Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I wonder where is the Minister for Health and Children. Is there anyone from the Department of Health and Children in the Chamber who cares about the health of the people of Monaghan? Today, meetings are taking place between management and staff regarding further winding down of services at Monaghan General Hospital. Some 48 nurses, 42 non-clinical staff, 22 administration staff and 18 support staff are to be redeployed. Most doctors will be redeployed or will go and the hospital, where €14 million has been spent in the past few years, will be restructured into a rehabilitation centre. Two thirds of the services and staff are being removed.

In the past week we have seen the anger of ordinary people at the treatment of over 70s by this Government. The Minister for Health and Children and the Fianna Fáil-led Government has done a partial U-turn regarding the medical card for most but not all. Is it fair that these will be the group of people to suffer most from the proposed withdrawal of Monaghan General Hospital from the public service? That the service will no longer be available in Monaghan and that they must pay transfer costs to Cavan or Drogheda means that people will delay going for treatment where possible, until it is much more serious and may even lead to death. At this late stage, I beg the Minister to ignore more highly paid experts from London and listen to the consultants and staff at Monaghan General Hospital. Can the Minister of State advise me as to the difference between the elderly and the sick in County Roscommon who voted for the Minister of State, Deputy Finneran, and the families who voted in County Monaghan? Are the taxpayers of County Roscommon more important than those of County Monaghan?

Is it not time that the Minister for Health and Children, Deputy Harney, or some senior person on her behalf, looked at the excellent refurbishment work that has been carried out, not only on the two active wards in Monaghan General Hospital but also at the one that was recently closed? In the accident and emergency room patients are dealt with more quickly than in most others in Ireland and there is also the partially used state-of-the-art theatre.

I appreciate that the Minister of State, Deputy Conor Lenihan, and his colleagues have apologised openly in the Dáil to the elderly people of Ireland for their ill-informed actions regarding medical cards. I have been told that some Ministers actually had tears in their eyes. They should remember the 17 patients who died when Monaghan General Hospital was off-call before. I beg the Minister of State, his ministerial colleagues and his colleagues in Government to end the stupidity of closing down Monaghan General Hospital while there is no alternative. They would avoid having the deaths of future patients on their hands if not on their consciences.

I have the document in my hand that we were given only a few minutes ago. That is the courtesy we, as Members of the Oireachtas, were afforded.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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This afternoon the Health Service Executive informed 130 staff that they will no longer be employed in Monaghan General Hospital and are to be redeployed. The HSE has confirmed that the final removal of all acute medical services from this hospital will take place in late January or early February 2009. In other words, the HSE has confirmed the death sentence for Monaghan General Hospital. A hospital which has provided care to generations of people will be no more.

The Minister for Health and Children, Deputy Harney, her Fianna Fáil colleagues in Government, the HSE and above all, the Fianna Fáil Oireachtas Members for Cavan-Monaghan should hang their heads in shame. They have betrayed the people and have allowed vital services to be taken away with grave consequences for the health and the very lives of the people of County Monaghan. This will be a devastating blow to the people of that county and will be a major reduction in overall hospital services in the entire north-east region. It is the culmination of years of attrition by the Government and the HSE during which time service after service was taken from the hospital. The HSE has stated that once a medical assessment unit opens in Cavan General Hospital in late November or early December, the transfer of acute medical services from Monaghan to Cavan will happen within two months.

There are currently 3,000 acute medical admissions to Monaghan General Hospital per annum. If the HSE plan goes ahead, by the beginning of February 2009 this service must be provided by Cavan General Hospital where not one single additional acute hospital bed will be provided. The plan outlined to staff today by the HSE makes no mention of the location of additional accident and emergency ambulance cover in Monaghan town, as promised by the HSE. In a letter to me of 3 September, the HSE lists measures that must be in place prior to the centralisation of acute inpatient services at Cavan General Hospital. These included an additional 24-hour emergency ambulance at a Monaghan ambulance station, an increase of one, or 50%, from two to three ambulances. When I learned from sources within the HSE that the promised extra ambulance service may not be located in Monaghan town the HSE failed to deny this and confirmed that other locations were being considered.

Our hospital is to be closed and we do not even have a guarantee that we will be provided with the ambulance service which the HSE stated was vital. The removal of services from Monaghan General Hospital has already caused the deaths of patients. I have no doubt that the closure of the hospital will lead to considerable inconvenience, totally unnecessary suffering and, in some cases, the avoidable deaths of patients.

