I wish to give one minute of my time to Deputy Ó Caoláin which I understand he will take, following Deputy Crawford.
Adjournment Debate. - Hospital Services.
Is that agreed? Agreed.
I am opposed to the conclusion of the Condon review on the maternity unit in Monaghan Hospital that it should be closed. The Condon review included Mr. Condon, a former secretary of the Department of Health, a consultant obstetrician from Dublin where there are 6,000 deliveries a year in her hospital, a consultant with a similar number of deliveries in Belfast and a nurse from outside the State. I am very disappointed that the review group did not have a consultant or nurse from a hospital in the area. It did not have a GP, a public health nurse or a mother from the catchment area of Monaghan General Hospital. I know the group met a small number of such people during their deliberations. The report calls for the closure of the maternity unit which will entail women from Monaghan having to travel to Cavan for obstetric care. This is totally unacceptable. Some 96% of deliveries are normal and it shows no regard for the terrain of the Cavan-Monaghan area to propose that women travel 40 or 50 miles on a poor road network with the type of weather conditions experienced in the winter months in the region.
I travelled yesterday from Carrickmacross to Cavan in frost and fog. Asking women with a normal delivery to travel these distances does not make sense. It will result in babies being born on the roadside, bleeding not being properly attended to because of the distance and women deciding not to go to the hospital and having their babies at home. I request the health board members to reject this plan on Monday. This report should be discussed with the staff of Monaghan General Hospital, with the general practitioners in the region and with the public health nurses who are at the coal face. A decision should be made to provide a new maternity unit as promised by the North Eastern Health Board only two years ago in the five years' plan and to staff the unit with a second obstetrician and paediatrician to ensure a quality service is provided and to build up the catchment area. It has been made clear that money is not the problem. Such a unit will provide an excellent service for the woman and child and eliminate the risks involved in travelling long distance. It would also take account of the human, social and economic factors, for example, the husbands, partners and children who regularly visit a mother. This is so particularly if the mother is detained in hospital for several weeks as can often be the case.
The obstetrician should be based in Monaghan. Obstetricians more than any other discipline have difficulty in leaving their hospital base to provide outpatient services – and we are talking about 30 or 40 miles away – because they have an ongoing commitment to their patients who might come into labour at any time in the hospital where they are located. They would have difficulty getting out to provide the necessary outpatient care in obstetrics and gynaecology. In 1985, a proposal was made by Mr. McGrath to close Monaghan maternity unit. I was then a member of the health board and I opposed the closure of the unit for the same reasons I have outlined this evening.
Yesterday I requested that the Minister for Health and Children meet the health board members from Monaghan. I wish to record my appreciation that, at very short notice, he met the health board members and Oireachtas Members from the area today and listened carefully to their views.
Like Deputy O'Hanlon, I wish to share time with Deputy Ó Caoláin.
I thank the Ceann Comhairle for the opportunity to raise this important issue. I also thank the Minister of State, Deputy Ned O'Keeffe, for being present but I am disappointed a Minister or Minister of State at the Department of Health and Children is not present. However, I thank the Minister for Health and Children, Deputy Martin, for meeting us today at short notice.
The fact that the Condon report states that consultant-led maternity services at Monaghan General Hospital must cease in the immediate future and that a midwifery-led obstetric service will not be allowed has come as a bombshell to the people of Monaghan and I do not believe they will accept it. Promises were made by the health board's executives that Monaghan maternity unit would not only be maintained but that it would be upgraded. In spite of the public furore over a number of years, the number of births at Monaghan General Hospital has remained steady or even increased. With the improved prospects in the Border region and the dividend from the peace process, we should be looking to increase numbers in addition to encouraging constructive co-operation with the new Northern Ireland Assembly.
The Minister for Health and Children, Deputy Martin, must arrange an immediate meeting with his counterpart in Northern Ireland, Bairbre de Brun, because, with Monaghan General Hospital situated only four miles from the Armagh border, there should be an opportunity to serve a much wider region. One need only visit the car park in Monaghan town on any day of the week to see that people from the entire region use the town as a centre for shopping.
Monaghan General Hospital must be upgraded to level two maternity status and given three consultant obstetricians and the relevant consultancy support services. As Deputy O'Hanlon stated, mothers requiring this service have to travel between 40 and 60 miles on poor quality roads in all kinds of weather to the nearest alternative hospital. Did the Condon review group consider any of these problems or any of the opportunities offered by the new situation along the Border? I believe it did not.
The maternity unit in Monaghan General Hospital has given a first class service to all those who chose to use it. One mother informed me this evening that she could not favourably compare the care and treatment she received in Monaghan during the births of three of her children to that she received when she gave birth in a large Dublin hospital. A young couple expecting their first child spoke to me in desperation this morning and inquired about what is going to happen.
