Paudge Connolly (Cavan-Monaghan, Independent)
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This afternoon I raised with the Minister for Health and Children a letter the consultants in Cavan and Monaghan sent to management flagging the difficulties imminent within the service. I was shocked today when the Minister told me a bed was available for Pat Joe Walsh in Cavan but that it was not made known to staff at Monaghan General Hospital. What makes this more difficult is the fact this issue was flagged.

I would like to explain the manner in which it was flagged. The letter sent by the consultants stated:

We, the undersigned consultant surgeons met at a joint Department of Surgery of Cavan and Monaghan Hospitals on Thursday 8th September '05 in Cavan General Hospital and unanimously decided that Monaghan General Hospital should go back on call for acute surgical emergencies. This is following an unprecedented number ... of patients waiting for treatment on trolleys in Cavan A&E Department and we would be grateful if you could arrange for adequate resources including hiring of theatre nurses in Monaghan General Hospital for evening and night duties and meetings with the regional ambulance control to ensure there is no delay about Monaghan going back on call for acute surgical services.

That letter clearly states that there is a major problem. All the consultants in Cavan and Monaghan have outlined that the system they are expected to operate is unsafe, not workable and is costing lives. Worse than that, it will cost lives in the future and it is not a matter of if but when these lives will be lost. To date, 16 people have lost their lives in Monaghan General Hospital as a result in the change in services. This requires an urgent remedy.

It brings health care to a whole new dimension to think surgeons must flag a difficulty. The configuration of services devised by the steering group of chief executive officers was brought in to ensure safe services. These consultants who are asked to deliver the service are the experts and they have told us it is not safe and what they are expected to do is not good. However, we still read about patients on trolleys in Cavan General Hospital. They simply cannot cope with the level of demand for services in Cavan and Monaghan general hospitals.

The letter sent by the consultants was dated 15 September, yet no action was taken on foot of it. This is unacceptable. If something had been done, a death such as Pat Joe Walsh's could have been avoided. I call on the Health Service Executive to take action.

There is a new six-day accident and emergency unit at Monaghan General Hospital but resources have not been provided to open it fully and to make it operational. It is state-of-the-art with facilities to deal with infectious disease and so on in that it has positive-negative air ventilation systems. We hear there is no lack of resources but management will say it has not been allocated additional resources to open and increase the six-day accident and emergency unit at Monaghan General Hospital.

The consultants hit the core of the issue as well and have called for adequate resources, including the hiring of theatre nurses. It beggars belief that this issue has been ignored. Today I felt the Minister hid behind the fact the steering group report stated that this is the level of service we should have. In September 2001 the then chief executive issued what he called a configuration of health services. He made numerous attempts to get people to agree to and endorse what he considered an adequate service for the hospital. The consultants in Cavan and Monaghan have tried this system for a period but it is not working and is unsafe. Safety was allegedly what drove this. Responsibility lies with the Department. When something is not working, the Minister must take a hands-on approach and demand answers.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I cannot say I welcome the opportunity to speak on this issue because it is one of tragic proportions. I sympathise with the Walsh family on their great loss. I ask the Tánaiste and Minister for Health and Children to visit Monaghan General Hospital. It is a simple request so that she can see for herself the excellent staff, the brand new theatre and the potential to save lives which could have been used in this case.

The Tánaiste has visited other hospitals and I am aware that when she sat opposite a few days ago, she said she had got private individuals to go to one of the hospitals near this town to talk about building a private health sector. Here we have a brand new theatre, capable staff and facilities which could be utilised in the public sector but which are underutilised.

I listened with interest and some trepidation to the Taoiseach. He said the most important issue was patient safety and that it must come first. Is insurance the main issue? Since Monaghan General Hospital went off call in 2002, there have been 16 deaths. That does not say too much about safety, yet the Taoiseach insisted that he and the Minister for Health and Children must go by the experts.

Why was Mr. Patrick Walsh transferred, in the first instance, from Our Lady of Lourdes Hospital to Monaghan General Hospital? Is it correct that three intensive care beds were vacant on that Thursday in Drogheda? If the protocol introduced by the former health board CEO and the so-called expert group was as good as the Taoiseach said today, why was there not a back-up service in Cavan or why did Drogheda not accept the patient back? Does the Tánaiste have any confidence in the management of the health service in respect of the hospitals in the north east and, if not, what will she do about it?

