Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I thank the Ceann Comhairle for allowing me to raise this important issue, along with my constituency colleague, Deputy Caoimhghín Ó Caoláin.

Monaghan General Hospital must be allowed remain on call and retain its accident and emergency and high care units. According to senior personnel in the HSE, it is under order to wind down the service at Monaghan General Hospital as quickly as possible and specifically to take the hospital off call, leaving only a day service available in the accident and emergency area. This is to be done in spite of the fact there is clearly no alternative available either now or in the foreseeable future. A similar order was in place for Roscommon County Hospital, but this has now been removed by the Minister, allowing the HSE to retain the services there. I beg the Minister to do the same in Monaghan and I urge my constituency colleagues in the Government party to ensure this happens. The HSE recently gave my council and town council colleagues the same message, which is that they are only doing what they are under order to do by the Government.

In the past ten days I have come across two cases of people who were sent home from Cavan General Hospital. One man, who was 90 years of age, was sent home by ambulance at 1.30 a.m. The other was a lady who was sent home and passed away a few hours later. It is absolutely clear that Cavan General Hospital is not in a position to cope with its own patients, never mind the additional load from Monaghan.

We have an excellent cardiac unit with an extremely strong independent report to state its records of success are at the highest level. Our accident and emergency unit, named by the HSE as a treatment room, is of the highest calibre and we have the most modern bed units. Nothing can justify the Minister's orders to wind down such a unit. The people of Monaghan need this service more than ever. Existing industries and potential new industries depend on such a hospital service.

There is no doubt the actions of the Minister and this Government are nothing short of an introduction of euthanasia through the backdoor. Home help and home care are not available, subvention for nursing homes has never been sorted out and now patients are being pushed by the Minister into areas where there is no service to cope.

I realise the Minister for Health and Children, Deputy Harney, has never felt the need in her heart to visit either Cavan General Hospital or Monaghan General Hospital, but if lives are to be saved she must either change the order that she and her Government have given to wind down our Monaghan General Hospital or take the only honourable alternative and step down from her position.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I note again, with some vexation, that the Minister has not seen fit to take this Adjournment debate. Perhaps it is past her bedtime, or does she continue to have little or no interest in hospital services in the north east?

The Health Service Executive confirmed in a letter to me two weeks ago its plans to remove all acute care from Monaghan General Hospital and to downgrade it, essentially, to a minor injuries unit. The HSE has confirmed the death sentence for Monaghan General Hospital and in reply to my Dáil question today the Minister also confirmed that sentence. The Minister and the HSE confirm the ongoing implementation of the so-called transformation report, which I revealed in April. The HSE is denuding Monaghan of services and working towards a deadline that, if adhered to, will mean that by Christmas 2008 Monaghan General Hospital, as we have known it for some years, will no longer be a hospital.

When read carefully the HSE letter, entitled "Developments in Cavan & Monaghan Hospital Group Services" and dated 3 September 2008, reveals a number of inconsistencies, raising huge concern about future patient care. It speaks of having specific measures "in place and bedded down prior to or in parallel with the transfer of acute care to Cavan" by the end of November. I note that those words are repeated in the Minister's reply to my parliamentary question today. What does "in parallel with" actually mean?

The HSE says it is committed to the enhancement of ambulance services, including an additional 24 hour emergency ambulance at Monaghan ambulance station, bringing the number of ambulances from two to three. Will we be faced with a situation where acute care is removed from Monaghan before the extra ambulance is provided? How long would such a gap in services be allowed to continue? We have seen in the past where the HSE commits in principle to provide new services but we wait months or years to see them delivered.

There are currently 3,000 acute medical admissions to Monaghan General Hospital per annum. By the end of November this service will have to be provided by Cavan General Hospital, which already has to cater for 5,000 acute medical admissions per annum and has 160% bed occupancy. This is to be done under this plan without a single extra bed being provided in Cavan. How can this be achieved?

The plan for the destruction of Monaghan General Hospital must be opposed in the strongest possible manner by the entire community and every elected representative. I welcome Deputy Rory O'Hanlon who is here to view the debate this evening because I believe it must include the Fianna Fáil TDs for the Cavan-Monaghan constituency. Like all Opposition Members, they too must be called to account on this matter.

Surely what is good for Roscommon is also good for Monaghan. How is it that we have not been able to prevent the loss of services at Monaghan General Hospital through the years, yet, with apparently little effort, such a situation can be put on hold, checked or reversed with regard to a hospital elsewhere in the State? We want equality of access to health services for all citizens.

Máire Hoctor (Tipperary North, Fianna Fail)
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I am taking 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, clearly indicated that the service configuration in the north-east region was unsustainable. It 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 significant future role for all five hospital sites in the provision of acute hospital services.

The report has helped to inform the approach being adopted by the HSE to the implementation of its transformation programme. The programme involves widespread and fundamental change and is designed to build a health system that is in line with the model of care emerging internationally. The overriding aim, which the Minister fully supports, is the improvement of safety and standards of care for patients in the region.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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It is not doing that.

Máire Hoctor (Tipperary North, Fianna Fail)
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As part of the reconfiguration of acute hospital services in the north east the HSE previously indicated that it plans to transfer acute inpatient services from Monaghan to Cavan and to develop services at Monaghan. The transfer is scheduled to take place later this year. The HSE is working to ensure the necessary capacity is in place prior to or in parallel with the planned transfer date to ensure a smooth and safe transition.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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It is not doing that.

Máire Hoctor (Tipperary North, Fianna Fail)
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The necessary capacity is to be generated in a number of ways. For example, a medical assessment unit is to be established at Cavan to help manage the anticipated increase in activity. Beyond that measures are needed to ensure a more efficient use of available capacity and this has been highlighted in the national bed utilisation capacity report prepared for the HSE. The average length of stay for inpatients needs to be reduced in line with best practice. The discharge planning process also needs to be improved. Alternatives to acute inpatient care are required through the provision of additional packages of care in the Cavan-Monaghan community care area.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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Where are they? They are not there.

Máire Hoctor (Tipperary North, Fianna Fail)
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The capacity at Monaghan is to be increased through, for example, the development of additional respite and rehabilitation services. Enhancements in pre-hospital care in the Cavan-Monaghan area are also required.

Deputy Crawford referred to the position at Roscommon County Hospital. In the past, Roscommon County Hospital and Portiuncula Hospital, Ballinasloe, have operated independently, with two consultant general surgeons in each hospital. The difficulties faced by Roscommon and Portiuncula in maintaining surgical services independently, and the need for closer co-operation between them, were highlighted by the former Comhairle na nOspidéal in March 2006. Advances in clinical care and ever-increasing levels of specialisation mean the present model of care faces important practical difficulties, which must be addressed.

In the light of these factors, the best way of retaining and developing services in Roscommon and Portiuncula hospitals is for these hospitals to work closely together. The HSE has indicated it is proceeding with the proposal for a joint department of surgery and anaesthesia at Roscommon County Hospital and Portiuncula Hospital, Ballinasloe. The establishment of a joint department of surgery already is in place in the Cavan-Monaghan hospital group and is operating very successfully. A joint department of emergency medicine is also in place and is operating across both hospitals.