Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Teamwork report is the latest in a long series of reports on hospital services in the north-east region. Most of these reports have been commissioned for the purpose of supporting the increased centralisation of hospital services and the downgrading of the smaller hospitals in the region. This highly centralised model of hospital care is preferred by the Government and the HSE but it is vitally important to state that this is not the only model of hospital care that exists. At all times, we must challenge the argument that the highly centralised model is the only safe way to deliver hospital services. It is not. Other countries and some parts of this country, to some extent, are doing it differently.

The bottom line is that the Teamwork report recommends the further loss of services at existing hospital sites in the region, namely Monaghan, Cavan, Navan and Dundalk. It is basically a re-hash of the Hanly report, which made similar recommendations about hospitals throughout the Twenty-six counties. The difference with the Teamwork report is that it also holds out the promise, but only the promise, of a new regional hospital. While the carrot of a major new hospital facility will be attractive for some, for the vast majority of people throughout the north east, it spells the end of our hospitals as we have known them and it places that same majority at an even greater risk, given the distances, road and weather conditions that must be faced in journeying to a far-off new hospital location.

The answer to the long standing crisis in our hospital services in the north east lies in the reversal of decisions taken in recent years by the health board and HSE managers, at the behest of the Department of Health and Children and the Minister of the day. We know we cannot have all services available at all sites but we firmly believe that our existing hospital network should be retained, with essential services provided at all five hospitals and specialist services available on an apportioned basis, where appropriate.

The Teamwork report envisages only the most basic of care provision at all existing hospital sites. Minor injuries, routine diagnostics and outpatient clinics will be the order of the day. All surgical and medical emergencies and all accident and emergency treatment will be centred in the new regional hospital. What of travel times from all parts of the north east? What of the so-called "golden hour"? Under this plan, more people are being condemned to death because the doors of hospitals will be closed against them.

The Teamwork report presents an idealised picture of hospital services in the north east, with a new regional hospital in place and with the five existing hospitals working under the new regime. What happens in the meantime, as we wait for years for the new regional hospital to be built, if it is ever built? Already, services have been downgraded further at Monaghan, Dundalk and Navan and ever more pressure is being placed on Cavan General Hospital and the Lourdes Hospital in Drogheda. The picture painted by the Teamwork report relies heavily on an ambulance service which is fully staffed with fully trained paramedics. We do not have such a service. Only a tiny proportion of ambulance crews — some 2% — is trained up to this level, yet under Teamwork, paramedics will be responsible for emergency care until patients reach the new regional hospital.

Do we oppose a new regional hospital? Certainly not, but it must be a hospital that will provide services in addition to, and as an enhancement of, those already being provided at the existing five hospitals. Certainly, major change and real improvements will have to take place in the region. Key services and specialties will be located in the regional hospital, but our focus must be on services as near to the patient and community as possible. Sinn Féin wants to see the configuration of all hospitals to ensure that emergency services are available as locally as possible. For the vast majority of the population, these services should be located less than 45 minute's travel time away. No one should be more than one hour's travel time from an accident and emergency unit, when the three critical access factors of hospital location, road conditions and ambulance provision are taken into account.

The report on the death of Mr. Pat Joe Walsh and the HSE's response to that report fails completely to acknowledge that the embargo on acute surgical services and surgical emergencies being dealt with at Monaghan General Hospital led to that tragic death. The embargo meant that staff at Monaghan General Hospital were prevented from performing a life-saving operation on Pat Joe Walsh. No amount of placing blame on others will dispense with that fact. As highlighted in the report, the matter was compounded by the failure of Cavan and Drogheda hospitals to accept the transfer of Pat Joe Walsh, despite his critical condition and the availability of beds therein.

Monaghan General Hospital is being turned into a five-day week, limited service medical centre. There is consternation at the HSE, which has the full backing of the Minister for Health and Children, Deputy Harney, and her Fianna Fáil colleagues in Government, who are dealing the final death blow to Monaghan General Hospital. It is doing a grave disservice to the memory of Pat Joe Walsh that the report emanating on his death is now being used as a tool to aid the objective of further eroding services at the hospital, given that such erosion already contributed to his tragic death.

My party and I pledge our continued and outright opposition to what I can only describe as the scorched earth policy of the HSE and the Government regarding acute hospital services in the north-east region.

Brian Lenihan Jnr (Dublin West, Fianna Fail)
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I am taking this matter on behalf of my colleague, Deputy Harney, the Minister for Health and Children.

The Government did not write this report or any previous report on Monaghan General Hospital. External consultants were retained to write the reports. One of the consequences of the agitation regarding this hospital is that as each complaint is made about a particular incident, a report is then compiled which does not find favour with those concerned about services in the hospital. All involved should reflect on that fact.

The Health Service Executive has recently established a steering group and a north east project group to oversee a programme designed to improve safety and standards across the acute hospital network in the north-east region. The decision was taken having regard to the issues raised in the report prepared for the HSE by Teamwork Management Services, Improving Safety and Achieving Better Standards — An Action Plan for Health Services in the North East, and taking account of the findings of the recent report into the death of Mr. Patrick J. Walsh. Led by the HSE's National Hospitals Office, the steering group has representation from key stakeholders such as clinicians and primary care providers. The project group is being led by a consultant surgeon from outside the region.

The report concluded that the present system, in which five local hospitals deliver acute care to relatively small populations in the region, is exposing patients to increased risks and creating additional professional risks for staff. The report highlights the need to develop a high quality and responsive emergency and planned service, in line with international standards, by developing local services within existing hospitals and other local centres supported by a new regional hospital.

The HSE recently published the report of the independent inquiry into the death of Mr. Walsh. The report details the difficulties that arose in trying to secure his transfer from Monaghan to either Our Lady of Lourdes Hospital, Drogheda, or Cavan General Hospital. It also exposes a failure in communications between clinicians and hospitals in the region.

Since the death of Mr. Walsh, a new protocol in respect of patient transfer has been put in place. It provides that all requests for transfer from Monaghan General Hospital to Cavan General Hospital or Our Lady of Lourdes Hospital, Drogheda, should be granted and processed immediately.

International best practice demonstrates that patients have better outcomes when treated in hospitals with appropriate numbers of specialist staff, high volumes of activity and access to the right diagnostic and treatment facilities. Patient safety and quality must be paramount and must be the key drivers in the reconfiguration of our acute hospital services. The policy of the Government is to provide safe, high quality services that achieve the best possible outcomes for patients. This will mean rebalancing service delivery so those services that can be safely delivered locally are delivered locally and that more complex services that require specialist input are concentrated at regional centres.

The HSE has assured the Minister that, in progressing the implementation of the Teamwork report and the report of the independent inquiry into the death of Mr. Walsh, there will be no discontinuation of existing services until suitable alternative arrangements have been put in place.