Léim ar aghaidh chuig an bpríomhábhar

Dáil Éireann díospóireacht -
Thursday, 28 Sep 2017

Vol. 959 No. 5

Priority Questions

Health Care Policy

Billy Kelleher


1. Deputy Billy Kelleher asked the Minister for Health the action his Department is taking to implement the Sláintecare report. [41051/17]

What action is the Department of Health taking to implement the Sláintecare report? As the Minister knows, the report was published after a great deal of deliberation and was primarily cross-party in nature. Has the Department set up the task force to deal with the timeframe for the report's implementation?

I thank Deputy Kelleher for his timely question. The Government is committed to making tangible and sustained improvements to our health services. I believe genuinely that the Sláintecare report now provides a framework and a direction of travel to do this. We have a level of consensus and support for the vision and strategic direction outlined in the report that is unprecedented in the House. I am determined to harness this consensus by working with colleagues across the political spectrum and all other stakeholders to move forward on this very important agenda.

The Government has already approved the establishment of a Sláintecare programme office. That happened at its last meeting before the summer recess. The office will be tasked with implementing a programme of reform, as agreed by Government, arising from the Sláintecare report. It will be led by a senior executive with a strong track record in implementing reform. Work is under way between my Department and the Department of Public Expenditure and Reform to ensure that we are positioned to attract candidates of this high calibre for one of the largest public service reform processes ever undertaken in this State. It is essential, therefore, that we get this recruitment process right.

In parallel, work is under way in my Department to develop a detailed response to the report for consideration by the Government in December. The Deputy will remember that the report itself talks about the delivery by the programme office of a draft implementation plan by the end of the year. This plan will seek to translate the Sláintecare report into a programme of action for the next ten years. It will consider the issues that arise in designing such a programme, including key actions, deliverables, costings, timelines and key performance indicators. It was acknowledged in the Sláintecare report that more detailed consideration of these issues was required and it is important that this work is undertaken now. My Department will involve professionals with significant experience of developing implementation arrangements for major change projects.

We are all aware that there will be significant challenges to overcome to effect deep and systemic change in our health care system, but we have no choice and must begin the change process now. It is one of the Government's key priorities. The focus now must be on ensuring that the implementation phase is properly designed and that a clear implementation plan is developed as quickly as possible. As I said, I expect to have the implementation plan by the end of the year.

The Minister stated that the principles set out in the report provide a basis on which to get the important calls right through the implementation process. Given the broad cross-party consensus, it is something into which we can all buy. In that context, there were a number of issues which were the subject of protracted debate in the committee which prepared the report. One key recommendation as a result was the elimination of private care in public hospitals. There was a great deal of debate on that issue. Concerns were also expressed, however, that there could be unintended consequences. With that in mind, the committee acknowledged that it would be complex to remove private care from public hospitals and stated that there was a need to set up a process to analyse the impact it could have on services recruitment, as well as other unintended consequences. How far along is the Minister in establishing an independent impact analysis of the separation of public and private care, in particular with reference to the difficulty of recruiting and retaining consultants and other unintended consequences? It is a key area which must be addressed very quickly. It is a fundamental part of the overall Sláintecare report's recommendations.

The Deputy is entirely correct. As a member of the committee which published the report, he will be more familiar even than I with the debates which took place. The call for an impact study by the committee was sensible. We all want to get to a position where we can decouple the public from the private; certainly, I do. It is ethically questionable that we have a situation in the Irish health service today where emergency departments are crowded, there is a shortage of beds and public waiting lists are long while private practice carries on unabated and, sometimes, unchecked within public hospitals. None of us feel that is fair. The issue is exactly as the Deputy suggests. What would be the consequences of doing that, what road should we travel and how are these things to be disentangled? That is likely to take a number of years to determine, which is why the best thing to do is establish the independent impact study to provide a full appraisal of all of the facts. I spoke about this at the Health Management Institute of Ireland conference this week and expect to be in a position to announce details of the impact study in the coming weeks.

Will that be separate from the overall implementation body? It will be a completely separate entity.

I think so, yes.

Will terms of reference be published and will experts be appointed?

