Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I thank the Leas-Cheann Comhairle for the opportunity to raise this matter.

Two months ago my Sinn Féin elected colleagues in the north-east region and I presented the media with copies of a document we had received, which spells out in detail the Health Service Executive plans for acute hospital services in the north east, including costings, staff reductions and timeframes. The HSE and the Government did not want this document to enter the public arena before the general election. They sought to conceal the full facts regarding their plans for the future of services at Monaghan and Cavan general hospitals, the Louth Hospital in Dundalk, Our Lady's Hospital, Navan, and Our Lady of Lourdes Hospital in Drogheda but we fully exposed them. The plans include the following: the further loss of services at Monaghan General Hospital; the reduction in treatment room services to an 8 a.m. to 8 p.m., seven-day service by 2008; the transfer of acute medicine from Monaghan General Hospital to Cavan General Hospital by July 2008, with the loss of 5.5 whole-time equivalent posts; the transfer of all Monaghan critical care patients to Our Lady of Lourdes Hospital, Drogheda; closure of the Monaghan high or critical care unit; all in-patient activity to be non-acute and nurse-led; Monaghan General Hospital to become an ambulatory care facility providing diagnostics, rehabilitation and related services, with a target date of July 2008; increases in ambulance staff and vehicles to accommodate increased movement of patients within and to services beyond the region; one bed increase in ITU capacity at Our Lady of Lourdes Hospital, Drogheda, to accommodate the transfer of critically-ill patients from Monaghan; the establishment of a single department of anaesthesia within the Cavan-Monaghan hospitals group with a target date of February 2008; key pathology posts to be Cavan and Drogheda-based, with a reduction in overall staffing of 15 by July 2009; and psychiatric services priority 1 — as it is described — acute psychiatric services to be located on a new regional hospital site, with all this entails for the St. Davnet's hospital facility in Monaghan.

The Monaghan high dependence care unit was to close by Sunday last, 1 July, but this has not yet happened, thank God. We need to know if and when it will happen, or whether public pressure has caused the HSE to relent on this latest cut, which I hope has happened. Following the initial further transfer of services and workload from Monaghan to Cavan, and from Dundalk and Navan to Drogheda, and with a projected staff reduction of 48 by July 2009, the Teamwork implementation project sets 2012 as the target date for the establishment of a new regional hospital that will incorporate all acute and planned inpatient activity for the region upon which, it states, all existing hospitals in the region, including Cavan General Hospital, will become ambulatory centres. The document which we revealed refers to the proposed changes as presenting "major opportunities for savings, efficiencies and staff redeployment". It also refers to front-line staff reductions and the savings that will result as a consequence. Savings of €2.2 million in 2007 and €5 million in 2008 are projected.

This was a damning exposure of the real intent and purpose of the Teamwork recommendations. Improved services and patient safety get scant mention in the text of this implementation document. The real intent of the HSE and the Government towards hospital services in the north east has been shown as never before. I call on the Government to state categorically to the people of Cavan, Monaghan, Meath and Louth that it has at last seen the folly of its approach to acute hospital services and health care in general in the north east and will withdraw their support for the Hanley-Teamwork proposals, and instead commit their long-awaited support for the network of hospitals across this region and throughout the State. I call on the Green Party in particular to honour the signed pledge it gave to the people of County Monaghan in the course of the recent general election.

What is needed is a radical change in the direction of health care policy in both the Department of Health and Children and the Health Service Executive. Democratic accountability must return to the office of the Minister and services must return to our local hospitals. The Sinn Féin vision of health care is one that truly places the patient first and is geared to meeting the needs of communities. Sinn Féin will remain committed to the pledge it gave in support of Monaghan General Hospital and the retention and development of the network of smaller hospitals across this State. For us, our pledge is our word.

Pat Carey (Dublin North West, Fianna Fail)
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I take this matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney. I am sure the House will join with me in extending our sympathies to the Minister on the death of her mother.

I thank Deputy Ó Caoláin for raising the matter. The Teamwork Management Services Limited report, Improving Safety and Achieving Better Standards, provides a detailed assessment of hospital services and recommends an action plan for health services in the north east. The report finds that the present system, whereby five local hospitals deliver acute care to a relatively small population, has exposed patients to increased risks. The report recommends a three strand action plan as follows: the development of local services, with the existing five hospitals and primary and community care providers playing central roles; the development of a new regional acute hospital; and the development of a series of clinical networks which bind these local and regional services and are centred around the needs of patients, including networks for emergency care, surgery and critical care.

The Teamwork report includes a number of recommendations to improve patient care in the region. It particularly highlights the need to develop a high quality, responsive emergency and planned service in line with international standards. It recommends that there be one major regional hospital in the north east, supported by the five existing local hospitals. The new hospital is to provide emergency and trauma services on a 24-hour basis and also provide planned specialist procedures that are complex and require the facilities of a large regional hospital.

The hospital reconfiguration process is being overseen by the HSE steering group which is leading the project. A sub-committee of the steering group was established to progress the issue of site selection. Following a tendering process, the HSE appointed consultants to carry out an independent site location study. The study, which the HSE expects to be finalised in August, will take account of various criteria including demographics, access, planning and development considerations and interdependencies.

The first step in the development of a fully integrated regional health service is to ensure the people of the north east have local access to both routine planned care and immediate life saving emergency care. Over the next few years, in preparation for all acute emergency inpatient care and complex planned care being provided at a regional centre, services at the existing five hospitals will continue to be improved. The Department of Health and Children has been advised that the existing hospitals will continue to provide services which meet the majority of health needs of the community.

The HSE advises that the implementation plan will involve some level of redeployment of existing staff but that the plan will result in an increase in the overall number of staff in the region. The HSE has given an assurance that, in progressing the implementation of the Teamwork report, there will be no discontinuation of existing services until suitable alternative arrangements have been put in place.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It has not done that at any time in the past.