Today I was asked where the Tánaiste was hiding and why she could not visit the hospitals in this area, especially Monaghan General Hospital. Has she met the hospital alliance group or the hospital consultants who, as Deputy Connolly said, have demanded that Monaghan General Hospital be put back on call for emergency surgery? Are the Tánaiste and the Taoiseach suggesting that the consultants in Cavan and Monaghan general hospitals know less about the needs of the area and the services they must provide than non-medical executives?

The Taoiseach stated that he cannot understand what is going on in this part of the country. However, it is no secret that he did not visit Monaghan General Hospital when he visited County Monaghan on Friday last. That would have been an opportunity for him to clarify the issue for himself. He did not meet the elected councillors who requested a meeting to deal with the hospital issue. While I welcome the inquiry into the death of Mr. Patrick Walsh, more committees or expert groups are not needed for Monaghan General Hospital. As the hospital alliance committee advised the Taoiseach, if the surgical nurses were put back on staff for night purposes, everything else would be in place.

I welcome the efforts of the steering committee to bring Monaghan General Hospital back on-call for medicine, as many lives have been saved since last January. However, it is unfair to say, as the Taoiseach did today, that the steering committee was happy or satisfied with the surgery situation in the hospital. The laws were laid down by the chief executive officer and it had no choice but to sign on the agreement. All surgery consultants in the Cavan General Hospital are demanding an emergency surgeon be put back. All consultants in Monaghan General Hospital say the same. I urge the Tánaiste and the Minister for Health and Children to listen to the experts on the ground. She must do as she has done on the IT issue and take control of services at Monaghan General Hospital.

Tim O'Malley (Limerick East, Progressive Democrats)
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I thank Deputies Connolly and Crawford for raising this matter. I offer my sincere sympathies, and those of the Tánaiste and Minister for Health and Children, to the family of the late Mr. Patrick Walsh, rest in peace, who died tragically at Monaghan General Hospital last Friday.

The Health Service Executive has commissioned Mr. Patrick Declan Carey, a consultant surgeon at Belfast City Hospital and an honorary senior lecturer at Queen's University Belfast, to carry out an independent and external review of these circumstances. This review will be completed and a report issued within a timeframe of eight weeks or less. The Tánaiste and Minister for Health and Children expects the review to answer all questions around this tragic case as a matter of urgent public interest.

It is disturbing to learn, even in advance of the review, that a fully staffed intensive care bed was available at Cavan General Hospital. It has also emerged that a high dependency bed was available at Our Lady of Lourdes Hospital, Drogheda. The position of Beaumont Hospital is being clarified by the Health Service Executive.

On the specific questions raised by the Deputies about surgical services at Monaghan General Hospital, the Health Service Executive has advised the Department that the policy approach in respect of surgical services across 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 group was representative of all key stakeholders and included consultant representation from both hospital sites in the disciplines of surgery, medicine and radiology. The Department is further advised that the members of the group unanimously approved the recommendations of the steering group. The executive board of the former North Eastern Health Board accepted the steering group's recommendations in late 2004.

The steering group recommended 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 took account of advice received 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 Health Service Executive 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 college of surgeons' advice on the future configuration of surgical services in Cavan and Monaghan.

In accordance with the steering group's recommendations, Monaghan 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 status.

The arrangements outlined are being put in place by the Health Service Executive. They are designed to enhance the overall level of surgical services across the Cavan-Monaghan Hospital Group. The Tánaiste will give her consideration to Deputy Crawford's invitation to visit Monaghan.

Paudge Connolly (Cavan-Monaghan, Independent)
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I wish to ask one question.

Séamus Pattison (Carlow-Kilkenny, Labour)
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I call on Deputy Connaughton. He has five minutes.

Paudge Connolly (Cavan-Monaghan, Independent)
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I need to ask one question.

Séamus Pattison (Carlow-Kilkenny, Labour)
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There is no provision in Standing Orders for questions at this point.

Paudge Connolly (Cavan-Monaghan, Independent)
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The Minister of State refers to a report in 2004. However, our consultant surgeons say publicly that this arrangement is not working. This situation needs to be re-examined.

Jerry Cowley (Mayo, Independent)
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Hear, hear.

Séamus Pattison (Carlow-Kilkenny, Labour)
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I call on Deputy Connaughton.