Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I thank the Leas-Cheann Comhairle for the opportunity to raise the difficulties regarding Monaghan General Hospital. It was with absolute shock that I and my constituents read of the HSE proposals for the winding down of services at Monaghan General Hospital, in spite of the fact that no alternatives are available. We were assured by the Minister for Health and Children, Deputy Harney, and by Professor Drumm on many occasions that no services would be removed until as good, if not better, alternative services were available. The proposal to take Monaghan General Hospital off call, that is, to close the medical and treatment casualty room, the precise date for which is to be confirmed, is totally unacceptable and unjustified, in light of the fact that the new high-quality treatment room, together with two refurbished wards, are capable of giving excellent results. This was particularly true up until such time as the HSE removed two consultants from the hospital. That was done at a time when the Minister was advising that we need 400 extra consultants, rather than junior doctors. There appears to be one law for the Minister's hospitals and another for Monaghan.

I ask the Minister and the general public to examine what has happened in Monaghan General Hospital. A high quality, well equipped treatment casualty room was built four years ago, at a cost of approximately €1.5 million. It was opened for service less than 18 months ago and is now being wound down. The female medical ward was completely refurbished four years ago, to the highest specifications and contains approximately 30 beds. That ward is now completely closed, with high-quality beds in private storage, while patients lie on trolleys in Cavan and Drogheda. The coronary care ward in Monaghan General Hospital has five to six beds constantly in use. That ward has been proven by independent surveys to have a higher record of safety and service than any other similar facility in the country, yet the Minister for Health and Children, who is not here tonight, together with the HSE, is suggesting that one bed in either Drogheda or Cavan will cover the needs of the people of Monaghan. So much for patient care and patient safety.

Just before Christmas the hospital alliance met senior HSE personnel but were not even advised that two consultants had been given their notice. They were further told that the maternity ward was to be restructured into a high-care unit. Even when I visited the hospital a few weeks ago to discuss the situation regarding the two consultants, I was assured that the high-care unit would be restructured in the former maternity unit. I subsequently found out that the unit was already being used for other purposes.

The absent Minister was entrusted with the management of approximately €16 billion of taxpayers' money. Can she advise how it is that when the country was literally broke, 30 years ago, a small number of administrators could employ sufficient nurses, consultants, doctors and so forth, to provide a satisfactory service for the area without any mass administration structures, outside consultants or committees? Does the Minister or her Department have any interest in or say on patient care? Do they understand that while home care and home help is only available, in the main, for a few hours a day, sufficient quality home carers are not being employed to do the necessary work?

I urge the Minister to meet personnel from the Cavan, Monaghan hospital group which is interested in saving lives and avoiding hardship. During the last period that Monaghan General Hospital was taken off-call, at least 17 lives were lost, without justification. Today I received a copy of a letter from Mr. Finbar Lennon, former medical adviser to the North Eastern Health Board, which clearly states:

. . . the present Teamwork transformation projects have and will inevitably fail. This is due to the fact that the medium term plan is unrealistic, but also because many vital front line staff have been excluded, by design, from the so-called consultation process. Their medical and nursing experience and advice has been largely disregarded by the planners and decision makers.

I humbly suggest that the Minister feels that she has no role regarding patient care and safety on behalf of the people of Monaghan. In the interest of similar hospitals nationally, she should do the honourable thing and resign.

I wish to read into the record a very quick statement from the same doctor: "The situation in Drogheda was very unsafe and I call for a fundamental appraisal." That is how serious the situation is within the health services in the north east.

Máire Hoctor (Tipperary North, Fianna Fail)
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I am replying to this matter on behalf of my colleague, the Minister for Health and Children, Deputy Mary Harney.

The HSE has advised the Department that no decisions have been taken regarding a reduction in services at hospitals in the HSE north-east area, including Monaghan General Hospital.

The HSE has indicated that it is facing a challenging year ahead and is exploring how best to deliver services within budget. Senior managers in the north-east area met recently to discuss budgets for 2008 and how services could be delivered within budget. A document which was leaked to the media is a draft internal document arising from that meeting which sets out certain options for consideration. The HSE has advised that it expects to be in a position by mid-February to be more definitive about service provision for the year.

I want to emphasise that the Minister has previously been given an assurance by the HSE that in progressing the reconfiguration of services in the north east, including services at Monaghan General Hospital, there will be no discontinuation of existing services until suitable alternative arrangements have been put in place.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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That is not happening.

Máire Hoctor (Tipperary North, Fianna Fail)
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Over the next few years, in preparation for all acute emergency inpatient care and complex planned care being provided at the regional centre, the existing five hospitals will continue to provide services which meet the majority of health needs of the community.

There have recently been significant improvements at Monaghan General Hospital, including two newly refurbished inpatient medical wards.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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There have been ward closures. Is that an improvement?

Máire Hoctor (Tipperary North, Fianna Fail)
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This project, which cost €5 million, consists of two 25-bed inpatient wards, male and female, with each ward providing a range of multi-bed and single rooms.

The ward project builds on the investment of €1.2 million on new equipment, an upgrade of the pharmacy and on general facility upgrades for the hospital.

The HSE has advised the Department that the role of Monaghan General Hospital in the future will be to provide a range of diagnostic, outpatient, day cases and some inpatient treatment services within clinical networks. Significant developments have taken place in the provision of surgical services across the Cavan-Monaghan hospital interface.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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Closures.

Máire Hoctor (Tipperary North, Fianna Fail)
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Emergency surgical services on a 24 hour, seven day basis are provided on the Cavan site, while significant elements of diagnostic, outpatient and day case services are provided on the Monaghan Hospital site. This has resulted in lower waiting times for outpatient appointments and inpatient elective services. Since the reconfiguration of Cavan-Monaghan surgical services, patients can, if necessary, be seen on the day of referral by their general practitioner to the visiting consultant surgeon.

Monaghan Hospital has an important role to play in the provision of health services in the north east. This view was confirmed in the Teamwork Management Services Report, Improving Safety and Achieving Better Standards — An Action Plan for Health Services in the North East, and also in the North East Transformation Programme.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I pity the Minister of State for having to read out such a reply.