Yes. It is my strong view that we do not need to wait for the implementation plan at the end of the year to make progress on this. I will be happy to discuss the terms of reference with Members across the House.

HSE Staff Recruitment

Louise O'Reilly


2. Deputy Louise O'Reilly asked the Minister for Health the vacancy rates for consultants, doctors, nurses and midwives in the HSE; and his plans to fill those vacancies while also retaining existing staff in the HSE. [41006/17]

My question is very straightforward. It provides the Minister with a platform and opportunity to tell the House all of the good news he has on recruitment and, specifically, retention measures for staff. My understanding is that we are losing consultants and other health care professionals as fast as they are coming in due to the poor quality of the working environment.

There is a degree of chicken and egg in this case. The Deputy referred to the poor quality work environment but to improve that we need more people to work in the public health service. I appeal to people, in particular our young graduates from nursing and medical school, to work with us and to give the Irish health service a chance as we enter a period of reinvestment.

The staffing environment of the HSE is dynamic and subject to significant service demands. When a position is vacated, work may be covered through a variety of measures, such as redeployment, restructuring or reallocation. It may also be necessary for duties to be covered by agency staff or through overtime arrangements. The HSE does not operate a vacancy rate, as the question terms it, but rather records a staff turnover rate. The HSE estimates that the adjusted turnover rate for 2016 was 5.7%. This means that, each year and at any one time, people will be moving in and out of about one in 20 posts across the health service. This can be for a range of reasons. People may simply move to a new location while remaining within the HSE. Other reasons include retirement, resignation or taking up other types of leave such as maternity leave.

As the Deputy is well aware, there are difficulties in filling consultant posts in certain specialties and locations. Approximately 200 such posts may be vacant at any one time. However, most of these are filled on a locum or agency basis to ensure continued service delivery. The figures at the end of July 2017 show that there were more consultants employed at that point than at the same time last year. They also show that the number of consultants in the service has increased by more than 700 in the past decade. The number of non-consultant hospital doctors has also increased year on year. I note also that there were over 36,000 nursing and midwifery staff members in employment at end July 2017. This is an increase of more than 700 in the past 12 months against a backdrop, as the Deputy rightly points out, of intense global competition. Under the agreement reached with the nursing unions earlier this year, the HSE has developed a funded workforce plan for an additional 1,224 nursing and midwifery posts in 2017.

One element of this workforce plan is that of agency conversion. I am supportive of the efforts being made in converting agency staff into permanent posts.

The Public Service Pay Commission did not find that the rate of staff turnover in the health sector gave cause for concern generally. However, it did identify problems in recruitment and retention in specific and specialist groups, including nursing, which are internationally in demand. The commission will now carry out a more comprehensive examination of underlying difficulties and is committed to reporting on several health sector grades in 2018.

I welcome the fact the health sector unions voted in favour of the public sector deal in the knowledge that this body of work will take place at the Public Service Pay Commission.

If pay were the only issue, it would be sorted by now. However, it is not. Poor working environment is also an issue.

The Minister is right that it is a chicken and egg question. We do need people to come and work in our health service. I note the Minister issued an appeal to graduates. I would appeal to him to make their workplace more appealing and, thereby, encourage more of them to work in our health services. We will not be in a position to implement the maternity strategy or any of the other documents that sit gathering dust on shelves in the Department of Health unless we have the staff to so do. Recording vacancy rates is important because it will identify where we have staffing deficits. While talking about staff turnover and where those staff might be going, the evidence is that staff are leaving the health service to work in the private sector or abroad. We also know that we have a problem with consultants who are practising but are not on the specialist register. I have not seen any proposal to address this. This issue will get worse because a situation will arise whereby they will drift into a legal entitlement to a contract of indefinite duration unless something is done to ensure they are converted.

Will the Minister give the figures on the conversion of agency staff to directly employed staff? If he could give that information in hours it might be helpful.

I do not have a figure to hand for the conversion of agency staff to permanent staff here but I will revert to the Deputy directly on that.

I am sure the Deputy did not intend it in respect of the maternity strategy but I can assure her, challenges aside, that it is not a document gathering dust in my Department. We are moving ahead with the plans to relocate one of our stand-alone maternity hospitals to an adult acute hospital site. We will be publishing an implementation strategy for the national maternity strategy in the coming weeks.

