Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Gabhaim buiochas leis an Ceann Comhairle as an deis seo chun géarchéim na noispidéil a chur arís os comhair na Dála.

I thank the Ceann Comhairle for this opportunity to again put before the Minister for Health and Children and the Dáil the crisis facing communities, patients and health care workers in Counties Cavan and Monaghan if the Minister and the Health Service Executive proceed with their plan to finally destroy Monaghan General Hospital and to push Cavan General Hospital to breaking point.

My raising the crisis today is prompted by this week's open letter from 41 general practitioners in Counties Cavan and Monaghan expressing alarm regarding the safety of the proposed ending of acute inpatient care at Monaghan General Hospital and the replacement of its 56 beds with six medical assessment unit beds in Cavan General Hospital. The letter announced the withdrawal of GP representation from HSE planning groups on the so-called transformation of hospital services in Cavan and Monaghan.

The withdrawal of the GPs removes the HSE's last pretence that this process has anything to do with improved patient care or moving care closer to the patient. These key primary health care providers have made clear that the safety of patients will be at risk if acute inpatient care at Monaghan is axed as planned.

The Minister for Health and Children Mary Harney must listen to the GPs who are saying that the safety implications of the plan are such that they require the HSE to provide a full independent risk assessment of the closure of the 56 beds and of the capacity of GPs to provide a safe service in such circumstances.

It is very significant that the GPs have pointed out that the HSE is attempting to replace 56 acute medical beds in Monaghan with six beds in the medical assessment unit in Cavan General Hospital. The GPs do not regard this as a replacement, and rightly so. It represents a cut in services overall and will place an untenable burden on an already over-stretched Cavan General Hospital. If the Minister for Health and Children and the HSE refuse to act on the call of the Cavan-Monaghan GPs, the gross irresponsibility of their plans will be more clearly exposed than ever.

Today the County Monaghan domiciled Deputies for Cavan and Monaghan met with the Minister for Health and Children, Professor Brendan Drumm, chief executive officer of the HSE, and Michael Scanlon, Secretary General of the Department of Health and Children. I have no hesitation in stating that there was no real engagement with the Minister, Deputy Harney, for whom the meeting appeared to be little more than a sufferance. While Professor Drumm did engage, it was deeply disappointing that he concluded by reaffirming that the HSE's pace of change will proceed. That is most worrying and, with potentially very serious consequences for me, my family, my community, my county and my constituency. At this 11th hour I urge that the madness now stop.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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I wish to thank Deputy Ó Caoláin for the opportunity to participate with him in this debate, which is extremely important as far as our constituents are concerned in Cavan and Monaghan.

On Wednesday, 10 December last, the Minister, Deputy Harney, met with a group of practitioners from Monaghan after which the doctors concerned sent a letter to the Minister emphasising their grave concerns regarding the proposed closure of acute medical services and causality services in Monaghan General Hospital. They also emphasised that the hospital provides safe, efficient and assessable health care.

Since that meeting and as Deputy Ó Caoláin said, 41 GPs from Cavan and Monaghan have demanded a full independent risk assessment regarding the safety of the proposed closure of 56 acute beds in Monaghan General Hospital and their replacement with six medical assessment beds in Cavan General Hospital.

The GPs are clearly worried about their own capacity to provide a safe service in the circumstances where acute services have been removed from Monaghan and have advised that there will be no further GP representation on any of the HSE planning groups regarding transformation or the medical assessment unit development. It is clear from the doctors' statement published in the Irish Medical Journal and from a discussion today between four Members representing the Monaghan part of the constituency, the Minister for Health and Children, Deputy Harney, Professor Drumm, chief executive of the HSE, and Mr. Michael Scanlon, Secretary General of the Department, that consultation between the general practitioners and the consultants has not been the order of the day.

While the Members had a frank and open discussion with Professor Drumm through the Minister, it was clear her involvement or interest was less than productive. It is vital at this late stage that the general practitioners and consultants be involved in any discussion or decision towards a safe service. This can only be done through the retention of the acute medical service, the intensive care ward and the accident and emergency treatment room.

This is a last ditch request from all the constituents of Cavan-Monagahan. Four Members of the constituency have united to some degree on this matter because we realise the damage that could be done to lives.

John Moloney (Laois-Offaly, Fianna Fail)
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I am taking this Adjournment matter on behalf of the Minister for Health and Children, Deputy Harney.

The overriding aim of the transformation programme for the north-east region, which the Minister fully supports, is to improve safety and achieve better standards of care for patients in the region. This process involves widespread and fundamental change and is designed to build a health system in line with the model of care emerging internationally. The transformation programme has been informed by the teamwork report to the HSE, which demonstrated the service configuration in the region was unsustainable.

A series of focused service changes is being implemented across the region. The immediate focus is the reconfiguration of existing services by moving acute and complex care from five hospital sites, including Cavan and Monaghan, to two, including Cavan for Cavan-Monaghan. With regard to the Cavan-Monaghan hospital group, the HSE intends to complete the transfer of acute inpatient services from Monaghan to Cavan over the coming months and to develop additional services in Monaghan. The transfer of acute medical care to Cavan is due to take place during the second quarter of this year. It is also subject to several dependencies first being in place, particularly the establishment of a medical assessment unit at Cavan and the development of an enhanced ambulance and pre-hospital thrombolysis service. The Minister has been assured the transfer will not take place until two months after the medical assessment unit has opened. The existing medical wards at Monaghan will provide rehabilitation and step-down services with 26 beds, including 13 for rehabilitation and 13 beds for step-down care. This will be in addition to the day surgery, outpatient and minor injury services.

The change process in Cavan-Monaghan is being managed through a network of sub-groups. It is important that all relevant stakeholders are involved in the change process. The HSE has sought the participation of general practitioners, and several sub-groups particularly, in the development of the medical assessment unit in Cavan. It is a matter of some concern that the general practitioners in Cavan and Monaghan felt it necessary to withdraw from engagement and involvement in these groups. The HSE has indicated it will ensure communication lines are maintained with general practitioners in the area. The sub-groups are being supported by specialist risk advisers to ensure the change process is managed smoothly and any associated risks or challenges are identified and addressed in advance of any service changes.

The changes proposed by the HSE, and fully supported by the Government, are for reasons of patient safety. We are committed to providing the best possible service for patients in a manner that ensures quality and safety. It is understandable there will be concerns about change but the Government is satisfied this is the best way forward. The HSE will work with all stakeholders to bring about the improvements in a carefully planned way that puts patients first.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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The Government is the only satisfied party in all this.

Seymour Crawford (Cavan-Monaghan, Fine Gael)
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It is clearly the Government's situation.