Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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The people of Monaghan deserve adequate health services, the same as anybody else in the State. We are fortunate to have a hospital in Monaghan, given closures in other communities across the State under previous Fine Gael and Fianna Fáil Governments. We are fortunate to have incredible, hard-working staff in our local hospital, staff who provide among the highest standards of care, all too often in challenging circumstances not of their making. Monaghan is one of the areas where successive Fine Gael and Fianna Fáil Governments have not only failed to deliver adequate services but have callously ripped crucial health services from the heart of our community. The care provided by workers in the minor injury unit is of a standard we expect from our healthcare professionals. However, the standard we expect can only met by them when they have access to the equipment we expect to be available.

Some weeks back, a former town councillor, Tommy Hagan spoke to Northern Sound radio and to me outlining that he had to be referred to Cavan General Hospital because the minor injuries unit in Monaghan could only do X-rays below the knee. At the same time, people presenting at the accident and emergency department in Cavan can wait up to 24 hours. Does the Minister of State believe this situation is acceptable? How has she examined the need for more services in Monaghan Hospital? There is no MRI machine there and the HSE informed me that patients from Cavan and Monaghan have access to MRI services in Cavan. However, the waiting list in Cavan is significant, with more than 500 people waiting for over three months, an additional 500 people waiting for six months to a year and 58 people waiting for over a year. The HSE assures me that all referrals are vetted by a consultant, but I genuinely struggle to believe it. Does the Minister of State think it is credible that any referral is issued with a view to an MRI being carried out at some vague, indeterminate stage somewhere down the line? That does not sound like adequate access to me.

The Minister of State cannot tell me that an MRI machine would not be impactful or give value for money. The HSE tells us it cannot determine this without a feasibility study, but that there is not a plan for a feasibility report because there is no service requirement, as people have access to Cavan. Over 1,000 people whom a consultant has determined to be in need of a scan are waiting three months to a year. Some 58 people are waiting for more than 12 months and we are told there is not a need to examine the possibility of a machine in Monaghan Hospital and the impact it would have. The gall of circular logic is utterly astounding. Does the Minister of State accept that the approach of successive Governments to strip services from Monaghan Hospital has been a failure? I appeal to her to finally commit to restoring services and investing in County Monaghan.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Deputy. I welcome the opportunity to address the House on the services provided at Monaghan Hospital. I absolutely see the Deputy's concerns. The Government is committed to the ongoing development of our regional hospitals, including Cavan and Monaghan Hospital. Cavan General Hospital and Monaghan Hospital operate as a single hospital, with an integrated managerial and clinical governance system, care pathways and support functions. Since 2020, the Government has allocated significant resources to improve services, enhance patient care and better meet the needs of patients using the hospital. There has been substantial investment in the hospital in recent years. The budget for the hospital has increased by 30% from €114 million in 2020 to €149 million at the start of this year.

At Monaghan Hospital, the number of beds has increased significantly since 2020 and there has been an increase of 70% in staffing. I absolutely agree with the Deputy in complimenting all of our hospital staff. They do an excellent job and we do appreciate the work they do. This is one of the largest increases in staff of all hospitals nationally over this period. Investment in the hospital has enabled a number of important service developments. A minor injury unit now operates 12 hours a day, seven days a week. I did hear what the Deputy said about the concerns regarding the injury unit. I will bring that back to the Minister. A frailty intervention therapy team and early supported discharge team have been put in place. These teams will help identify at-risk patients and will help ensure that patients get the right care in the community or at home where possible. At Monaghan Hospital, there is also ongoing development of pain services, haemochromatosis and an expansion of cardiology services. These improvements greatly enhance the supports provided to patients and their families and lead to better, more appropriate care, delivered in the right setting.

I am aware of recent news reports regarding bed allocation rates at the hospital, particularly in relation to the rehabilitation and step-down beds. The HSE has advised that bed occupancy rates vary from time to time due to factors such as infection prevention and control, building works and the criteria for patient admission. Figures from the HSE show that overall occupancy in these beds has been at 85% or higher over the past year. For rehabilitation beds, the average occupancy rates are 95% from January 2024 to present. The hospital fully recognises the importance of rehabilitation and step-down beds to patients and their families. The Deputy is right that it is about the patients and their families. These are a critical support in enabling patients who may have been treated in another hospital to recover further before being discharged home. Every effort is made to ensure that these beds are maximised while recognising that there can sometimes be factors which impact on the number of patients who can be cared for. We do see the challenges. I am glad the Deputy is highlighting them because we need to make sure we work on these challenges.