My message to young graduates is simple. They will have more colleagues working alongside them in their hospitals this year than last year. If they work with us, they will have more people working alongside them next year than this year. We are back reinvesting. Health Ministers in years gone by could not offer young graduates a full-time permanent contract if they worked in the health service. This is now happening.

The Deputy is correct that it is not all about pay. The recruitment and retention process which will be undertaken by the Public Service Pay Commission, in consultation with the unions, will not just be about pay either. Some of our nurses are coming back to the country, a fact we need to acknowledge. I saw it when I went to a recruitment fair in the HSE. I saw it recently when we took on 17 new nurses in Cork University Hospital to re-open critical care beds. Six of those nurses were Irish who had been working in the UK but decided to come back. The independent group set up to monitor the nursing pay agreement will publish its next report shortly, which I will lay before this House.

I do not doubt there are nurses coming from overseas to work here. However, they are staying six months and then they are going on elsewhere. This has been said to me on more than one occasion by nurses' representatives because that is what they see in their workplace.

I welcome the fact that there will be a nursing commission. We need a commission along the lines of the previous one to address this issue.

I do not believe the Minister and the Government are doing enough to retain staff. A clear message needs to be sent to the staff that their work is valued. The feeling on the ground is that their work is not. There are people working in our health service who are under extreme pressure. They will tell the Minister that they are haemorrhaging staff left, right and centre. We do not make it any easier for them. It is taking months for staff to get full-time permanent contracts.

That is not true.

It is true. It was taking much longer previously, but it is still taking months to get a permanent contract. They need to be issued as a matter of course. If that involves devolving the authority to do so down to the level of hospital management, then that should be done. The centralised recruitment process is not working.

We did that in the agreement I reached with nursing unions. I also signed a section 10 direction to the HSE. The last time such a direction was signed by a health Minister was when Mary Harney brought about the policy of co-location. It is the strongest instrument available to a Minister. In this case, it delegates the sanction for the employment of nurses directly to directors of nursing, many of whom will be members of the nursing unions, such is the priority we are attaching to this.

I am not suggesting we have enough nurses, midwives or doctors working in health service. However, the facts matter. There are more nurses working in the health service this year than last year. I hope there will be more next year than this year. There are more doctors working in the health service this year than last year. I accept there are significant recruitment and retention challenges, not just in this country but globally. One can ask how Britain is managing to recruit and retain nurses in the context of Brexit.

There are many challenges with a mobile workforce. We want them to stay in this country. We have a new public sector deal, which has been accepted by unions. We also have new career opportunities such as advanced nurse practitioners, the new community nursing scheme and the task force on skills mix to check how many individual nurses we need in each ward to ensure they are safely tasked. There are several measures under way that will aid the recruitment and retention process in order that we will continue to see more nurses and doctors working in the health service.

Mental Health Services

James Browne


3. Deputy James Browne asked the Minister for Health his views on the Mental Health Commission’s call for it to be given powers to regulate community-based care services. [41052/17]

The Mental Health Commission is a statutory body whose functions are set out in the Mental Health Act 2001. Among its key responsibilities is the establishment and maintenance of a register of approved centres. The Act also provides that the inspector of mental health services visits, inspects and reports on every approved centre at least once every year. Details of these inspection reports, including compliance issues, are available on the commission’s website. While the commission has the authority to visit and inspect any other premises where mental health services are provided, the enforcement powers of the commission only apply in the case of approved centres.

As regards the regulation of community-based services by the commission, the expert group review of the Mental Health Act 2001 examined this issue in detail in its 2015 report. The expert group recommended that a proportionate and risk-based system of inspection should be developed by the commission. This would include a phased introduction of registration and inspection of all community mental health teams. In addition, all high, medium and low support hostels, crisis-respite houses, other residential services, day hospitals and day centres would also be subject to inspection and enforcement by the commission.

The expert group also suggested that to enhance the standard of care provided in approved centres, the revised legislation should provide for the Mental Health Commission to make standards in respect of all mental health services and to inspect against those standards. The standards would be made by way of regulations and the regulations would be underpinned by way of primary legislation.

