Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Question 7: To ask the Minister for Health if his attention has been drawn to a statement by a member of the working group on the proposed Medical Assessment Unit at Monaghan General Hospital that the working group has not met its terms of reference and that its recommendations cannot be accepted; if he will ensure that the development of the MAU will proceed; and if he will make a statement on the matter. [16565/12]

James Reilly (Dublin North, Fine Gael)
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I am unaware of the comments referred to by the Deputy. I am aware that the HSE established a representative group to undertake a feasibility study on the development of a medical assessment unit in Monaghan and that this report was submitted to the Cavan and Monaghan hospital group manager in February 2012. As I stated at a committee meeting last week, I have seen the report prepared by the group and I have asked Dr. Barry White, national director for clinical strategy and programmes, to review it. Naturally, my concern is to ensure that patients in the Monaghan area have a safe, high quality and effective service. In order to meet these criteria, the review of the national director of clinical strategy and programmes requirements and the determination of the resources which may be required are key considerations which will determine what additional services may be introduced to the Monaghan hospital site.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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As incredulous as I was with the Minister's reply to me on 13 March, which opened with the words, "I am not aware of the comments referred to by the Deputy", I am doubly incredulous that the Minister would repeat the same line in his response to the question today, particularly given that I outlined all this to him at last week's meeting of the Oireachtas Joint Committee on Health and Children and pointed out the deficiencies in the report's position. I pointed out also that it was a majority report and that there was a clear dissenting voice among the eight, that of Dr. Illona Duffy, a general practitioner representative from my community. I find it incredible that the Minister would repeat the assertion that he is not aware of the comments to which I referred. These comments have been sent to him directly and for him to repeat today that he is unaware of them is beyond belief.

I outlined last week and I repeat again now that the terms of reference were clearly not met by the eight-person group established to carry out the feasibility study. The report states that costs "could not be clearly defined", yet the terms of reference require that it "provide a detailed analysis of the pay and non-pay costs". That is confirmation, in the words of the report, signed off on by Dr. Doherty, that Dr. Duffy's claim that the terms of reference had not been met is indeed the case. The time period was inadequate - six weeks within which to carry out a study on an important proposal regarding the future of services at Monaghan General Hospital. Last week, when I put the question to the Minister, he indicated, and he has repeated it again, that he agreed with me the matter could not end on that and that the issue was being referred to the acute medicine programme. I presume that means it is being referred to Dr. Barry White who has oversight of this as national director of clinical strategy and programmes.

Will the Minister elaborate on the purpose and intent of that referral? Is he asking for a further opinion on the potential of the siting of a medical assessment unit, MAU, at Monaghan General Hospital? Is Dr. White likely, working alone or with others, to come back with a different opinion from that of seven of the eight members of the group? Will the Minister accept that the terms of reference could not have been met and were not met? The words of the authors demonstrate they found the project impossible within the constraints of the six-week period.

James Reilly (Dublin North, Fine Gael)
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I reiterate that my Department trawled through its files today to see whether we were sent that statement, but we were not sent it or informed that its recommendations cannot be accepted or that it did not meet its terms of reference. I have not received that. The key point is we have not received the minority report we are supposed to have received.

I said last week, and I reiterate today, that the acute medicine programme would review the position through the clinical programmes, under the auspices of Dr. Barry White. I have no problem in ensuring that is done. For the Deputy to ask me to answer the question as to what his likely opinion will be is unfair. That would be to prejudge and pre-empt his considerations and I do not intend to do that. I will give him and the acute medicine programme a free hand to review the position and see whether they come to the same or a different conclusion. That is the only fair thing to do in this situation.

I emphasise again that we want to extend as many more services as we can to Monaghan General Hospital and to ensure that it becomes busier and that jobs there are secure. I cannot guarantee each individual job or where the jobs will be, but I want to see a greater footfall in that hospital. A 10% increase in activity is planned for this year.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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I agree with the last remarks made by the Minister. Not only is that our hope for the future of Monaghan General Hospital, but I hope the Minister will do everything he can to ensure there will be enhanced service provision at the hospital into the future. It clearly has the capacity to cater to a much greater provision of services for the significant catchment, not only of County Monaghan but further afield and cross-Border, which the site presents.

It was not a question of whether the Minister had received Dr. Duffy's minority report; I have not had sight of it either. In the Minister's own words, he was not aware of the comments referred to but most certainly he was aware before he gave his reply here this afternoon because I made him fully aware of it at last week's meeting of the Joint Committee on Health and Children. I again conclude by asking for an assurance that Dr. Barry White's further consideration of the proposals in regard to the medical assessment unit siting at Monaghan is not constrained by the opinion presented in what is, finally, a flawed report. It is flawed because of the time constraints and the inability of the group to perform its task in line with the terms of reference as set out and with all the circumstances with which it had to contend.

Will Dr. White give the matter further consideration, taking the views into account, but wider than that, in the understanding that this will be a significant advance in terms of service provision at a key hospital site within the north east, something to which the Minister has indicated as having a warm disposition not that many months ago?

James Reilly (Dublin North, Fine Gael)
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Absolutely. The Deputy opposite is well aware of the financial situation in the country and well aware of the consequences of such for the health budget. He is also well aware of the need for cost-based analysis for our actions. The volume of business in a facility must justify a medical assessment unit. The reply and the report from the initial group indicates this is not the case. The clinical programmes and the acute medicine programme in particular will review this decision and give their opinion free from any influence from me or anybody else. This remains the case and it is the only way it can be. Of course I would like very much to see a medical assessment unit in Monaghan if one were justified but I cannot justify it if the volume of patients would not be such as to make it financially viable when we are so constrained in budgets and there are implications across our health service for every euro we have.

The Deputy opposite belongs to a party that is in another jurisdiction on this island where it is presiding over cuts right, left and centre but when that party is down here, they do not want to see anything being cut. That may be the politics of opposition-----

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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It is not the case.

James Reilly (Dublin North, Fine Gael)
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-----but the fact is that we have to take responsible decisions and I have to maintain a service which is safe and this is what I am attempting to do, with tremendous co-operation from the many people who work in the health service. I take this opportunity to commend the staff for the job they are doing.

Caoimhghín Ó Caoláin (Cavan-Monaghan, Sinn Fein)
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Doing everything to protect and defend services, North and South of the Border.

Michael Kitt (Galway East, Fianna Fail)
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We will now deal with Question No. 6 from Deputy Kelleher.