The staff of Monaghan General Hospital, who have been given so many promises in the past, cannot understand what is happening. The Minister for Health and Children must ensure that the necessary consultants are provided, even on a temporary basis, until negotiations with Minister de Brun and full consultations take place in respect of this issue. Comhairle na nOspidéal, the Condon review group and Professor John Bonnar, chairman of the obstetricians and gynaecologists association, seem to be running this country's health service at present.
The care given in Monaghan General Hospital has been first class. As Deputy O'Hanlon stated, money does not seem to be the problem. It would be difficult to explain to expectant mothers why they should be obliged to travel between 40 and 60 miles to the nearest alternative hospital. Why should they be obliged to bear the expense and undergo the stress involved in so doing? Like Deputy O'Hanlon, I believe babies will be born in cars rather than in Monaghan General Hospital.
I thank my constituency colleagues, Deputies O'Hanlon and Crawford, for sharing time.
The report of the Condon review group has provoked widespread dismay and anger throughout County Monaghan and beyond. We are faced with proposals for the closure of key services at Monaghan General Hospital, proposals which must be resisted. The people of County Monaghan successfully campaigned against the closure of their hospital and have long been working to ensure that this vital health facility is not only maintained but expanded. Now, however, the members of the North Eastern Health Board are to be asked to discontinue a key element of the health infrastructure of the region, the maternity service on offer at Monaghan General Hospital.
As a member of the health board, I am strenuously opposing this threatened closure of an essential service for mothers and children. This is an issue not just for the people of County Monaghan but for the citizens and elected representatives of our entire region which comprises counties Cavan, Monaghan, Louth and Meath. A reduction of service in any part of the region will reduce health provision for everyone who lives there.
With other Oireachtas representatives from counties Cavan and Monaghan, I met the Minister for Health and Children, Deputy Martin, in Government Buildings earlier today. We expressed our strongest opposition to this proposal and urged his direct intervention. I repeat that call for intervention now. Our subsequent meeting with the North Eastern Health Board executive was very unsatisfactory. Those representatives showed an inflexibility and unwillingness to address the concerns of the community whose service is now threatened. In these circumstances, the Minister's role is now vital.
I appeal to all members of the North Eastern Health Board to oppose the proposal to close Monaghan General Hospital's maternity department. This is not an issue of hospital against hospital or county against county. As demonstrated in this Chamber this evening, people of diverse political opinions have united in their efforts to save this service.
Having worked diligently for many years to support and enhance the dedicated service provided by the staff at Monaghan General Hospital to our community, I again pledge my total commitment to this vital health facility. In conjunction with the community and representatives of diverse political opinion, I am determined to save this service.
I wish to apologise on behalf of the Minister for Health and Children, Deputy Martin, who cannot be present this evening due to other commitments. I thank the Deputies for affording me the opportunity to address the House this evening and to outline the position in relation to the provision of maternity services at Monaghan hospital on behalf of the Minister.
In 1998, the North Eastern Health Board unanimously adopted a framework document for the development of acute hospital services. This document provided for a review of maternity services across the region in the context of ensuring best and safest medical and nursing practice, while respecting and responding to the requirement among women for their right to choose the maternity service most appropriate to their individual needs.
It was, therefore, agreed by the North Eastern Health Board in June 1998 that the chief executive officer would initiate a process to investigate fully all options in the light of current practice, knowledge and developments both in Ireland and internationally. The board agreed to involve obstetricians, anaesthetists, paediatricians, general practitioners, senior nurses and midwives and representatives of user groups in the local communities in this process. The board also agreed to invite expert advice from outside the region.
The review group was established by the chief executive officer and commenced its work in September 1998. It carried out the review in accordance with the following terms of reference: to investigate fully all the options in relation to maternity services in the area of the North Eastern Health Board in the light of current practice, knowledge and developments, both here and abroad; to involve in this process obstetricians, anaesthetists, paediatricians, senior nurses and midwives and representatives of user groups in the local communities; and to seek appropriate expert advice from outside the region.
The board has informed the Minister for Health and Children that in conducting the review, the group had regard to the following: review of the literature on best practice and standards; the outcome of a consultative process; results of a research project involving more than 500 women in the north-eastern area who had given birth within the past three years; and submissions made by interested parties.
The review group also took cognisance of the board's acute hospital framework document. It concluded its review and submitted its report to the chief executive officer of the North Eastern Health Board on 14 November 2000. Deputy Martin has been informed that the chief executive officer presented this report to the board, in committee, on 20 November and will present it formally to the board on Monday, 27 November. The Minister has been further informed that the deputy chief executive officer held briefing sessions with staff at both the Monaghan and Dundalk sites on Tuesday, 21 November and that the chief executive officer was meeting Oireachtas Members earlier today. This matter now falls to be dealt with by the health board in the first instance.