Amendments to the Mental Health Act 2001 based on the recommendations of the expert group review of the Act are being progressed. The Government approved plans to proceed with the general scheme of a Bill. Officials are working on the heads of the amending Bill that will legislate for the recommendations of the review, including those relating to the proposed registration and inspection of community mental health services.

My Department and I accept the importance of advancing this work as quickly as possible. We acknowledge it is taking longer than stakeholders in this area would like. That said, it is a comprehensive legislative undertaking, which must also now take account of the provisions of the Assisted Decision-Making (Capacity) Act 2015, enacted after completion of the expert group report. I expect the text of the general scheme of a Bill to be significantly advanced by the end of the year.

I understand only one out of the 168 recommendations from the expert review group has been implemented. The review group is now three years out of date. As the Minister stated himself, the Assisted Decision-Making (Capacity) Act is beginning to become obsolete, which is unacceptable.

Over 90% of all people receiving supports received them in non-approved centres. Only 10% of centres are actually approved and inspected. The next Leas Cross will happen in people’s homes because no inspections are being carried out and there is no risk that anyone will be caught.

The Mental Health Commission has reiterated its call on the Government to give it powers to regulate community-based services with the increasing number of patients accommodated in those. We had the policy of closing down the old Victorian hospitals, which was right, but adequate community supports are not being put in place. No one is inspecting those supports being put in place. There needs to be increased supports. The Mental Health Commission is seeking regulatory powers and they should be given to it.

I share the Deputy's concerns. I would like us to get to a position on enforcement. The commission has the powers to inspect and visit those facilities if it wishes. I met the Mental Health Commission last week and discussed this issue at length with it. I am anxious to get this legislation in place. It is a comprehensive piece of work.

There is a great deal of legislation before the Houses, such as a couple of amendment Bills put forward by the Deputy and Senator Joan Freeman's Bill. There is much legislative work being undertaken and competing for time in the Department at present. However, I am as anxious as the Deputy to get to this stage because I wish to see it regulated, with the powers of enforcement in place, to ensure we can guarantee safety and quality in the services we are providing.

The Fianna Fáil Bill that attempts to amend part of the Mental Health Act will go through Second Stage in the Seanad in October. Effectively, that is an attempt to force the Government's hand to bring forward the comprehensive Bill that is required to reform the Mental Health Act in light of modern human rights changes in that area. Mr. John Saunders, chairman of the Mental Health Commission, said: "These community residences have become too large by accommodating too many people, creating a number of mini institutions... These residences are not regulated and yet they provide care to a large number of vulnerable people with mental illnesses." The Minister of State must be aware of the comments of the Mental Health Commission. These stem from the recent publication of a report on Roscommon mental health services. The external review found that mental health services in the county were marked by control, negativity and a culture of blame. The author of the report said that some senior staff normalised bad behaviour while others perpetuated it. The evidence is available. I have no doubt that what happened in Roscommon is happening in other parts of the country. This issue will become worse and will perpetuate itself unless proper investigations and assessments are made in these areas.

Again, I appreciate what the Deputy said. My reference to the Deputy's legislation is by way of information. There are a number of different, conflicting elements in trying to progress legislation as quickly as possible.

I am acutely aware of the Roscommon situation. I have discussed it with numerous people, including the Acting Chairman, Deputy Eugene Murphy, who has a keen interest in it, and other Members from the area. I will visit Roscommon next Monday to meet some of the people there, to hear about what is happening, to see what went wrong there and to ensure that the recommendations are fulfilled. I appreciate the concern that this could be replicated in other parts of the country. That concern is real and I share it.

Mental Health Services Provision

Bríd Smith


4. Deputy Bríd Smith asked the Minister for Health when the closed beds in the Linn Dara facility in Cherry Orchard will be reopened; and if he will make a statement on the matter. [41005/17]

In June, we lost half of the beds in the child and adolescent mental health services unit in Linn Dara in Cherry Orchard. At the time it was promised that they would be reopened in September. Half of the complement of psychiatric nurses was missing. Can the Minister of State enlighten us on what is happening with Linn Dara? Will the facility be fully staffed and opened in full?

