As the next two items relate to Monaghan General Hospital, they will be taken together. Deputies Crawford and O'Hanlon will have five minutes each.
Adjournment Debate. - Hospital Services.
I thank the Ceann Comhairle for allowing me to raise this important matter tonight. I thank the Minister of State, Deputy Moffatt, for coming to the House to listen to the case I have to make on Monaghan General Hospital. My contribution is a last-ditch effort to persuade the Minister for Health and Children to take emergency measures to save the hospital. I have tried to avoid turning this into a party political issue and I welcome the fact that the Minister, Deputy Martin, made a belated visit to the hospital and spent many hours in discussion with those concerned. His visit can be judged by its results, however, as while he met consultants and Members of this House, he has not met the commitment he made during the visit to meet other groups.
Services continue to be removed from the people of Monaghan. There are no maternity, gynaecological or children's wards in the hospital and post mortems are no longer carried out there. These closures have serious effects on family life in the county, especially as many of them relate to women. The failure of the Minister for Health and Children to act has facilitated the removal of these services and it is obvious that accident and emergency services, a CAT scanner and major surgery facilities will not be put in place without his intervention. Having heard the concerns of electors, a Government candidate in the general election has demanded a written statement of the Minister's plans for the hospital, which proves that people do not believe the Minister's promises. The Progressive Democrats candidate says that the Minister's word is useless and that plans should be produced in writing.
The failure to appoint an accident and emergency consultant at Monaghan General Hospital raises major question marks over the idea that trainee doctors will apply to work in the hospital's treatment rooms. The people of Monaghan have contributed to the proposed provision of an urgently needed CAT scanner, but the machine has not been delivered. Three new consultants have been promised at the hospital: a consultant physician was promised in 1999, but the post has not been filled; a replacement for the late Archie Moore has not been found; and the split appointment of a consultant dermatologist has not taken place.
Those involved in minor accidents are no longer sent to Monaghan General Hospital. A man who needed an X ray was recently sent to Drogheda, which meant that a member of his family had to collect him there. The hospitals in Drogheda and Navan are clogged up, but the X ray department in Monaghan is virtually idle, the gynaecological unit is closed and the children's ward is scarcely used, at a great cost to the State. Many individuals have told me how their lives were saved by consultants and other personnel in Monaghan.
When the hospital in Dungannon, just north of the Border, was closed, the people in its vicinity were able to avail of the services of Craigavon Regional Hospital, just 20 miles down the motorway. It is 60 miles on bad roads, however, from Border areas like Moybridge, Clara or Knockatallon to Drogheda and Navan. I ask the Government, particularly the Minister of State, Deputy Moffatt, and the Minister, Deputy Martin, to accept responsibility for loss of life or long-term damage which may result from the lack of service provision in Monaghan General Hospital. I protest to the Government on behalf of those who have to get off work to travel long distances, rather than availing of the normal services to which they are entitled in Monaghan. It does not give me great pleasure to say that without ministerial intervention, Monaghan General Hospital has a dim future. I have tried to work in a constructive manner within the system in the hope that such an attitude would pay off, but that has not been the case.
I thank the Ceann Comhairle for allowing me to raise this issue this evening. The supposedly imminent closure of Monaghan General Hospital has been predicted during many election campaigns over the years and we have heard reference to it again tonight. Since the 1970s, successive Fianna Fáil Ministers with responsibility in this area, including myself, have gone to Monaghan to reassure people that the hospital will remain open and will continue to deliver acute services to those in its catchment area. I call on the Minister for Health and Children to spell out how his Department and the North-Eastern Health Board intend to deliver services, to outline future developments and to alleviate the confusion that exists, some of which has been initiated by vested interests.
Day to day spending on the running of Monaghan General Hospital has increased from €9.9 million in 1997 to €19.5 million in 2002. It is reasonable to accept that a hospital with such an increase in spending is not on the point of closure. The figures I have outlined do not take account of over £4 million which has been spent on refurbishing wards and operating theatres and providing equipment. The Minister for Health and Children recently announced that ten of the 700 extra beds he is providing in the current year will be in Monaghan. The level of activity in the hospital has increased every year, which is not a sign of imminent closure. There were only 17 day cases in 1994, but there were 2,176 last year. There are excellent medical and surgical units in the hospital and its consultants and surgeons compare favourably with the best in Ireland.
The Minister has announced that he intends to appoint a third consultant surgeon and I ask him to declare when the surgeon will be in place. The appointment of staff to support the surgeon will ensure that there will be an efficient accident and emergency service to cater for the needs of about 80% of the people of Monaghan General Hospital's catchment area. A small number of patients' serious head injuries should be treated in Beaumont Hospital, serious chest and spinal injuries are best handled in the Mater Hospital and bad fractures can be dealt with in Navan.
