Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I want to be associated with remarks congratulating the Leas-Cheann Comhairle on his long service.

I thank the Chair for allowing me raise this issue but I am a little amazed and shocked that no Minister with a health portfolio is in the House to discuss this serious matter.

The issue of Monaghan General Hospital has taken on a new urgency over the past few days. A proposal to restructure the male medical unit at the same time as the surgical ward will seriously curtail the ability of the hospital to continue a realistic level of services that would justify the staff and consultant numbers, maintain a hospital on call service and retain junior hospital doctors and anaesthetists.

I ask that both the Taoiseach and the Tánaiste and Minister for Health and Children, Deputy Harney, take the same interest in Monaghan General Hospital as they have taken in hospitals such as those in Nenagh and Ennis, where they have individually committed large sums of money.

On 15 September last the consultant surgeons belonging to the joint departments of surgery of Cavan General Hospital and Monaghan General Hospital unanimously requested that the Health Service Executive bring Monaghan General Hospital back on call for acute surgical emergencies. This followed the unprecedented instance where 30 patients were waiting for treatment on trolleys in Cavan General Hospital's accident and emergency department. On 23 September the board of Monaghan General Hospital supported the same request and asked the HSE — formerly the North Eastern Health Board — to review the wrong decisions and correct them by putting Monaghan General Hospital back on call for acute surgical emergencies as Cavan General Hospital had advised medical practitioners not to send patients to Cavan if at all possible — I have proof of that in writing.

Can the Tánaiste and Minister for Health and Children, Deputy Harney, advise what doctors are to do and, above all, what rights have patients in this position? Can she advise what will happen if two thirds of the beds available in Monaghan are to be closed at one time? Can she further advise what discussions she had — of course she cannot do so because she is not here — with the HSE regarding this project and its implications for long-term care? Does she realise that the proposed programme will do little to restore a proper general hospital service and more to establish a home for the elderly? How can she justify the fact that the treatment room, which was promised for last February and construction of which finished in July, has not yet opened? Can she ignore the statement by the consultants that putting Monaghan General Hospital on call for acute surgical emergencies would alleviate pressure on beds, both at Cavan General Hospital and at Our Lady of Lourdes Hospital in Drogheda? Will she make sure that adequate resources are made available, including providing theatre nurses in Monaghan General Hospital for evening and night duties? Does she realise that many people owe their lives to the service of Monaghan General Hospital? Unfortunately it can be clearly seen that lives were put in danger, if not lost, during the period that the hospital was on call.

The Taoiseach is entitled to get respect and to be thanked for his involvement in the peace process in Northern Ireland. However, no other hospital in Ireland has served a more difficult area or as long a Border region, and it is impossible to understand why he and Deputy Harney have ignored this vital organisation which is based alongside the N2 motorway leading from Dublin to Derry, the fourth largest city in the country. With Dungannon Hospital now closed, and the hospital in Omagh under threat, the services of Monaghan General Hospital are even more crucial. Industry, sport and every other aspect of life depend so much on proper general hospitals. With a permanent peace, Monaghan General Hospital could have a much broader service base and that should be our aim.

How can Deputy Harney stand over the waste of €150 million on computerisation that did not work while funding is curtailed to a few million euro for a hospital as important as that in Monaghan? How can she stand over the minimum use that is being made of a brand new theatre in Monaghan General Hospital as she pours out money to the national treatment purchase fund to do the same job?

Would the Minister of State, Deputy Parlon, who is from a rural constituency, like to stand beside a widow, with her handicapped child, whose husband was only 100 yards from Monaghan General Hospital but was not allowed in because it was off-call? That is the type of occurrence we face on a daily basis. It is impossible to understand how the Taoiseach could come to Cavan to hold a parliamentary party meeting and not mention Cavan General Hospital or Monaghan General Hospital, or how Deputy Harney still has not mentioned the group in charge of trying to restructure Monaghan General Hospital in a positive way. I just want straight answers.

Tom Parlon (Laois-Offaly, Progressive Democrats)
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I am taking this Adjournment matter on behalf of my colleague, the Tánaiste and Minister for Health and Children, Deputy Harney. I thank the Deputy for raising this matter as it provides an opportunity to outline to this House the position with regard to the provision of surgical services across the Cavan/Monaghan hospital group.

Under the Health Act 2004, the Health Service Executive is required to manage and deliver, or arrange to be delivered on its behalf, health and personal social services. Responsibility for the provision of services at Monaghan General Hospital rests with the HSE.

The Department is advised by the HSE that the policy approach in respect of surgical services for the Cavan/Monaghan hospital group was set-out in the 2004 report of a steering group established by the former North Eastern Health Board. The steering group was representative of all the key stakeholders and included consultant surgeon, radiologist and physician representation from both hospital sites. The Department is further advised that the steering group's recommendations were unanimously approved by its members.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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They were not given any choice.

Tom Parlon (Laois-Offaly, Progressive Democrats)
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The steering group's recommendations were accepted by the executive board of the former North Eastern Health Board in late 2004. The HSE has informed the Department that it does not intend to review the steering group's recommendations in respect of surgical services.

The steering group recommended that major and emergency surgery should be carried out in Cavan General Hospital and that Monaghan General Hospital should provide selective elective surgery. The report's recommendations reflect advice from the Royal College of Surgeons in Ireland. In accordance with the recommendations of the steering group, a full surgical team based in Cavan will provide services at Monaghan General Hospital, in the form of selective elective surgery on a Monday to Friday basis.

The HSE has also recently appointed a non-practising lead consultant surgeon at the Cavan-Monaghan department of surgery whose remit is to oversee an implementation plan arising from the RCSI's advice on the future configuration of surgical services in Cavan and Monaghan. Measures to achieve this include the appointment of surgeons to fill existing or forthcoming vacancies. All these posts will be structured, eight sessions at Cavan Hospital and three sessions at Monaghan Hospital.

In accordance with the steering group's recommendations, the hospital returned to 24-hour seven-day medical cover in January 2005. A third consultant physician has been in post since November 2004 and five new anaesthetic non-consultant hospital doctors have been recruited to facilitate the return of the hospital to medical on-call. The arrangements, which I have outlined and which are being put in place by the HSE, are designed to enhance the overall level of surgical services across the Cavan/Monaghan hospital group.