I thank the Deputy for giving me the opportunity to address this issue, which has been a matter of concern for a number of Deputies and Senators for some time. There are currently 60 child and adolescent mental health service, CAMHS, beds operational nationally. This is up from 48 in early summer and will increase further once Linn Dara resumes its full capacity of 22. There are currently 20 operational beds in both Cork and in Galway, eight in Fairview and 12 in Linn Dara.

In June last, due to staffing difficulties, some beds in Linn Dara could not take new admissions. This, unfortunately, left Linn Dara with just half of its 22 bed complement operational. For those discharged for clinical reasons, the HSE provided dedicated follow-on supports from the community-based CAMHS service, where deemed necessary. The executive has also made available the CAMHS day service, as appropriate in individual cases, to enhance supports for young people and their families. The operational difficulties that faced Linn Dara recently arose from problems in recruiting and retaining mental health professionals. Staffing cover had to be augmented in recent times through methods such as staff working additional hours, overtime and engaging agency staff. Funding availability is not the issue in this case.

A phased opening of the closed beds in Linn Dara is planned for the week beginning 30 October, with a graduated increase in bed capacity. The HSE aims to be back at the full capacity of 22 beds by mid-November. This is similar to the approach taken when the unit increased bed capacity originally. The HSE is required to provide advance notification to the Mental Health Commission of its reopening plan.

The HSE has been exploring every option to resume normal operational levels and to maximise the use of Linn Dara in the future. The executive has intensified its efforts on recruitment, and a number of staff have been identified to join the service. The Deputy may rest assured that all efforts will continue to be made to address ongoing service difficulties at Linn Dara, with a view to reopening beds as quickly as possible.

I have no doubt that the Minister of State is doing everything he can within his limits. The problem is that the limits are very tight. As in the earlier discussion about staffing and pay, everybody acknowledges that it is difficult to recruit and retain nurses in this country. It is even more difficult to recruit and retain psychiatric nurses. That is not because they have an aversion to working in institutions, hospitals and clinics in Ireland but because their pay and conditions, stress levels and the pressure on them are wicked. They prefer to emigrate. We are haemorrhaging nurses as a result. Of the 17 nurses needed to staff Linn Dara so the beds can be reopened and be operational how many have been recruited? I accept that the Minister of State is doing his best. He says that every effort is being made and I do not doubt his sincerity, but one arm of the Government is saying it is doing its best to keep the service going while another arm, the Minister for Public Expenditure and Reform, is boasting about the new pay deal, which does not restore pay equality to nurses. That is restricting the ability of the service to recruit in the manner it requires. There are two different forces competing in tandem and that is wrecking fundamental and essential services such as the mental health services.

There are different stages of recruitment but there should be a new complement of five nurses within the next two to three weeks. I met the Psychiatric Nurses Association last week and listened to the challenges its members face. I will continue that engagement. I also addressed the conference of the mental health nurses this week. I am familiar with the struggles and challenges facing them and the Minister for Health, Deputy Harris, and I are determined to continue to try to deal with them as best we can. Hopefully, Linn Dara should be back at full capacity by mid-November. I will welcome any efforts by the Deputy to ensure that happens and to hold us to account for that in the meantime.

Today is the 25th anniversary of the UN Convention on the Rights of the Child. On the "Morning Ireland" programme today, the Ombudsman for Children said the Government will be called to the UN to account for the lack of services for children. Linn Dara is a facility for adolescents with mental health issues. Between June and August last, six young people committed suicide in the area between Cherry Orchard and Ballyfermot where Linn Dara is located. Tragically and shockingly, most of them were young women. I am not saying all of them would have gone automatically to Linn Dara. One has to be suicidal to get into that facility. However, there are needs for mental health treatment which become apparent much earlier that are not caught by the system.

