Paudge Connolly (Cavan-Monaghan, Independent)
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Question 94: To ask the Tánaiste and Minister for Health and Children if she has noted the unanimous call by the seven consultant surgeons at Monaghan and Cavan general hospitals three weeks ago for restoration of acute emergency surgical services at Monaghan General Hospital; if she will prevail on the Health Service Executive north-east region to accede to their call by restoring Monaghan hospital to surgical on-call status; and if she will make a statement on the matter. [30005/05]

Mary Harney (Dublin Mid West, Progressive Democrats)
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I express my sincere sympathies to the family of the late Mr. Patrick Walsh, RIP, who died tragically at Monaghan General Hospital last Friday. His death should not have happened. I have been informed that an intensive care bed was vacant in Cavan General Hospital when Mr. Walsh needed to be transferred.

The circumstances surrounding this tragedy require thorough investigation. Mr. Declan Carey, a consultant surgeon at Belfast City Hospital and an honorary senior lecturer at Queen's University, will carry out an independent and external review of the circumstances surrounding Mr. Walsh's death. The review will be completed and a report will be issued within eight weeks. I look forward to the review answering all the questions relating to this tragic case as a matter of urgent public interest and patient safety.

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 that was established by the former North Eastern Health Board. The recommendations of the steering group, which was representative of all the key stakeholders and included consultant representation from both hospitals, were unanimously approved by the group's members. 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 steering group's recommendations reflected the advice of the Royal College of Surgeons in Ireland. In accordance with the recommendations, 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.

In accordance with the steering group's recommendations, the hospital returned to offering 24-hour seven-day medical cover in January 2005. A third consultant physician has been in position 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 HSE recently appointed a non-practising lead consultant surgeon at the Cavan-Monaghan department of surgery. The remit of the surgeon is to oversee an implementation plan arising from the Royal College of Surgeons in Ireland's advice on the future configuration of surgical services in Cavan and Monaghan. Measures being taken in that regard include the appointment of surgeons to fill existing or forthcoming vacancies.

The arrangements I have outlined, 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. The HSE recently informed the Department of Health and Children that it will keep the matter under continuing review.

Paudge Connolly (Cavan-Monaghan, Independent)
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I am sure the Tánaiste will agree that if we had taken on board the letter written by the consultants, we would not have had to endure the events of last Friday, which was a very sad day for the family of the late Mr. Patrick Walsh, who was admitted to Monaghan General Hospital on Thursday at 6 p.m. and died at 7 a.m. the following morning. We should not forget the other 16 deaths which have occurred since Monaghan General Hospital went off-call.

Does the Tánaiste agree that somebody is getting it wrong and that the people are not being listened to? Does she accept that the configuration of the health services preferred by the former chief executives is not working and is costing lives? It is not a case of whether another life will be lost but of when it will be lost. Does the Tánaiste agree that the letter of 15 September last, in which each of the consultant surgeons in the Cavan-Monaghan hospital group asked for on-call status be restored to Monaghan General Hospital for acute surgical emergencies, should have been dealt with as a matter of urgency? If the consultants' request had been accepted, Mr. Walsh's death could have been avoided.

Finian McGrath (Dublin North Central, Independent)
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Hear, hear.

Paudge Connolly (Cavan-Monaghan, Independent)
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The consultants' letter constitutes a serious admission on their part that all is not well. The system is not working, it is unsafe, dangerous and costing lives. I am sure the Tánaiste will take into consideration the view of those charged with delivering this service that it is not safe.

The nation is shocked that the health service is in such a state that a person can be admitted to hospital, left in a hospital bed, given blood and allowed to die. Last Friday's tragedy is compounded by the fact that a bed was available. Was ageism a factor in this regard? A major investigation is needed. We need to be reassured.

I am bitterly disappointed by the quality of the Tánaiste's response to my question. I hoped she would say she would listen to the consultant surgeons who know what they are talking about. The Tánaiste needs to ensure that on-call status is restored to Monaghan General Hospital for acute surgical emergencies, in line with the consultants' request. Will the Tánaiste assure the House that she will talk to every consultant surgeon in the Cavan-Monaghan hospital group? Will she assure me that she will listen to these professional people?

Finian McGrath (Dublin North Central, Independent)
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Hear, hear.

Mary Harney (Dublin Mid West, Progressive Democrats)
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As I said in my initial response, it is clear that the death of Mr. Patrick Walsh should not have happened. The inquiry I referred to previously will have to consider why the intensive care bed that was available at Cavan General Hospital was not made available to Mr. Walsh.

Finian McGrath (Dublin North Central, Independent)
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It is a disgrace.

Mary Harney (Dublin Mid West, Progressive Democrats)
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I look forward to receiving the outcome of the inquiry quickly as it is clear that many questions need to be answered.

The issue of giving on-call or off-call status to certain hospital services, about which I was specifically asked, is a matter for the Health Service Executive. It is a question of patient safety rather than of resources. Deputy Connolly said that a group of surgeons called unanimously in a letter for the return of on-call emergency status at Monaghan General Hospital. However, the steering group that unanimously recommended that such status be retained at Cavan General Hospital included representatives of the group of surgeons.

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

Mary Harney (Dublin Mid West, Progressive Democrats)
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The Royal College of Surgeons in Ireland was also involved. Patient safety must be of paramount importance.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It clearly is not.

Paudge Connolly (Cavan-Monaghan, Independent)
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Does the Tánaiste agree that the consultant surgeons wrote to the Health Service Executive because they had concerns about patient safety and because the steering group's report was not working? The people on the steering group had their hands tied. The consultant surgeons were asked to implement a configuration of services that was presented to them by the then chief executive officer. As the consultants have made it clear to us that the configuration in question is not working, we will have to address the matter by examining it again. Further deaths will occur if we do not do so.

Mary Harney (Dublin Mid West, Progressive Democrats)
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We now have a new organisation. We have received the opinions of representatives of the Royal College of Surgeons in Ireland who are experts in this area. There are hospitals in Drogheda, Dundalk, Cavan, Monaghan and Navan. The HSE must decide on the configuration of hospitals in that region. It will decide on what will happen when and where. Patient safety must come first above all else. It must be paramount in any decision we make on this issue. It will guide us in making future decisions.

Paudge Connolly (Cavan-Monaghan, Independent)
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The consultants signed the letter to which I referred because they are concerned about patient safety. They are concerned when they hear about 40 patients being placed on trolleys at Cavan General Hospital. They are concerned about not being able to cope. That is why the letter was sent to the HSE. The Tánaiste cannot allow the problems to which I have referred to continue.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The consultants were represented on the steering group.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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No.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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There was one consultant on the steering group.

Mary Harney (Dublin Mid West, Progressive Democrats)
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The group agreed unanimously on its report.

Finian McGrath (Dublin North Central, Independent)
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It is a disgrace.