Consultants plead for infrastructure urgency in letter to public reps

Dear TD/Senator,

As the senior clinical leadership team at Galway University Hospital/University of Galway, we request an urgent meeting with you, as our elected representatives from County Galway. We are extremely concerned about the lack of progress to develop key and urgently needed infrastructural developments across the two sites of Galway University Hospitals (GUH ). This puts the future of healthcare delivery, recruitment and retention of staff and particularly the welfare of our community and region at risk.

As you are aware our current hospital infrastructure is extremely old and dated. University Hospital Galway (UHG ) was opened in 1956 and the core central 6 storey ward block and linked paediatric and maternity ward units have changed little in the intervening years. Investment on the UHG site has been limited to urgent remedial works or temporary add-ons to the site, other than the current near completed development of replacement radiotherapy building on the west of the hospital site (a project that has taken almost 15 years to bring to completion ).

Similarly, Merlin Park University Hospital (MPUH ) was opened in 1954 as a TB sanatorium and the core layout remains intact with limited change over the years. An external independent Options appraisal for the future configuration of acute hospitals in Galway (by KPMG/AeCom and Scott Tallon Walker ), conducted in 2018 and updated in 2021, found that the majority of the hospitals infrastructure was not satisfactory/unacceptable for its current function (64% on the UHG site and 95% on the MPUH site ). Despite the recent Covid-19 pandemic, we continue to have large “nightingale type” multi-bedded wards on the UHG site (13 beds with a single shared toilet ) and multiple wards where single rooms have no ensuite bathroom facilities.

Compared to other regions and large model 4 hospitals, Galway has had little significant investment in its acute hospitals over the years and clearly ranks now as the model 4 hospital with the most dated and inadequate infrastructure in the country, a status reinforced by the Covid-19 pandemic where despite the best efforts of staff, we had to manage repeated hospital acquired outbreaks of Covid-19.

In addition to the inadequate infrastructure, we have a significant capacity bed deficit across the two hospitals sites of GUH. The role and function of GUH has evolved significantly in recent years with the development of the Saolta University Healthcare Group. GUH now needs to be able to provide the twin functions of providing acute and elective secondary care for the population of County Galway, most of County Roscommon and parts of adjacent counties, whilst also providing tertiary specialist care for a wide number of specialties, in particular Cancer care and cardiac care for the population of the six counties of the West/Northwest – Donegal, Sligo, Leitrim, Mayo, Roscommon and Galway and parts of adjacent counties. This tertiary function was not envisaged when the original hospitals were developed 70yrs ago.

We have major capacity issues, objectively confirmed by the KPMG Options appraisal in 2018. The report outlined the need for 222 additional acute inpatient beds and 34 additional day beds and outpatient facilities in Galway by 2030, if we are to meet the current and future projected requirements for the population of our county and region. This demand capacity analysis included the current capacity, waiting lists, and future demographic and epidemiological disease changes as well as projected efficiencies including the move of services to the community and primary care.

Compared to other model 4 hospitals nationally, we have amongst the highest numbers of patients waiting for beds on a daily basis as well as having the longest waiting lists. What we do not often hear commented on is the fact that GUH is consistently one of the busiest model 4 hospitals in the country with activity levels across acute and elective inpatient admissions, day- cases and outpatient numbers that are amongst the highest when compared with peer model 4 hospitals nationally.

There are huge clinical risks associated with the current situation where patients are exposed to increased risk whilst being delayed on trolleys in our ED, or whilst waiting on waiting lists for assessment or prescribed treatment plans, both for urgent time dependent care, in particular potentially curative cancer surgery/treatment but also other procedures/assessments to improve both quality of life and survival.

Over the years, Galway has lagged significantly behind other major hospitals with a lack of a clear strategic vision for the future hospital developments. The 2018 Options appraisal was initiated following a letter to the Minister of Health signed by all 198 consultants at GUH at that time. The outcome of this was to recommend a new hospital on the MPUH site. In 2021, in light of Covid-19 and the size of the investment required for a full acute new hospital on the MPUH site and the fact that some progress had been made with developing a new combined Emergency Department/Women’s and Children’s building on the UHG site, KPMG were requested to revisit the feasibility of this preferred option.

The outcome was a new preferred option – Develop the Model 4 hospital on the UHG site with an elective hospital (including the majority of outpatient facilities ) on the MPUH site. This will ensure that we do not waste or delay current planned infrastructural developments on the UHG site and that we protect and separate elective services from acute hospital services. In addition, the high level cost benefit assessment favoured this.

Currently, there are a number of proposed developments for the two hospital sites at varying stages of project development. All have to comply with the DPER Public Spending Code for major developments and require navigation of multiple layers of the HSE before being progressed through both the Dept of Health and Dept of Public Expenditure to Government. All will require enabling works to ensure that the functions of both hospitals can be maintained through major building projects on site.


