Joe O'Reilly (Fine Gael)
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With an Acting Chairman and Minister of State from County Roscommon, I am expecting a very good hearing. I join in welcoming the Minister of State, Deputy Feighan, who now represents the people of Sligo-Leitrim but whose family origins are in Roscommon.

There is significant pride in Cavan, Monaghan and all that region in Cavan General Hospital. It has been part of the fabric of that area for the past 30 years. We must acknowledge the Herculean efforts of the staff during the pandemic and throughout the year. The hospital is tremendously well staffed. The case for a new accident and emergency department in the hospital has been highlighted by me and by other public representatives over a number of years. It is a case acknowledged in the 2040 plan and while that is encouraging, action is needed. Cavan and Monaghan are fast-growing counties and on occasion, the hospital also provides services to people from counties Meath, Louth and Longford. Outpatient attendance at the accident and emergency department is increasing and can be in excess of 100 per day.In circumstances where there are ten beds available and more than 100 patients per day, the Minister of State will appreciate that ten turnarounds will be required. Attendance is very high and in recent months we have had two very big outbreaks of Covid in Cavan. Part of the difficulty is down to the overcrowding in the hospital and the lack of facilities there. There is no point in saying otherwise.

There has been only piecemeal investment, effectively, since the hospital was built. It needs a major investment now. The old accident and emergency department is not fit for purpose. There is a need for a second resuscitation room and for administrative facilities. There is a need for a complete upgrade, improved capacity for privacy, better spacing and more facilities. The accident and emergency department is cramped and this has an impact on privacy and in the context of the pandemic. There is an absolute need for something to be done about this immediately.

There are suggestions that the designs for a new accident and emergency department, endoscopy unit and isolation area are being examined. Is there a real commitment to the absolute need for an improved accident and emergency department? Where does the project stand at present What is the timeframe for it being put in train? This needs to be dealt with as a matter of urgency and the pandemic has emphasised that. The number of patients presenting each day - approximately 110 most days - is another example of the need for urgent action. Just ten beds in an old-style, cramped area are not enough. Cavan General Hospital is a teaching hospital. It is a very important regional hospital. We need to know the commitment and timeframe, how it will all evolve and when the new unit will be built. It is badly needed.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Senator for his good wishes. I come from the constituency comprising Sligo, Leitrim, north Roscommon and south Donegal and I understand that some of my constituents in Donegal are playing a big match against the Senator's county next Sunday in the Ulster final.

I thank the Senator for raising this issue and giving me the opportunity to outline the position on plans for the development of a new accident and emergency unit at Cavan General Hospital. Cavan and Monaghan hospitals are part of the RCSI hospitals group. Cavan General Hospital operates as a single hospital with Monaghan General Hospital and currently provides services to the population of both counties. Its catchment area extends to counties Meath, Longford and Leitrim. Together, they share an integrated managerial and clinical governance system, as well as integrated patient care pathways and support functions.

Cavan General Hospital is a teaching hospital, as the Senator rightly said, with links to the Royal College of Surgeons, the Royal College of Physicians and Dundalk Institute of Technology. All acute inpatient services are in Cavan General Hospital and in addition the hospital provides extensive outpatient, theatre and day services. Cavan General Hospital is a level 3 hospital and Monaghan General Hospital is a level 2 hospital. The smaller hospitals framework defines the role of smaller hospitals and outlines the need for smaller hospitals and larger hospitals to operate within hospital groups. The Cavan and Monaghan hospital emergency department is located in Cavan, with facilities in Monaghan focused on elective care and the appropriate streaming of patients to the minor injuries unit. These minor injury units help to provide valuable services to local communities and alleviate the pressures on emergency departments. The HSE intends to progress a project to extend the emergency department, which includes a second resuscitation room, additional clinical administration area and additional waiting area.The HSE has advised it has received some proposed layouts for review. This project was approved by the HSE's national capital steering committee in November 2019, subject to the availability of funding.

The process of engaging a design team to progress this project was being initiated prior to the Covid-19 pandemic. The pandemic has placed additional stresses on all areas of acute hospitals, including emergency departments, and a design team has now been selected to progress this emergency department project whilst taking account of the learnings presented by the Covid-19 pandemic.

Cavan and Monaghan Hospital, serving the people of counties Cavan and Monaghan and the wider RCSI Hospitals Group, has a reputation for the delivery of high quality, innovative and safe care to patients. Given the critical role of Cavan General Hospital within Cavan and Monaghan Hospital, I assure the Senator that this Government will continue to support the hospital to develop its valuable services into the future.

Joe O'Reilly (Fine Gael)
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I thank the Minister of State for his reply. I apologise for inadvertently shrinking his constituency. He represents all of it with great heart, interest and commitment.

I appreciate his remarks. He said that we will get a new emergency unit with resuscitation rooms and a new administrative area. I welcome that commitment. I am also heartened to be informed by him that a design team is in place. That is all good, acknowledged and welcome. My request to him is that we get real action, and fast, and that we get over all sorts of bureaucratic hurdles as quickly as we can, get the money and get the job done. It badly needs to be done. I acknowledge it is in the capital programme but action is needed immediately and we need the job done. My final message is that the Minister of State should please treat this as an absolute priority because it is something the place is so badly in need of. It must be done eventually so why not get it done fast and meet the real need that is growing daily?

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I again thank the Senator for his great interest in this project. As he knows, the Covid-19 pandemic has placed increased demands on emergency departments, particularly in respect of infection prevention and control. The Government is committed to developing the emergency department at Cavan General Hospital and the project under way intends to provide a second resuscitation room, additional clinical administration area and an additional waiting area at the hospital. The design team has been selected and some proposed layouts have been received by the HSE for review. The project is being progressed and this is good news for the population served by the hospital.

Eugene Murphy (Fianna Fail)
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I thank the Minister of State. I have no doubt the Senator will be shouting for County Donegal next weekend.

I welcome the Minister of State, Deputy Troy, to deal with the final two Commencement matters.