Hospital Services.

Wednesday, 10 November 2004

Dáil Eireann Debate
Vol. 592 No. 2

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Mr. Crawford: Information on Seymour Crawford  Zoom on Seymour Crawford  I wish to share time with Deputy Connolly.

This is an urgent and important issue regarding the removal of five junior doctors specialising in surgery from Monaghan General Hospital. I acknowledge the presence of the Minister of State, Deputy Brian Lenihan, but I am disappointed the Tánaiste and Minister for Health and Children is not here. I assure the Minister of State that I am not in the business of pulling rabbits out of hats as far as Monaghan General Hospital is concerned. I think too much of that hospital, of the patients it looks after and of the people it serves. This is not a joke, or the pulling of a rabbit out of a hat, and I am extremely disappointed at the Minister of State for making that comment earlier because I do not see it as such.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  I did not refer to any rabbits.

Mr. Crawford: Information on Seymour Crawford  Zoom on Seymour Crawford  The Minister of State did and it is on the record.

The North Eastern Health Board, like every other health board, employs such staff on a six monthly basis starting in January and July. To this end, the North Eastern Health Board accepted applications for, in its words, the post of surgical SHOs at Monaghan General Hospital from 1 January 2005 to 30 June 2005. However, it advised the applicants that it acknowledged receipt of their applications for the above post but that it regretted that, due to unforeseen circumstances, it would not pursue this competition at this time. The health board further advised me by telephone today that this marked the beginning of the implementation of the report of the Cavan-Monaghan acute hospitals steering committee.

This action by the health board management raises major questions over not only the future of surgery in Monaghan General Hospital, but over the services available to the people of Cavan-Monaghan taking into account the ongoing difficulties and overflow situation in Cavan General Hospital. There is a serious question over whether the contract of the surgical senior house officers will be renewed in January and over the long-term situation of the two surgical registrars whose contracts expire in six months' time.

This move is unexpected and totally out of line with the promises made by the former Minister, Deputy Martin, in a letter last May and in a statement on 29 September which were welcomed with open arms by his Fianna Fáil colleagues in north Monaghan. My Independent colleague, with whom I am sharing time, also felt it was the answer. Those of us who raised questions based on previous commitments were accused of being [462]negative and were partially blamed for the ongoing situation. I remind the House that this is the way maternity and, especially, gynaecological services were removed from Monaghan General Hospital. Without surgeons and junior doctors on site in Monaghan General Hospital, five day surgery will not happen. This will limit the work for the permanent anaesthetist not to mention the five junior doctors promised.

It is not so long ago that the theatres in Monaghan General Hospital, together with its excellent surgeons and staff, were used by the Northern Ireland health service under contract. Now the Tánaiste and Minister for Health and Children is more committed to the national treatment purchases fund which draws on services outside this country. It must be remembered that if worthwhile active surgery is removed from Monaghan General Hospital and anaesthetic cover is not available, then the high care treatment room will be under threat.

I beg the Tánaiste and Minister for Health and Children to meet the people of Monaghan as a matter of urgency. She should stop the lunacy in the name of health care in Monaghan General Hospital. When the country had no money, Monaghan County Council could assure access to all care and treatment. It may have been an older style but the hospital never turned anyone away. Surely no service should be withdrawn without a proper alternative. It seems the people of Monaghan deserve neither.

I refer to Mr. Ben McCullagh who lived 500 yards from the hospital. An ambulance was sent for him but as there was no doctor on site, he had to travel 30 miles to Cavan and died en route. How does his family feel?

Mr. Connolly: Information on Paudge Connolly  Zoom on Paudge Connolly  I thank Deputy Crawford for sharing his time. Deputy Crawford was right in that on 29 September, I welcomed the deal announced by the former Minister for Health and Children, Deputy Martin, and I would do so again in the same situation. Many people gave it a guarded welcome but I gave it a straightforward one. If one does not listen to, believe or trust people, one could be described as paranoid and I would not like to think that I am, or that I would have to become an eternal sceptic.

The Tánaiste and Minister for Health and Children in her contribution to Private Members’ time last night and the former Minster for Health and Children, Deputy Martin, on 29 September, both clearly stated that this is additional funding for six NCHDs for Monaghan General Hospital. Additional to me means that if five doctors went away, it would be cost neutral and there would be no cost involved.

There appears to be a view that the surgical personnel will be moved to Cavan but that they will still perform surgery in Monaghan, that is, they will be based in Cavan but will travel to [463]Monaghan to perform surgery and will go back to Cavan. That is an awful waste of resources because it would eat into their session time. It would take an hour to travel from Cavan and another hour to go back. I am sure a team of at least three or four people would be travelling. There would be costs in terms of man hours and travel. In wintertime, it might not be suitable or safe to drive.

It is not sensible for people to continue with that type of thinking. Another group of people will have to travel from Monaghan to Cavan to check the reports on the work they have done. This cannot continue. Common sense must prevail and we must get back to the basics.

Mr. B. Lenihan: Information on Brian Joseph Lenihan  Zoom on Brian Joseph Lenihan  If, in the heat of the moment, I referred to rabbits being taken out of a hats, it certainly was not in reference to Deputy Crawford who never misses an opportunity on this subject. I welcome the opportunity to respond to the Deputy on this matter and to outline to the House the position with regard to the provision of surgical services across the Cavan-Monaghan hospital group.

At the outset, I wish to refute any suggestion that all surgical services will be removed from Monaghan General Hospital. The position in relation to the reconfiguration of hospital services in the Cavan-Monaghan group has been discussed in great detail in this House in recent weeks. Members will be aware that in September the former Minister for Health and Children, Deputy Martin, met with the North Eastern Health Board and was briefed on the progress made by the steering group, which had been established by the board to oversee the reconfiguration of hospital services across the Cavan-Monaghan group.

The Department is advised that the position in relation to the reconfiguration of surgical services is as follows. The steering group, following consultation with the Royal College of Surgeons in Ireland has recommended that major emergency and elective surgery be carried out at Cavan General Hospital and that selective elective surgery be performed at Monaghan General Hospital. In accordance with the recommendations of the steering group, a full surgical team, based in Cavan, will provide services at Monaghan General Hospital daily, Monday to Friday. This joint department of surgery team will provide selective elective surgery, endoscopy and outpatient services and consultation on inpatients as required. Protocols governing surgical admissions to both sites will be developed by the RCSI in consultation with the new joint department of surgery.

In addition, the steering group proposed the restoration of 24-hour, seven-day medical cover at Monaghan and the employment of additional NCHD anaesthetists in order to bring the [464]hospital back on-call. The role of the five new anaesthetists will be to ensure the safe transfer of patients when required and to assist the consultant anaesthetist in theatre during surgery. The Department is advised that the recruitment process is underway and that subject to the satisfactory completion of registration with the Irish Medical Council, the additional personnel should be in place in January next year.

Consistent with the recommendations of the steering group, the Department has approved revenue funding of €500,000 to commission ten additional day beds at Monaghan General Hospital. These beds are designed to facilitate the development of surgical services across the Cavan-Monaghan hospital group. The commissioning of the beds is to be progressed by the board as a priority.

Finally, the Department has also given financial clearance for the recruitment of three replacement consultant surgical posts to facilitate the development of surgical services across the Cavan-Monaghan hospital group. Detailed applications in respect of these posts have been submitted by the board to Comhairle na nOspidéal for approval.


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