Máire Hoctor (Tipperary North, Fianna Fail)

I am taking the Adjournment on behalf of my colleague, Deputy Mary Harney, the Minister for Health and Children.

The Health Service Executive transformation programme is designed to build a health system that is appropriate to the 21st century and is in line with the model of care emerging internationally. The transformation programme is expected to deliver an integrated care system with local and regional hospitals functioning within a co-ordinated, integrated clinical network as part of the wider system of primary, community and continuing care.

The HSE has advised that the north east transformation programme is approaching the end of its initial phase of planning and is moving towards detailed design and implementation. Operational management and transformation management arrangements in the region have now been linked in order to achieve full integration of the transformation programme with the management of operations.

The Department understands that the HSE north east made a presentation recently on the north east transformation programme to meetings of two committees of the regional health forum, Dublin and north east. The HSE advises it emphasised a clear commitment that existing services in the region will remain in place until they are replaced with higher quality, safer or more appropriate services. It also emphasised that an indicative list of measures outlined in the presentation is a draft work in progress.

The HSE has indicated that it is not possible until the detailed planning phase is complete to be definitive as to what aspects of the north east transformation will be implemented during 2008-09. An indicative list which was included in the presentation is dependent on a range of factors including significant change management and changes to work practices. The degree and pace of change will also be influenced by the extent to which resources can be freed up by the HSE for re-investment in transformation initiatives. The HSE has advised that no decisions have been taken on reducing services in the north east. The HSE is facing a challenging year and is exploring, in the case of the north east, how best to deliver on service plan targets within the level of resources available.

With regard to the critical care unit in Monaghan Hospital, the Department is advised by the HSE that international best practice evidence suggests that in the region of 200 ventilations per annum for level 3 critical care is the appropriate critical mass of patients per annum. This critical mass is related to improved patient outcomes and ensures the necessary skills and competencies required to deliver an optimal critical care service.

The HSE has advised that less than 20 patients per annum fall into this category of level 3 critical care at Monaghan. Since the intensive care unit in Cavan General Hospital has capacity to facilitate these patients, it is a priority for the HSE, as set out in the Teamwork report, Improving Safety and Achieving Better Standards — An Action Plan for Health Services in the North East, to have these patients treated in Cavan.

The relevant clinical transfer protocols and reconfiguration of anaesthetics across the Cavan-Monaghan hospital group are being developed by the HSE critical care clinical network. When these are completed the transfer of care will take place, thus improving the safety and quality of care for these patients. The HSE has indicated that the relevant clinical protocols for the development of the minor injuries treatment unit at Monaghan hospital are currently being developed by the emergency care clinical network in conjunction with Cavan-Monaghan hospital group management. There have been a number of significant improvements at Monaghan General Hospital, including two newly refurbished inpatient medical wards. This project, which cost €5 million, consists of two 25-bed inpatient wards, one male and one female, each of which provides a range of multi-bedded and single rooms. The ward project builds on the investment of €1.2 million in new equipment, an upgrade of the pharmacy and general facility upgrades for the hospital.

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