Paudge Connolly (Cavan-Monaghan, Independent)
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I am sure people who are not from the north east consider the Teamwork report as nothing to do with them. Moreover, some of my colleagues from the north east, including counties Cavan, Louth and Meath, consider it to be none of their concern. The perception is that it only applies to Monaghan General Hospital. However, if such persons were to consider the implications of patients being unable to avail of services in Monaghan, they would realise that the facilities in Cavan General Hospital and Our Lady of Lourdes Hospital in Drogheda are unable to cope with increased demand.

One may well ask how it can be proposed to close a hospital on which so much funding has been expended. I acknowledge that the level of resources assigned to Monaghan General Hospital in the past three or four years is unprecedented. Some €4.5 million has been spent in renovating two wards and a state-of-the-art six-bay accident and emergency unit has been constructed. Despite this, however, the hospital is about to be gutted in terms of services.

What is happening in the north east is part of a pilot project. People sometimes forget that a pilot project will eventually get to their door also. It is proposed to roll out these changes nationally but a mess has been made of the project in the north east. The Teamwork report is not short on glossy, flowery language; one could describe it as five star language. It is laced with references to "world class services", "international best practice", "evidence based practice", "safer services" and so on. It is also laced with references to non-existent staff grades. There are no advanced paramedics in the State, for example, and we have only one advanced nurse practitioner in Monaghan General Hospital. These grades represent the backbone of what is envisaged in the Teamwork report but the staff are not in place.

Whose view of "safer services" should we accept? Should we listen to the experiences of the patient who has suffered a heart attack, for example, or the mother who has taken her child in the throes of an asthmatic attack to hospital? Should we listen instead to the views of a health administrator based in Dublin on what constitutes safer services?

In addition to the problems of the language in the report, what is also evident is the confusion that exists in regard to services in the north east. I cannot use the word "lie" because that is not a nice word to use in the House and I will be asked to withdraw it. There seems to be an attempt to confuse people and divide opinion. We have several versions of the future of health services in the region. The Minister for Health and Children tells us that Monaghan General Hospital will not close, but this assertion was scuppered by the Pat Joe Walsh report which recommended that the name "hospital" be removed altogether and that the facility should be closed as quickly as possible. That report has never been debated and there is no official acceptance or rejection of its findings. If it has not been rejected, it must be in the pipeline.

We were told last week that Monaghan General Hospital will lose its seven-day, 24-hour services. In other words, we will lose the hospital per se. We are told, however, that a vast volume of work will continue to be done there. I can only assume that assigning appointments at other hospitals to the people walking up and down the corridors there will be classified as work. Professor Brendan Drumm stated that no service would be removed from Monaghan General Hospital until a better service is in place. We would be fools not to want better services and we would be greater fools not to use them. These improved services should be installed and people will then be able to vote with their feet.

Five days after Professor Drumm made that statement, however, the general manager of the five hospitals in the north east stated that acute emergency services at Monaghan General Hospital would cease in March. Although he made this statement in front of several county councillors and other concerned persons, he now denies it. The head of the implementation group in the north east then said that services will be phased out over a two-year period rather than in March. In other words, the services will be removed in the night when nobody is watching.

It is not the case that people do not understand what is being proposed in regard to the services to be provided in the north east. We had a practice run in the region from June 2002 to January 2005, during which time at least 17 lives were lost at Monaghan General Hospital. The lives of some patients were saved because they were brought in cars to other hospitals. We were accused by Professor Drumm of scaremongering in this regard. Despite the 17 lives lost, the attitude was that we must move on and secure "safer services". Can anybody claim that a safer service is one in which so many lives are lost? I cited three examples of people who died while being brought from Monaghan General hospital and three examples where lives were saved when people were brought there in that period. I could have given many more examples of each but I was met simply with a shrug of the shoulders.

At last Thursday's meeting of the Joint Committee on Health and Children, of which I am a member, two representatives of Teamwork Management Services attempted to sell their wares. In the course of this meeting, Mr. John Saunders said there is no logic to what is being done at Monaghan General Hospital. Somebody should go back and check the record. The co-author of the report is effectively saying that it is not being implemented in the way he envisaged. This is serious and deserves further examination. Mr. Saunders should be invited to address the steering group so he can discover what is happening, after which he should make a further assessment of whether his report is being accurately implemented.

Tim O'Malley (Limerick East, Progressive Democrats)
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I am replying on behalf of the Minister for Health and Children, Deputy Harney.

The Health Service Executive recently established a steering group and 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 and the findings of the recent report into the death of Mr. Pat Joe Walsh.

The Teamwork report concluded that the current system, where 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 Mr. Walsh's transfer from Monaghan General Hospital 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, the HSE has confirmed that a new protocol was put in place which provides that all requests for transfer from Monaghan General Hospital to Cavan General Hospital or Our Lady of Lourdes Hospital, Drogheda, 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. It must be ensured no patient is exposed to increased risk because specialist services are being provided in some hospitals that lack the necessary critical mass of activity and patient throughput. Patient safety and quality must be paramount and the key drivers in the reconfiguration of our acute hospital services. Government policy is to provide safe, high-quality services that achieve the best possible outcomes for patients. This will mean rebalancing service delivery to ensure those services that can be safely delivered locally are and more complex services that require specialist input are concentrated at regional centres.

Led by the HSE's National Hospitals Office, the north-east steering group has representation from key stakeholders including clinicians and primary care providers. The project group is led by Dr. Eilish McGovern, a renowned consultant surgeon. The Minister, HSE representatives and Dr. McGovern met recently with Members, including Deputy Connolly, and members of Monaghan County Council to specifically discuss the future configuration of services at Monaghan General Hospital arising from the recommendations in the two reports. The HSE has given the Minister an assurance that, in progressing the implementation of these reports, there will be no discontinuation of existing services until suitable alternative arrangements have been put in place.

Paudge Connolly (Cavan-Monaghan, Independent)
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On a point of order, the Minister of State referred to protocols being in place.

Séamus Pattison (Carlow-Kilkenny, Labour)
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That is not a point of order. I call on Deputy O'Dowd. There is no provision for questions on the Adjournment Debate.

Paudge Connolly (Cavan-Monaghan, Independent)
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There are no protocols in place. Five weeks ago a young man who came off a motorbike was left begging for a bed for two hours.

Fergus O'Dowd (Louth, Fine Gael)
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Deputy Connolly is eating into my time. Throw him out, a Leas-Cheann Comhairle.

Paudge Connolly (Cavan-Monaghan, Independent)
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The protocols are not in place.

Séamus Pattison (Carlow-Kilkenny, Labour)
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Deputy Connolly should resume his seat. I call on Deputy O'Dowd.