On the floor of this Chamber today I accuse the Minister for Agriculture, Fisheries and Food, Deputy Brendan Smith, the Fianna Fáil Deputies, Rory O'Hanlon and Margaret Conlon, and Senators Diarmuid Wilson and Francis O'Brien of betraying the people of counties Monaghan and Cavan whom they were elected to represent. Thanks to these Fianna Fáil time servers who failed to confront their Government on a life and death issue, health care in County Monaghan is to be devastated while Cavan General Hospital will be forced to cope with a considerable additional workload of patients without the additional resources required.

However late in the day it may be, I call on these people and on all others with positions of influence, to contact the Taoiseach, Deputy Cowen, the Minister for Health and Children, Deputy Harney, the HSE and the local Fianna Fáil Oireachtas Members and local authority representatives, not only in counties Cavan and Monaghan but throughout the region in a last minute 11th hour appeal. It is not too late to get a conscience about this issue.

Conor Lenihan (Dublin South West, Fianna Fail)
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I will be taking this matter 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 in order 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——

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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That is rubbish, absolute rubbish.

Conor Lenihan (Dublin South West, Fianna Fail)
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——is the need to improve safety and achieve better standards of care for patients in the region.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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To increase death.

Conor Lenihan (Dublin South West, Fianna Fail)
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As part of the reconfiguration of acute hospital services in the north east the HSE has previously indicated that it plans to transfer acute inpatient services from Monaghan to Cavan and to develop additional services at Monaghan.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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Where are the beds?

Jack Wall (Kildare South, Labour)
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Please, Deputies.

Conor Lenihan (Dublin South West, Fianna Fail)
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The HSE is working to ensure that the changes planned are introduced in a structured manner. This requires that specific measures are put in place and bedded down prior to, or in parallel with, the planned transfer of acute care to Cavan General Hospital. In particular, it is necessary to establish a medical assessment unit at Cavan to help manage an anticipated increase in activity arising from the transfer of acute care services. Enhancements in pre-hospital care in the Cavan-Monaghan area are also required, including the development of an enhanced ambulance and pre-hospital thrombolysis service. Beyond that it will be important to ensure that existing capacity is used more efficiently and this has been highlighted in the national bed utilisation capacity report prepared for the HSE.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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By throwing people out of beds.

Conor Lenihan (Dublin South West, Fianna Fail)
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For example, the average length of stay for inpatients must be reduced in line with best practice and the discharge planning process must be improved. Alternatives to acute inpatient care are required through the provision of additional packages of care in the Cavan-Monaghan community care area.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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They look to discharge the whole damn lot onto the streets by cutting the service in its entirety.

Jack Wall (Kildare South, Labour)
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I implore the Deputy to desist from interrupting.

Conor Lenihan (Dublin South West, Fianna Fail)
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A proposed date for the transfer of acute medical care from Monaghan was 30 November 2008, subject to a number of dependencies being in place, in particular the establishment of the medical assessment unit at Cavan——

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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Four beds.

Conor Lenihan (Dublin South West, Fianna Fail)
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——and the development of an enhanced ambulance and pre-hospital thrombolysis service. The HSE now expects that these developments will not be in place until late November or early December 2008. On that basis it is now intended that the changeover will take place two months after the medical assessment unit opens. This will remain under review and the transfer will be announced in due course once these key elements have been delivered.

With regard to Monaghan General Hospital the existing medical wards will in the future provide rehabilitation and step-down services. There will be 26 such beds including 13 for rehabilitation and 13 beds for step-down care. This will be in addition to day surgery, outpatient and minor injury services.

I understand that senior HSE management are today briefing staff at Monaghan General Hospital along with the union and staff representative bodies on these intended changes. I understand that the changes planned may give rise to a requirement for up to 130 staff to be redeployed. Staff are being advised that the jobs of permanent staff or temporary staff who have acquired rights under relevant legislation will be protected.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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This is infuriating, with respect. I know it is not the fault of the Minister of State and he is not the author of this reply——

Jack Wall (Kildare South, Labour)
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The Deputy must allow the Minister of State to conclude——

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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——but the cowards who have written this should have come into this Chamber and delivered it themselves——-

Jack Wall (Kildare South, Labour)
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Please, Deputy.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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This is what I think of it. Absolute ballyhoo.

Jack Wall (Kildare South, Labour)
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The Minister should continue.

Conor Lenihan (Dublin South West, Fianna Fail)
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Options that will be explored with staff over the coming weeks will be the following — redeployment to immediate funded vacancies in the acute hospitals and to primary, continuing and community care in the north east; career support and up-skilling of certain staff where appropriate; transfer to some immediate service vacancies, for example, the medical assessment unit in Cavan General Hospital; posts to support the delivery of the packages of care and additional posts to accommodate the 37.5 hour working week.

A proposed framework has been put together by the HSE in order to facilitate the above and this will be discussed with the union and staff representative bodies.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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If the Minister for Health and Children, Deputy Harney, were transferred it would be a lot better.