Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I thank the Ceann Comhairle for providing me with the opportunity to raise this important matter regarding the uncertainty about patient care for the people of Monaghan in light of the commitment of the Minister for Health and Children, Deputy Harney, and Professor Drumm to wind down services at Monaghan General Hospital. On Saturday, at least 5,000 people met in Monaghan Church Square to protest regarding their fear for the future.

On Saturday morning, my colleague and Fine Gael health spokesperson, Deputy James Reilly, together with Senator Joe O'Reilly and myself, paid an arranged visit to Cavan General Hospital to see for ourselves what preparation, if any, has been made to cope with the downgrading of Monaghan General Hospital and the further proposals to take Monaghan General Hospital off call. It was blatantly obvious that no such structure is available or likely to be available for the foreseeable future. While some planning was explained to us, it was made clear that no additional budget has been granted and funding is already under severe pressure.

We subsequently visited Monaghan General Hospital and met with the consultants and GPs to see at first hand the facilities available in Monaghan accident and emergency treatment room. However, we were advised that no more than three patients are allowed to remain on trolleys in Monaghan under the so-called "protocol" whereas they can be transferred to the trolley system in Cavan or Drogheda, mostly against the wishes of the patients. The treatment room at Monaghan General Hospital is fabulous and equal to none.

The consultants in Monaghan have made every effort to work within the system to provide a safe and quality service to our patients. An independent survey has shown that their delivery of service is of an extraordinarily high nature and better or as good as any other in the country. I will quote a recent letter to the programme manager for the north-east transformation structure from the consultants who made it clear that "it is apparent to us following our meeting with the Cavan consultant physicians, that the availability of a critical care bed for a patient from Monaghan Hospital cannot be guaranteed. We believe therefore, that the Protocol outlined is intrinsically unsafe and we hereby formally put that on the record."

They also made it clear that:

no extra resources have or will be provided at Cavan General Hospital to provide for 3,000 extra patients from Monaghan. It is also apparent to us from our contact with our General Practitioner colleagues that no extra resources have been provided for care in the community.

They further state: "if you discontinue the coronary care/acute care facility at this hospital you are compelled to show provision of a similar quality service elsewhere to which our patients can have recourse".

I will provide the Minister of State with the full content of the letter sent to the HSE by the four Monaghan General Hospital consultants. It is clearly one of a series of letters being sent to the Department and the HSE. The situation in Monaghan General Hospital is at crisis level where the knowledge and ability of consultants is being ignored and ambulances are being advised to travel directly to Cavan by administrative staff rather than to Monaghan, in spite of the fact that the patients are almost certainly likely to finish up on trolleys.

With a clear indication that no money is available for the necessary restructuring and provision of services in Cavan or elsewhere, it is vital that the Minister for Health and Children uses her influence to stop the lunacy of withdrawing an excellent service until, as she has previously promised, a better or as good alternative services is available. This has been put on the record several times but it has been completely ignored.

At least 17 people lost their lives unnecessarily as a result of Monaghan General Hospital being off call on a previous occasion. If similar happens again, I will personally hold the Minister for Health and Children responsible along with the Taoiseach and those who support them. I do not mean this as a threat but I want to make it absolutely clear. Mr. Finbarr Lennon, a consultant at Our Lady of Lourdes Hospital, was a special adviser to the health board. Once again, he has written to the HSE explaining how unsafe the situation is and begging it to step back

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

The teamwork report, prepared for the Health Service Executive, has helped to inform the approach being adopted with regard to the transformation programme. The report clearly indicated that the current service configuration in the north-east region is unsustainable and recommended a reconfiguration of hospital services across the existing five hospital sites to ensure the highest level of patient safety. The report also identified a future role for all five hospital sites in the provision of acute hospital services.

The transformation programme for the north-east region involves widespread and fundamental change and is designed to build a health system in line with the model of care emerging internationally. In progressing the programme, the HSE has repeatedly emphasised its commitment that existing services in the region will remain in place until they are replaced with higher quality, safer or more appropriate services. The overriding aim of the programme, which has the full support of the Minister, is the need to improve safety and achieve better standards of care for patients in the region.

The transformation programme is approaching the end of its initial phase of detailed planning and is moving towards detailed design and implementation. The initial focus of the programme has been to have acute and complex care transitioned from five to two hospital sites by 2010. In determining the future capacity of each hospital in the region, the HSE will need to have regard to the findings of reviews which it commissioned and which highlighted the potential to use the existing bed complement in a more efficient manner. The reviews confirmed, for example, that acute hospital admissions and length of stay could be reduced if access to a range of support services is improved.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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There is none.

Máire Hoctor (Tipperary North, Fianna Fail)
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The HSE has advised the Department that a draft interim report for the north-east transformation programme has been produced primarily to facilitate engagement and meaningful input, via the partnership process, with staff and unions. This interim report addresses many of the key short and medium-term planned service changes in Cavan and Monaghan together with a number of the initial changes proposed for Louth and Meath and lists the supporting changes that need to be in place in advance of or parallel with the centralisation of acute care. These include enhanced ambulance services, medical assessment units——

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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There are none of these either.

Máire Hoctor (Tipperary North, Fianna Fail)
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——rehabilitation and non-acute services, packages of primarily community-based care and additional long-stay services.

It is not possible until the current detailed planning phase is complete to be definitive as to what aspects of north-east transformation can be implemented during this year and what can be achieved in 2009. In its draft capital plan, the HSE proposes to spend approximately €100 million additional capital funding up to 2013 in the north east to progress the transformation programme. The HSE intends to make a capital allocation available in respect of each of the five hospitals in the region to meet the cost of interim infrastructural works necessary in each facility.

The HSE envisages that the role of Monaghan General Hospital in the future will be to provide a range of diagnostic, outpatient, day cases and some in-patient treatment services within clinical networks. Significant developments have also taken place with regard to the provision of surgical services across the Cavan and 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 Hospital site. This has resulted in lower waiting times for out-patient appointments and in-patient elective services. Since the reconfiguration of Cavan and Monaghan surgical services, patients can be seen by the visiting consultant surgeon on the day of referral by the GP.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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Ask the GPs.

Máire Hoctor (Tipperary North, Fianna Fail)
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Monaghan Hospital will continue to have 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. The reconfiguration of services in the north east in a way which demonstrably delivers safer and more effective services for people in that region will continue to have the full support of the Minister.