I worked as a medical practitioner for many years, but it has been my belief since the first day I qualified that our prime focus must be on the provision of quality service at the appropriate level for those who need it. As a member of the North-Eastern Health Board for 16 years and as Minister for Health my philosophy is the same – the patient is paramount. While I know that this is the health board's responsibility, I am calling on the Minister to ensure that the board gets on with the implementation of the framework document of 1998 on the provision and development of services in the north east with particular reference to Monaghan. A new midwife led maternity unit has been promised as a matter of urgency because, as Deputy Crawford said, people have long distances to travel. I know that the unit closed because there were only 300 deliveries. The unit in Dundalk, with double the number of deliveries, also closed. Deputy Crawford referred to post mortems. I ask the Minister, if the post mortem room is refurbished, whether the surgeons in Monaghan General Hospital will do post mortems as their predecessors did and not insist that they be done by a pathologist.
We all have an obligation to ensure a quality service is provided. Those with the interests of the county at heart would not want to rubbish the excellent services in place in the general hospital. By all means, work and fight for new services, but always be sensitive to the danger of undermining public confidence in services that are good. We have an excellent medical and surgical service at the hospital. The appointment of the dermatologist is important because, while dermatology services are not widely needed, those who do require a dermatologist often have a serious condition that needs to be attended to. What is important is that the dermatologist in Monaghan will cater for part of Northern Ireland. This is a significant development since part of the future of the hospital lies in expanding its catchment area to surrounding counties Tyrone and Armagh.
I thank the Minister for the personal attention he has given to addressing the concerns of the people of County Monaghan, particularly during his visit when he gave ten hours to meeting all the different groups which wished to see him, the amount of work and personal attention he has given to the needs of the county since, and what he has announced in terms of the provision of new specialties and services. Because of the confusion – in the run-up to the general election – I hope he will spell out clearly what the future development of Monaghan General Hospital will be.
I thank Deputies Crawford and O'Hanlon for the opportunity to speak to the House in relation to Monaghan General Hospital. First, I remind them that the North-Eastern Health Board is responsible for the provision of services at the hospital and that it is a matter for the board to determine service provision at the hospital in line with its commitment to the provision of a high quality, efficient and cost effective service. I met the board on numerous occasions in relation to the development of the hospital and the expansion of services there.
I recently visited the hospital and met hospital management, staff, local representatives and members of the general public. I have since had further discussions with the various delegations and was happy to be in a position to allay any concerns with regard to the future development of the hospital. I took the opportunity to outline to them details of a comprehensive investment package for the hospital.
Over the last three years in excess of €4.064 million has been allocated to the hospital in respect of various capital projects. The main projects completed included the refurbishment of the female medical ward and a new modular theatre and an extension to a car park. In addition, a major equipment replacement programme costing almost €1.27 million was undertaken throughout the hospital, which included specialist cardiology and patient monitoring equipment.
A significant level of capital investment in the hospital is proposed in the short-term. Plans are being advanced by the North-Eastern Health Board for the development and upgrading of the high dependency unit in addition to substantial upgrading and refurbishment of ward accommodation, the development of the emergency treatment unit and the development of a midwifery led unit. The associated capital cost is of the order of €7 million. I recently agreed to the selection and appointment of a design team to prepare a development control plan for the Monaghan site and advise the board on the future development potential of the site in line with its policies.
As the Deputies will be aware, on 16 January this year I announced the immediate commissioning process for an additional 709 acute hospital beds in public hospitals nationwide at a cost of €65 million in the current year. We asked all the health boards to come forward with proposals on how many beds they could provide in the short-term. This is the first phase in the provision of the additional 3,000 acute hospital beds by 2011. Of the additional 709 public hospital beds, 38 will be provided in the North-Eastern Health Board region with ten of these being provided in Monaghan General Hospital. All the additional bed capacity at the hospital will be designated for public patients and allow the hospital to significantly increase activity levels for its public patients.
Revenue funding to the North-Eastern Health Board has increased steadily in recent years as follows: in 2000, £226.806 million; in 2001, £289.122 million, and in the current year this figure increased to €450.053 million or £354.446 million. This has enabled the board to enhance service provision at the hospital through the appointment of additional consultant and non-consultant medical staff. Examples include the development of new consultant led services in dermatology and geriatric medicine. In this regard, the Department has recently issued formal approval to the board for the filling of two consultant posts in order to facilitate these developments. Approval has also recently issued to the board for the recruitment of a permanent replacement consultant surgeon post which had previously been filled in a temporary capacity. Additional medical support staff will also be recruited to support this post. In addition, approval has also issued for a replacement consultant anaesthetist post with a commitment to the hospital, which will support service developments at the hospital. With regard to maternity and gynaecology services, in-patient treatment ceased at the hospital at the end of 2001. Services continue to be available for out-patient and day services at the site. Out-patient and community paediatric services will continue to be provided, while in-patient paediatric services will be provided in Cavan and Drogheda for the region.
