commend the efforts of the likes of Una Clinton O'Neill, who is the chairperson of the group, and many others who met all the politicians from all sides to ensure this was fulfilled only to see half the hospital empty. This is not a desirable situation. Ms O'Neill and others were involved in what could be described as tense negotiations before the previous Government collapsed whereby a legally binding letter of agreement was issued by the HSE which ensured that for the first time we had a concrete sign to ensure, despite many years of promises, the hospital would open. I was delighted to be involved in the negotiations with the HSE and Glenbeigh Construction to ensure, despite many promises from 1974 and including 1997, 2002 and 2007 - the list of all the broken promises is too long - we eventually got the hospital. It is half-opened and I hope the Minister will have news as to when all the rooms and the required staffing will be in place.

I thank Senator Daly for raising this matter. I am taking this debate on behalf of my colleague, the Minister of State, Deputy Kathleen Lynch, who is abroad on Government business.

The Kenmare community nursing unit was opened in 2013. It replaced the existing 24-bed residential unit with a new facility which includes 40 residential beds, a mental health day care centre and a new ambulance base for the locality. The new unit provides an improved and enhanced environment for residents in which the strong local tradition of caring for the elderly can continue to flourish. When the stage is reached where an older person can no longer remain at home, the State provides financial support through the nursing homes support scheme for those who need long-term residential care. The scheme aims to ensure long-term nursing home care is accessible and affordable for everyone and that people are cared for in the most appropriate settings. The scheme is currently the subject of a review. This review is considering the scheme's long-term sustainability as well as looking at how well the current model of provision is balancing residential care with care in the community and whether this needs to be adjusted to better reflect what older people want.

Following registration with HIQA in June 2013, Kenmare community care unit opened on a phased basis, with the first phase being the transfer of the inpatient service within existing resources. The HSE Cork and Kerry community health organisation is carrying out a review of services in the Kerry community hospitals. The review of Kenmare community hospital will consider the requirement for both long-stay and short-stay residential beds. Following this review, HSE management in Kerry will be in a position to consider the viability of opening and funding additional beds in Kenmare community hospital, particularly through funding from the nursing home support scheme.

The collection of data for the review of services began on 9 January and concluded yesterday. A preliminary analysis of the data collected to date about short-stay bed availability in County Kerry has indicated that during the months of January to June, there was no evidence of a deficit in the number of short-stay beds available to meet requests for admission to these beds. Kenmare community hospital currently has two short-stay beds vacant. All the long-stay beds in the hospital are currently occupied. A final report on the bed requirements at Kenmare community hospital will be completed and available at the end of this month. The HSE will continue to explore how the additional beds in Kenmare community hospital can best be utilised to meet the needs of the wider community.

I thank the Minister for the reply. I note the issue with regard to the data collected and the fact that two short-stay beds are currently vacant but the real need relates to long-stay beds because that is the function of a community nursing unit. I have information about a person who will need a short-stay bed following a fall at mass last week when it took one hour for the ambulance to show up, but that is a matter for another day. There are 20 long-stay beds vacant but there is a pent-up demand for long-stay beds. I agree that the short-stay beds are a different matter. Perhaps the Minister will examine the issue of the long-stay beds because no staff have been allocated for the nursing unit to ensure the 20 other vacant beds on an entire floor of the hospital can be used.

Sitting suspended at 11.10 a.m. and resumed at 11.30 a.m.