ED and Women’s and Children’s Block

A new 6 storey ED and Women’s and Children’s block on the footprint of the now vacated old ED extending to the east of the hospital site has been approved in principle for many years, but continues to progress extremely slowly thought the formal approval stages nationally. This 6 storey build will have 2 floors for ED and acute medicine/Surgery and 4 floors to replace the current maternity and paediatric units in UHG and to include all gynaecology services including oncology. A Strategic assessment report (SAR ) and Primary Business Case (PBC ) has been under consideration by the Dept of Health since June 2022. Once the PBC is approved; we can then move towards the detailed design and tendering process and then will be able to provide a date for the planning application.

Replacement Laboratory Building:

A separate SAR to replace the current laboratory buildings (multiple single story modular buildings at the back of the hospital site ) with a new 5 storey laboratory block adjacent to the current mortuary, is currently being considered by the HSE nationally. Again this project has approval in principle within the HSE but the multiple layers of organisational oversight within HSE national are current reviewing this SAR and we await their initial feedback. This facility is vital to the functioning of the hospital and the cancer programme incorporating the blood and tissue lab (funded 5 years ago and the molecular diagnostic / pathology lab as well as all of the other vital laboratory facilities required for a regional model 4 hospital.

3. Cancer Centre and New Ward Block

The National Development Plan 2021-2030 (updated Oct 4th 2021 ) committed to developing a cancer centre at Galway - “...In accordance with balanced regional development, a cancer care network for the Saolta region (West, North West ) with a Cancer Centre at Galway University Hospital with appropriate infrastructure will be delivered”. Based on this we have submitted a SAR to HSE national for an Cancer Centre (in-patient and ambulatory ) incorporating a “hospital within a hospital” a 200 bed ward block build (incorporating additional theatres/diagnostic supports for cancer care ) and an ambulatory cancer care facility (incorporating rapid access clinics and haematology oncology day wards ). This additional capacity will have a dual function of providing ring-fenced services for timely access to cancer care whilst increasing the overall bed capacity in UHG, to help support acute emergency care. This will provide us with the additional beds required by the KPMG options appraisal (where 222 additional inpatient beds were required for Galway by 2020 ). The SAR for this project was submitted earlier this year to the national HSE who have reverted to us in recent weeks saying that this is not a key priority for them at the moment and that the SAR is pre-emptive!

MPUH4. Elective Hospital

Current government strategy as part of the role out of the Slaintecare project is to develop three elective hospitals, one in Galway, Cork and Dublin. As part of the options appraisal in 2018, KPMG did a demand/capacity analysis and reviewed the options for an elective hospital for the region in Galway. The outcome of this was a recommendation for a 75 inpatient bed, 125 daybed and 71 outpatient room hospital build. This would in addition to providing protected elective and day-case services for the region, will also accommodate almost all outpatient activity that is currently based in UHG – a major benefit to decongest the city centre UHG site. Our proposal was submitted to the Dept of Health in 2019 and we await formal feedback.

Therefore, we feel that we have a clear vision for the future configuration and strategic development of acute hospital services in Galway. What is currently lacking is a joined up approach nationally to facilitating the integrated progression of these developments and prevent the extensive delays intrinsic to the current approach to navigating the complicated bureaucracy of the HSE and national governmental departments. All these developments are urgently needed and are interdependent and need to be progressed together as an integrated plan across the 2 hospital sites. Currently each is progressing at a disappointingly slow pace, if progressing at all. This is the current situation, despite the urgent need for significant additional and replacement acute hospital infrastructure in Galway.

We need your support to get the key national political leadership to acknowledge the urgency of the situation for the population of the West/Northwest of Ireland and provide support, leadership and direction for an integrated approach to address all key developments together as part of a whole hospital development plan for Galway.

We all live in the West of Ireland and GUH is the only acute public hospital where the population can access acute/urgent, cancer, scheduled care and maternity and paediatric care. It is the hospital each of us will turn to if we or our families need care. We are advocating as key clinical leaders for urgent national dialogue and action to create a singular focus within government and the HSE to progress all the above developments in an integrated and urgent fashion. Our patients– your constituents expect this of us and we look forward to discussing this further.


Prof Pat Nash, Chief Clinical Director, Saolta and Consultant Cardiologist GUH

Prof Martin O’Donnell, Dean of Medicine, Nursing and Health Sciences, University of Galway and Consultant Geriatrician/Physician GUH

Prof John Morrison, Director of Women’s and Children’s MCAN, Saolta and Consultant Obstetrician & Gynaecologist, GUH

Prof Michael Kerin, Director of Cancer MCAN, Saolta and Consultant Breast and General Surgery, GUH

Prof Margaret Murray, Director of Laboratory, Saolta and Consultant Haematologist

GUH Prof Tim O’Brien, Director of Medicine MCAN, Saolta and Consultant Endocrinologist, GUH

Dr Ramona McLoughlin, Director of Quality and Patient Safety, Saolta and Consultant Gastroenterologist GUH

Chief Clinical Director Office University Hospital Galway Newcastle Road Galway Tel: (091 ) 893332

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