I am satisfied that the proposed development of additional consultant led services, with the provision of additional bed capacity and the proposed significant level of capital investment, reflects our commitment to the provision and development of acute hospital services to the catchment area population served by Monaghan General Hospital. I again thank the Deputies for allowing me the opportunity to clarify the position in relation to service provision at the hospital and say that some of the statements made about its future were exaggerated. I have no doubt it has a strong future. We are providing and delivering on new services for it. When I met the medical board in recent months, continuation of surgery, emergency medicine and other services were key issues. With the additional consultant appointments and junior doctors, the initial points made by the board have been met. I will continue to work with all concerned to oversee the ongoing expansion and development of the hospital.
(Carlow-Kilkenny): Ba mhaith liom mo bhuíochas a ghabháil leat, a Cheann Comhairle, as ucht an deis a thabhairt dom labhairt ar an ábhar seo anocht.
Carlow is an expanding town, one of the five fastest growing towns, according to a recent survey by the Irish engineers' association. It has an institute of technology, five excellent second level schools, the same number of primary schools, top class sports facilities and a railway station. Our Gaelic teams can take their place among the best while the rugby club was promoted to division one this year. While all this is marvellous, we cannot assure visitors to the town that they will have access to top class hospital facilities. Why is it being left behind? This is a major bone of contention. During the general election the people of the town will be demanding the provision of a general hospital. I am realistic enough to know, however, that this will not happen, although private enterprise may provide the badly needed hospital.
I draw attention to the fact that in 1996, before the Government came to power, a ten bed extension was approved by the health board for the hospital in the town, which has only 22 beds. The Minister has ignored the town and we have no Minister of our own. However, there are Ministers from Cork and Mayo. What is wrong? After six years the building of ten extra beds at Carlow District Hospital has not commenced. The beds were supposed to have been commissioned at the end of 2002, yet building has not even begun. The Minister will probably give me a promise but this is my swansong. This is probably the last time I will grace the House and ní bheidh mo leithéid ann arís. Humility is my second name.
I want the Minister to announce a date so that I can go back to the people of Carlow and say while the Government ignored them for six years and did not think they existed, the ten bed expansion will commence so that my successor will not have to pursue this issue. I ask the Minister for a date for the implementation of this promise made six years ago.
I thank the Deputy for raising the issue. A total of €2.54 billion, £2 billion, at 2000 prices, has been made available by the Government for investment in the health services under the national development plan. The purpose of the plan will be to create an infrastructure that will bring significant and tangible advances in delivering a more patient-centred and accessible service. There is a commitment from the Government to shift the balance of capital investment towards the non-hospital sector so that NDP funding is evenly divided between the hospital and non-hospital areas by the end of 2006.
In the case of services for older people it is proposed to provide a greatly improved physical environment to ensure a high quality and client-centred service. Approximately €254 million, £200 million, was indicated in 2000 for the capital development of services for older people over the period of the plan. A broad range of facilities will be provided, replaced or upgraded as a result including assessment and rehabilitation and ambulatory care facilities, community hospitals and nursing units, convalescent and respite beds, day care centres and services for the elderly and mentally infirm.
(Carlow-Kilkenny): And ten beds.
The provision of health services in County Carlow is the responsibility of the South-Eastern Health Board. Under the National Development Plan 2001-2006 the health board was advised in early 2000 of indicative funding of €18.79 million, £14.801 million, for the capital development of services for older people. It is a matter for the board to prioritise developments in line with the funding provided under the plan.
I have been informed by the South-Eastern Health Board that the need for a ten bed extension to Carlow District Hospital was identified in the Carlow Plan 1996 and was subsequently included by the board in its proposals for the NDP. Individual projects are subject to the normal approval process in relation to funding, technical and other requirements governing the approval of capital projects. My Department has recently received a number of technical reports relating to this proposed capital development. These reports are under active consideration and my Department will be contacting the board in the near future in regard to progressing the project.
It was only after the NDP was formulated and funding was made available under it that my Department received significant capital investment moneys. That is one of the major benefits of the plan and it will enable the ten bed unit in Carlow to be built.
I wish the Deputy an enjoyable retirement. He is a man of great decency and courtesy. I know he does not mean it when he says I have ignored Carlow because I have been there on a number of occasions in my current role and in my previous role in the Department of Education and Science. I will give this issue personal attention. I thank him very much.
The Dáil adjourned at 9.10 p.m. until 10.30 a.m. on Wednesday, 24 April 2002.