Seán Power (Kildare South, Fianna Fail)

At the outset, I would like to take this opportunity to offer my sincere sympathies and those of the Tánaiste to the family of the late Mr. Patrick Walsh, who died tragically at Monaghan General Hospital on Friday, 14 October 2005. Like everyone in this House, I was shocked and saddened to learn of Mr. Walsh's death. No words from anyone in either House will be of any great comfort to the Walsh family as they mourn their relative but the onus is on us to have a full inquiry into his death. There will be no cover up, the facts will disclosed and we will ensure there is no repetition of what happened to Mr. Walsh.

The House will be aware that the Health Service Executive has commissioned Mr. Declan Carey, a consultant surgeon at Belfast City Hospital and an honorary senior lecturer at Queen's University Belfast, to carry out an independent and external review of these circumstances. The review will be completed and a report issued within a timeframe of eight weeks. I hope the review succeeds in answering all the questions which have arisen following Mr. Walsh's untimely passing.

There are clearly many questions to be answered regarding the care provided to Mr. Walsh. Everyone wants answers regarding this tragedy, the political system, the Health Service Executive and the general public. Most important, we need to seek answers on behalf of Mr. Walsh's family whose distress is uppermost in our minds at this time.

It was particularly disturbing to learn, even in advance of the review, that beds were in fact available in the north-eastern region both at Cavan General Hospital and at Our Lady of Lourdes Hospital, Drogheda, to treat Mr. Walsh in the event that he required to be transferred from Monaghan General Hospital last Thursday night or Friday morning. It is now for Mr. Carey to establish all of the circumstances surrounding Mr. Walsh's death and in undertaking this task, I trust he will receive the full co-operation of everyone involved.

There has been much debate in both Houses in recent years about the configuration of medical and surgical services in the north east. Members will have taken particular note of the views expressed yesterday by Professor Brendan Drumm regarding the provision of acute medical and surgical services in the north east, having regard to best international practice. The north-eastern region operates five acute hospitals serving a catchment population of some 350,000 people. The policy basis for the provision and development of acute hospital services in the north east has been developed in recent years on foot of various studies, including a health strategy for the people of the north east and proposed development of specialist services 2001-06. This policy networks the five hospital sites in the region into two hospital groups — Cavan-Monaghan and Louth-Meath, which covers Drogheda, Dundalk and Navan — with clearly defined roles for each group and hospital.

The debate in recent days has centred on the provision of surgical services across the Cavan-Monaghan hospital group. The policy approach to the issue was set out in the 2004 report of a steering group established by the former North Eastern Health Board. This group was representative of all the key professional stakeholders and included consultant representation from both hospital sites in the disciplines of surgery, medicine and radiology. Members of the group unanimously approved the recommendations of the steering group. The executive board of the former North Eastern Health Board accepted the steering group's recommendations in late 2004.

The steering group recommended in its report that major and emergency surgery should be carried out in Cavan General Hospital and that Monaghan General Hospital should provide selective elective surgery. In making the recommendation, the group took account of expert advice received from the Royal College of Surgeons in Ireland. In accordance with the recommendations of the steering group and the expert advice from the Royal College of Surgeons in Ireland, a full surgical team based in Cavan will provide services at Monaghan General Hospital in the form of selective elective surgery on a Monday to Friday basis.

The Health Service Executive has also recently appointed a non-practising lead consultant surgeon at the Cavan-Monaghan department of surgery whose remit is to oversee an implementation plan arising from the advice of the Royal College of Surgeons in Ireland on the future configuration of surgical services in Cavan and Monaghan. With regard to medical services and in accordance with the steering group's recommendations, Monaghan General Hospital returned to 24-hour, seven-day medical cover in January 2005. A third consultant physician has been in post since November 2004 and five new anaesthetic non-consultant hospital doctors have been recruited to facilitate the return of the hospital to medical on-call.

Surgical services within the Louth-Meath hospital group were reorganised in 2004 to create a joint department of surgery across both the Drogheda and Dundalk hospital sites. Under these arrangements, all consultant surgeons provide services across both sites. A Drogheda-based consultant surgeon, with 24-hour, on-call non-consultant hospital doctor support, provides emergency on-call cover for the joint department. I understand that, as in Cavan-Monaghan, the service arrangements for the joint surgical department at Drogheda and Dundalk are supported by the Royal College of Surgeons in Ireland. The reorganisation of surgical services in both groups is designed, inter alia, to facilitate a more appropriate training system in that junior doctors will rotate between the hospitals during their employment, thus ensuring exposure to many different clinical experiences.

The arrangements for the north-eastern region that are being put in place by the Health Service Executive were developed in order to enhance the overall level of medical and surgical services. However, no matter how much careful preparation is put into formulating arrangements such as I have described, we must also work collectively to ensure their delivery and avoid a repeat of the tragedy which occurred at Monaghan.