The Government is being called to the UN so it can be told that it is failing young people and children. That is happening. Many issues affecting young people are not being caught early enough and the services are not available 24-7 so they can access them. It is a tragic situation, and it will get worse. The next generation is being reared through the austerity years and has seen special needs education at schools cut for eight or ten years. There are also those who are living in homeless accommodation, not to mention those who are coming out of direct provision and from homeless services back into so-called normal living. How will their mental health be dealt with in a system that is creaking and already failing? The consequences are not just tragic, but criminal. The UN will have to point this out to the Government when the Government is called before it. Telling me that there are five nurses out of 11 does not tick the boxes for the reopening of all the beds required in Linn Dara. It requires 11 nurses, not five.

I will not get into the micro-management of the staffing levels there, the individual nurses and so forth. Clearly, it is not an issue with funding. I do not say that defensively because it is a matter of fact.

Then pay the nurses properly.

That is a separate issue, and there are a number of different matters relating to that. However, I am assuring the Deputy that this is not an issue with funding but with the recruitment and retention of nurses. There are improvements coming in that area.

I share the Deputy's concern for the well-being and mental health of young people and I want to have the best system and a system we can be proud of. Much good work is taking place and a great deal of money is going into it. I want to ensure we are getting value for the money and that the services are being provided where they are needed. Appropriate referrals is another issue, where people are left on inappropriate lists, are inappropriately referred and so forth. There are many challenges within the system that go far beyond the issue of funding. As I have said previously, the job would be very easy if it was just a matter of funding. There are challenges which we are seeking to fix and I hope we can make improvements on them over time.

Hospitals Building Programme

Catherine Connolly


5. Deputy Catherine Connolly asked the Minister for Health further to Parliamentary Question No. 136 of 21 June 2017, the progress that has been made on the relevant plan and the options appraisal in view of his approval, in May 2017, for the Saolta health group to develop a plan for the future of its hospitals and necessary service expansion and for the conduct of an options appraisal for the future acute hospital needs in Galway; if the process has begun; the completion date; the person or body carrying it out; the cost of same; and if he will make a statement on the matter. [41007/17]

This is a specific question and I would appreciate if the Minister answered it, rather than discussing the accident and emergency unit or other planned developments at University Hospital Galway. I am seeking specific information. In December 2016, the Saolta University Healthcare Group wrote to the Minister seeking approval to carry out an options appraisal in respect of a new hospital. The Minister waited five months before, thankfully, giving it permission to do so. It is almost October 2017 and I ask specifically whether the options appraisal has commenced. If so, when did it start, when is the completion date and who is carrying it out?

I will endeavour to answer Deputy Connolly's question specifically. She is correct that in May I gave my approval to the Saolta University Healthcare Group to conduct an options appraisal in respect of the future acute hospital needs in Galway. The structure of the hospital groups is such that my approval is not required for such an analysis to be carried out. It is the responsibility of the hospital groups to carry out analyses of their needs. The whole idea of establishing these groups was to avoid having everything being done centrally and to have the Saolta group and all other hospital groups examine their needs. Nonetheless, I assured the Saolta group that any funding costs it incurred would be met and that continues to be the position.

As part of the appraisal, the Saolta group is undertaking a medium-term planning project to assess the population health needs for University Hospital Galway's catchment to inform existing and future service needs. I am informed by the group that this process will be completed by mid-2018. I would welcome its completion as soon as possible, as would Deputy Connolly, because any further investment in Saolta hospitals will have to be considered by the Health Service Executive based on the strategic priorities put forward by the Saolta University Healthcare Group. For this reason, we need to hear from the group what are its priority projects for further investment.

In the interim, I have requested the Saolta group to provide a short-term plan for the University Hospital Galway and Merlin Park sites to maximise the effective use of both hospital sites to meet the demand for care. The Deputy indicated to me previously that more could be done, even on a short-term basis, on the Merlin Park site.

The Deputy clearly does not want me to speak about a number of other investments made in the Galway area. However, a new 75-bed ward block was recently completed at University Hospital Galway and a new acute mental health department is expected to be operational by the end of 2017. Planning is also under way for a new emergency department at University Hospital Galway. I instinctively share the Deputy's view that the Saolta group needs to revert with its appraisal of its future options. We have given it approval to complete this task and its work is under way. I am informed the work will be completed by the middle of 2018. The appraisal will inform us of what further investments we can and must make in Galway.

