Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I thank the Ceann Comhairle for the opportunity to raise this important issue and I thank the Minister for State, Deputy Máire Hoctor, for answering, in the absence of the Minister for Health and Children, Deputy Mary Harney.

While this has specifically to do with the services being removed from Monaghan General Hospital, it is clearly a long-term plan of this Minister, with the backing of her Fianna Fáil and Green Party colleagues, to wind down the services at all small hospitals throughout the country. The report by Mr. Stephen Mulvaney sent by Mr. Ray Mitchell to all Oireachtas Members in the north east clearly states on page 8 that the critical care unit, better known as the high care unit at Monaghan General Hospital, will be closed down this year, all acute services will be removed and that the 24 hour seven-day accident and emergency unit, previously known as the treatment room, will be wound down to a five-day 12 hour service, for minor issues only. At the same time this same Executive advises on page 2 of the report that no service will be removed until an equally good or a better service is available.

The reality is that the site of the new hospital for the north east has not even been announced. Cavan General Hospital cannot cope with its present workload and the special adviser to the former health board, Mr. Finbarr Lennon, has advised by letter that the situation in Drogheda is completely unsafe because of its present workload.

The Taoiseach in the Dáil today emphasised the fact that the distance from services will obviously mean that there can be delays in those services being delivered and to him that seemed to be acceptable. However, as one who was glad to have the services of the high care unit in Monaghan General Hospital just last year, I am not prepared to sit idly by and allow such critical services to be removed. On a continual basis I meet people whose lives have been saved by that unit and who certainly would not have survived the journey to either Cavan or Drogheda.

During the period Monaghan General Hospital was "off call", at least 17 lives were lost unnecessarily and no doubt even in the last few days others would have been lost if we were in that same position. At this late stage I urge the Minister, Deputy Harney, to consult with the senior personnel concerned in Monaghan General Hospital to explain to them how their patients will be dealt with after the proposals by the Health Service Executive are implemented. She should stop the movement now, at least until the new hospital is working.

I further ask my constituency colleagues whether they are happy that all these services should be removed at a time when general practitioners cannot get personnel to deal with all the demands within their structures. Newcomers cannot get into general practice. It is clear from a reply received from the Minister this evening that she does not understand what is happening within the sector. She is clearly unaware of the lack of trust between the HSE, her officials, and the staff implementing systems on the ground. It is even more clear that the Minister has allowed the HSE to get out of control — it simply takes its own decisions, as it likes — and she has no interest in ensuring that people's health is top priority. Taxpayers' money should be properly utilised, given the fact that Monaghan General Hospital has a prime theatre, a first-class high quality treatment room and staff that can give a high quality and economic service. However, this clearly means nothing to the Minister or this Government.

I want to emphasise to the Minister of State that I am talking about a document issued by the HSE concerning the north east transformation programme. It is not scaremongering, but rather stating simple facts. The joke, however, is that it refers to "improving the safety and quality of patient care", and states that at its core the north east transformation programme is a risk mitigation strategy.

How can a critical care unit be removed from Monaghan General Hospital, when the Minister does not even have a single bed to put patients into in Cavan or Drogheda and when the man in charge of Drogheda says the situation there is extremely serious and unsafe? Yet HSE management — not the medical staff — is going ahead with the winding down and proposed closure within 2008 of those services at Monaghan General Hospital. That situation is certainly not acceptable to me. I am simply asking for some commonsense.

Finally, I say without apology that the Minister, Deputy Harney, was able to travel to America the other day to look at new systems. She has not once visited Monaghan General Hospital, or Cavan, for that matter.

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

The Health Service Executive transformation programme is designed to build a health system that is appropriate to the 21st century and is in line with the model of care emerging internationally. The transformation programme is expected to deliver an integrated care system with local and regional hospitals functioning within a co-ordinated, integrated clinical network as part of the wider system of primary, community and continuing care.

The HSE has advised that the north east transformation programme is approaching the end of its initial phase of planning and is moving towards detailed design and implementation. Operational management and transformation management arrangements in the region have now been linked in order to achieve full integration of the transformation programme with the management of operations.

The Department understands that the HSE north east made a presentation recently on the north east transformation programme to meetings of two committees of the regional health forum, Dublin and north east. The HSE advises it emphasised a clear commitment that existing services in the region will remain in place until they are replaced with higher quality, safer or more appropriate services. It also emphasised that an indicative list of measures outlined in the presentation is a draft work in progress.

The HSE has indicated that it is not possible until the detailed planning phase is complete to be definitive as to what aspects of the north east transformation will be implemented during 2008-09. An indicative list which was included in the presentation is dependent on a range of factors including significant change management and changes to work practices. The degree and pace of change will also be influenced by the extent to which resources can be freed up by the HSE for re-investment in transformation initiatives. The HSE has advised that no decisions have been taken on reducing services in the north east. The HSE is facing a challenging year and is exploring, in the case of the north east, how best to deliver on service plan targets within the level of resources available.

With regard to the critical care unit in Monaghan Hospital, the Department is advised by the HSE that international best practice evidence suggests that in the region of 200 ventilations per annum for level 3 critical care is the appropriate critical mass of patients per annum. This critical mass is related to improved patient outcomes and ensures the necessary skills and competencies required to deliver an optimal critical care service.

The HSE has advised that less than 20 patients per annum fall into this category of level 3 critical care at Monaghan. Since the intensive care unit in Cavan General Hospital has capacity to facilitate these patients, it is a priority for the HSE, as set out in the Teamwork report, Improving Safety and Achieving Better Standards — An Action Plan for Health Services in the North East, to have these patients treated in Cavan.

The relevant clinical transfer protocols and reconfiguration of anaesthetics across the Cavan-Monaghan hospital group are being developed by the HSE critical care clinical network. When these are completed the transfer of care will take place, thus improving the safety and quality of care for these patients. The HSE has indicated that the relevant clinical protocols for the development of the minor injuries treatment unit at Monaghan hospital are currently being developed by the emergency care clinical network in conjunction with Cavan-Monaghan hospital group management. There have been a number of significant improvements at Monaghan General Hospital, including two newly refurbished inpatient medical wards. This project, which cost €5 million, consists of two 25-bed inpatient wards, one male and one female, each of which provides a range of multi-bedded and single rooms. The ward project builds on the investment of €1.2 million in new equipment, an upgrade of the pharmacy and general facility upgrades for the hospital.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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They closed the rest.

Máire Hoctor (Tipperary North, Fianna Fail)
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The HSE has informed the Department that the role of Monaghan General Hospital will be to provide a range of diagnostic, outpatient day cases and some inpatient treatment services within clinical networks. Significant developments have taken place regarding the provision of surgical services across the Cavan-Monaghan hospital interface. 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 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 be seen by the visiting consultant surgeon on the day of referral by the general practitioner.

Monaghan General Hospital has an important role to play in the provision of health services in the north east. This view was confirmed in the Teamwork report and also in the north-east transformation programme.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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The Teamwork report does not even refer to Monaghan. I am sorry to say that but I do not blame the Minister of State.