The HSE also recognises the importance of access to diagnostic services such as MRI and CT scanners. Referral to these radiology services is based on clinical need. The HSE has not made an application for CT or MRI facilities at Monaghan. However, Cavan and Monaghan Hospital has made an application to replace the existing MRI scanner located in Cavan. The project has been approved and works are expected to be completed by the end of this year. There has been significant investment and expansion at Monaghan Hospital and the Government continues to support the very high quality care being delivered to patients in the region.

Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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I thank the Minister of State. It is disappointing to see that the Minister is not here today. I would love to see these issues raised with her. I am leaving it with the Minister of State and the Cathaoirleach Gníomhach to ensure these issues are raised with the Minister. To be clear, the substantial investment the Minister of State talked about is not enough.

The minor injuries unit and the MRI scanners are only examples of what we have to deal with in Monaghan. Similarly, both CT scanners for Cavan and Monaghan Hospital are in Cavan. The people of Monaghan have been left behind. The provision of an MRI and a CT scanner in Monaghan would contribute to alleviating the huge waiting lists in Cavan. I am giving the Minister of State a solution. I could also speak of the many other services in a similar situation. I appreciate the Minister of State is new to her office. I hope she can consider what I say to her today. She always says to bring solutions to the problem, so I am bringing one. The people in Monaghan and across this State cannot afford to endure more broken promises from Fine Gael and Fianna Fáil, which have not tackled any of the waiting lists. I heard the Minister for Health conducted a spot-check in the emergency room in University Hospital Limerick recently. I would like her to do the same in Cavan and Monaghan. She should come and do a spot-check and see how overcrowded the hospital in Cavan is and how doctors and nurses are at their wits' end. It is unsafe. Something needs to be done. I am giving the Minister a solution to the problem - put the proper equipment into Monaghan hospital and that will reduce waiting lists. This is needed in Monaghan for the restoration in full of each service taken away by Fianna Fáil and Fine Gael with the promise of an efficient health service, which the Minister's party has failed to deliver. Will the Minister make a commitment? Finally-----

Ken O'Flynn (Cork North-Central, Independent Ireland Party)
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Thank you, Deputy.

Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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With the leniency of the Cathaoirleach Gníomhach, I also ask that the Minister look to plan GPs in the towns of Cavan and Monaghan. People are struggling to get GP access. Will she look into that also?

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Deputy again for her contributions on Monaghan hospital. It is right that we acknowledge the excellent care provided by the staff, as the Deputy said herself. I will go back to the Minister for Health and request that she pay a visit, as the Deputy asked. The Government is committed to ongoing development and investment in regional hospitals. Significant investment in capital developments at Cavan and Monaghan Hospital includes two- and three-storey extensions currently at design stage, which is a good news story. They will further improve the hospital environment at Cavan and Monaghan Hospital, particularly for cancer patients. In line with the programme for Government commitment to Sláintecare, a number of service developments are also under way, aimed at improving access. I mentioned the frailty intervention therapy team and early supported discharge team, supporting the flow of patients through the hospital. Figures from the HSE showed overall bed occupancy at Monaghan to be 85% or higher over the past year. For rehabilitation beds at Monaghan hospital, the average occupancy rate was 95% to January 2024. The HSE has advised that clear clinical pathways exist to support the current arrangements of CT and MRI scanners in the region. It has not submitted a business case for CT or MRI services at Monaghan hospital but I reiterate Government support for the hospital.

I assure the Deputy I will bring all of these concerns back to the Minister. I thank the Deputy again for highlighting them. It is important we make changes. We are committed to funding our hospitals and services.

Cathy Bennett (Cavan-Monaghan, Sinn Fein)
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I reiterate we are here to work with the Minister of State and provide solutions.

Jennifer Murnane O'Connor (Carlow-Kilkenny, Fianna Fail)
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I thank the Deputy.