I thank the Minister for providing a completion date of mid-2018 for the appraisal. I also appreciate that he did not sidetrack from my question. I asked him not to do so because of the urgency involved. The Minister's party colleague in the Galway West constituency clarified through a question to the Minister that the hospital finds itself in the wrong position and unable to cope.

Today, I attended a meeting of the Committee of Public Accounts attended by representatives of the Health Information and Quality Authority, HIQA. I read some of the authority's reports on University Hospital Galway, one of which states, "The infrastructure and the design of the Paediatric Ward was outdated and as such had the potential to impact on effective infection control." The accident and emergency department has reached crisis point, while two theatres have been closed at Merlin Park Hospital as a result of a leak in a roof, an issue I will raise later in the Topical Issues debate. I could go on. The Government clearly has a role in this matter given the substantial capital outlay involved in building a new hospital. There are 150 acres available on the Merlin Park site. Higgledy-piggledy development is no longer acceptable because it was this approach that caused the crisis in University Hospital Galway. We want proper planning in Merlin Park rather than piecemeal development.

I do not disagree with anything the Deputy said. When people want responsibility to be devolved to the regions rather than exercised centrally, they must seize this responsibility. I have given the Saolta hospital group approval for the appraisal, if it ever needed it, and an assurance that the Department will meet the funding costs required to carry out a proper detailed appraisal. It will not only consider what projects need to be done immediately - some must be done and others have already been done - but will make a proper assessment of the planning and development of health services in Galway, which is a vibrant city and large county.

I acknowledge some of the progress that has been made by front-line staff and management in University Hospital Galway in recent times. The hospital is a pilot site for the national patient flow improvement programme and patient experience times have improved. For example, compliance with patient experience times for all patients of less than 24 hours in the emergency department increased from 93% to 98%. For those patients aged 75 years or older, compliance increased from 75% to 85% within the same period. That is not something to write home or get excited about but it shows that targeted investment in pilot projects is leading to improvements.

The new 75-bed ward block has been opened and 30 additional beds opened in early 2016 as part of the winter beds initiative. A new clinical research facility has been delivered, the maternity unit has been upgraded and a cystic fibrosis outpatient department was completed in 2014. I agree that a master plan is required and look forward to receiving it.

If the Minister continued to outline what he regards as improvements, I could not argue with him but all these improvements have added to the problems at the site. While a 75-bed unit was provided, the closure of two wards meant the hospital did not receive a single extra bed. The new mental health facility has been delayed and will not open until the end of the year. It also has implications for car parking at the site. There are 40 patients on trolleys in University Hospital Galway, where the number of beds has been reduced from 812 in January 2006 to 655 at present. We have a major crisis.

The Minister referred to good planning. There has never been good planning regarding the regional hospital in Galway. It has been forced ó ghéarchéim go géarchéim - from crisis to crisis - and has never had the luxury of long-term planning, nor the support of any Government. With the exception of today, every time I have asked a question since my election almost two years ago, I have been given a list of positive developments that will make a congested site more congested. Am I to understand from the Minister's reply that by mid-2018 we will have some answer with regard to planning for a new hospital on the 150 acres available at the Merlin Park site?

What I am telling the Deputy is that I expect an options appraisal paper by mid-2018, if not earlier. I would welcome the paper as soon as the Saolta group has completed it. The paper will indicate to the Government, Oireachtas and HSE how the group would like to develop its services. It is not for me to tell it how it should develop its services. What is the point in having a group and people in positions to manage the service if I try to micro-manage services? I have given the group the go-ahead in terms of funding to produce an options appraisal. If that plan is delivered to me, I assure the Deputy that the Government and I, as Minister, will support proper planned development of health services in Galway.

As the Deputy will be aware, the original emergency department at University Hospital Galway was constructed in the 1950s and upgraded in the late 1990s. The department accommodates more than 62,000 attendances per annum and sees 130 patients on a weekend and approximately 270 patients every day during the working week. We need proper planning in this area. The position in Galway is a microcosm of the broader challenges we face in terms of proper, long-term planning. I look forward to receiving the options appraisal from the Saolta group, acting upon it and liaising with Oireachtas Members from Galway.