Tuesday, 17 October 2000
Dáil Eireann Debate
Mr. Crawford: That Monaghan General Hospital theatre was not maintained or replaced, leading to its closure last week for all intents and purposes, is nothing short of a disgrace and a clear indication that its needs have been ignored for years. While I appreciate that all four county  council elected board members and the other Monaghan board member are working together to make sure patients and families in Monaghan General Hospital are provided with an adequate service in the long-term, that the consultants at the hospital decided to refer all but emergency operative procedures to other hospitals will cause serious inconvenience to patients and families, especially in the north Monaghan area. The maternity department, I understand, is also turning away patients and informing them that the department cannot take such cases for four to five months. As the Minister will be aware, these are people who cannot wait.
Many people fear this is an effort to further curtail services at Monaghan General Hospital in the hope that once patients get used to going elsewhere, it will remove the local pressure from the development committee and others. I beg the Minister for Health and Children, Deputy Martin, to intervene and make sure that promises made by all of the recent Ministers for Health that Monaghan General Hospital would be upgraded with two theatres and back-up services, will be fulfilled. I understand money has been committed to the North Eastern Health Board over the next five years to upgrade all its services. However, I beg the Minister of State, Deputy Hanafin, to make sure that Monaghan General Hospital is looked after as the number one priority in the region. It is and has been the most neglected hospital, a fact underlined by the recent report by English consultants appointed by the health board to inspect hospital facilities in the north-east region. The report adjudged the theatre in Monaghan General Hospital a potential health risk. Our consultants were warned that only bona fide emergency surgery should be conducted in a Monaghan operating theatre. I believe from advice I have received that this situation should have been foreseen without any outside inspections and should have been acted on long ago.
The patient waiting list in the North Eastern Health Board was one of the longest in the country before the closure of Monaghan. I know the Leas-Cheann Comhairle said some time ago that the waiting list in Monaghan was gone but, of course, we all know now that staff were withdrawing patients from it. Will Monaghan General Hospital be put on a never ending waiting list or will the Minister make sure it is a number one priority? I ask the Minister to make a clear statement on when we will get our full services back.
The former Minister, Deputy Cowen, could only provide £0.5 million to Monaghan, but £52 million to his own constituency. The food industry makes sure that factories and processing plants meet all health and EU rules. Why do health board executives not do the same for hospitals? Can the Minister imagine an emergency at Moybridge or Carrickroe along the Border where people would have to travel 45 to 50 miles in the middle of the night on secondary  roads? The High Court accepted that only because Monaghan General Hospital was there, patients in the past might have lost their lives. We have first class consultants, nursing and other staff who are prepared to give a good service if given the necessary tools of their trade, that is, theatres, intensive care units, etc.
The Leas-Cheann Comhairle and I have tried to work together with other elected colleagues and to arrange joint meetings with health board officials. We were never advised that we had reached this serious situation. I ask the Minister of State to make sure the Minister, Deputy Martin, provides the funds and makes sure they are used not only in the North Eastern Health Board area but to restore Monaghan General Hospital to its rightful place immediately. There must be a clear statement from the Minister. The health board must make all nursing and other staff permanent, if possible, to make sure there is a degree of understanding and certainty that there is a will within the Department and the health board at executive level that Monaghan General Hospital will not only be maintained but upgraded so this pocket, this difficult Border region, is given the service it deserves.
Ms Hanafin: I thank Deputy Crawford for raising this issue to which I will respond on behalf of my colleague, the Minister for Health and Children, Deputy Martin. I would like to clarify the position in relation to the provision of services at Monaghan hospital. The North Eastern Health Board at its meeting in June 1998 approved the framework for the development of acute hospital services in the north eastern region and submitted a set of proposals for the development of all five acute hospital sites in its region, including Monaghan hospital, to the Department of Health and Children.
In order to ensure the highest possible quality of service for patients, the North Eastern Health Board is now providing acute hospital services on the basis of two integrated hospital groups – the Cavan-Monaghan hospital group and the Louth-Meath-Drogheda group. This approach, in addition to promoting quality health care on each site, underlines the fact that all five hospital sites in the region are secure. The establishment of an integrated Cavan-Monaghan hospital group has ensured that the population of the catchment area of both hospitals will have available to them a range of high quality, easily accessible medical and surgical services.
The following developments are proposed by the North Eastern Health Board for the Monaghan site of the Cavan-Monaghan group: composite diagnostic and treatment unit for accident and emergency services, day services and improvements in out-patient and surgical services, improvement of existing hospital wards for high quality accommodation and immediate refurbishment of theatre and provision of an emergency recovery area.
 The North Eastern Health Board policy on acute surgical services is clear and explicit and the plans included in the framework will significantly develop the range and complexity of services in the region and allow the board to develop self-sufficiency in regional services. A project team, appointed by the chief executive officer of the North Eastern Health Board, with representation from the Department of Health and Children, is currently preparing a brief for the Cavan-Monaghan hospital group which will form the basis for instructing an architect and design team to advance the planned developments. Under the national development plan, £80 million has been approved for the North Eastern Health Board's hospitals and ambulance service development during the period 2001-06.
The general and specialist surgical services are an important component of the board's overall service. Joint departments of surgery have been developed at each of the hospital groups and the majority of surgeons have assignments across two hospital sites within the hospital groups. In this context, the North Eastern Health Board has an obligation to ensure that the health care services it provides meet acceptable standards of safety. A commitment was given in the 1999 service plan to introduce a clinical risk management programme for all services.
Risk management consultants appointed by the board advised the chief executive officer in August 2000 that they had concerns regarding serious deficiencies in the physical infrastructure of the operating theatre at the Monaghan hospital site. This gave rise to concerns for patient safety.
The present operating theatre was built as part of the hospital and dates from the early 1940s. While some upgrading of the ventilation, electrical and piped gas services has taken place, essentially it has had no additional development to reflect contemporary operating theatre requirements and standards.
A properly constructed and equipped operating theatre is one of the essential components for safe surgical services. The proposed development of Monaghan hospital contained in the board's 1998 framework document includes the provision of two fully equipped operating theatres. However, the deficiencies in the present theatre are such that remedial action must be taken in the immediate future to ensure a safe environment for surgical procedures pending the provision of the new theatres.
The North Eastern Health Board has informed me that the theatre users group at Monaghan hospital has made recommendations to health board management on the provision of a semi-permanent theatre facility and arrangements are currently in train to provide for this as an interim measure.
The consultants on call at Monaghan hospital continue to see all emergencies and protocols and procedures have been put in place for the transfer of patients to other hospitals if required following triage at Monaghan hospital. The board has also  put in place transport arrangements to accommodate patients and their families affected by transfers to other hospitals. The North Eastern Health Board is fully committed to the future development of Monaghan hospital and the brief being  prepared by the project team will ensure that planned facilities at the hospital are in line with best modern standards in all respects.
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