I wish to share my time with Deputy O'Hanlon.
Adjournment Debate. - Hospital Services.
Is that agreed? Agreed.
That the chief executive officer and the chairman of the North Eastern Health Board have convened a meeting of the board for Thursday morning to inform it that there is no extension from its insurance company for Monaghan General Hospital Maternity Unit by 28 February means the Minister must intervene to guarantee that cover. I understand the board, through the Minister, has requested one obste trician and one paediatrician which would allow adequate and safe cover to mothers and children. Up to now many relatively big maternity units are run by two consultants. These include Wexford, Kilkenny, Clonmel, Tralee to name just four. Why does the review group and chief executives insist that no less than three will be acceptable in Monaghan General Hospital?
The Condon report considered that it is safe for a midwife led unit in Dundalk but not in Monaghan because, in their words, "it is isolated and far from the nearest maternity unit in Cavan or Drogheda". How cannot the same review group see the dangers for emergency maternity cases in Carrickroe or Moybridge who would have to travel up to 50 miles if the Monaghan General Hospital maternity unit was closed? Consultants have tried to prove there is no problem in distance regardless of poor quality roads or weather conditions. Many families have true stories to tell in relation to how their babies were saved due to the Monaghan hospital maternity unit.
Cross-Border discussions are taking place regarding co-operation and possible increased numbers. The Minister should give these talks a chance by removing the deadline. Temporary closure will mean that a maternity unit will not ever again exist in Monaghan General Hospital. It sends out the wrong message. One review group closed a theatre and that is now being refurbished. What is to stop the executive officers using another review group to close the hospital altogether?
Morale was never at such a low level among the excellent staff. They have the lowest ratio per patient in the country.
The development committee is exhausted. This hospital was saved 17 years ago but has been starved of resources since then. When he was Minister for Health, Deputy Noonan provided £500,000 to upgrade the theatre but the work was not done until now. The female medical ward has been restructured but the £10 million the current Minister has guaranteed for the hospital must be spent. With the breakdown of trust between the health board members from Monaghan and the executive officers, it is vital that the Minister visit Monaghan and clarify to the people there that this £10 million, and more if necessary, will be spent to restructure and upgrade the hospital.
The fact that some relatively inexpensive equipment has not been provided leaves the doctors and staff in a vulnerable position. They generally believe a decision has been taken behind closed doors to bleed the hospital of services in the hope that it will die. Why not use the personnel available in the area to do blood tests instead of sending the tubes of blood or the patients elsewhere? The Minister has the funds, far more than was ever available in the history of the State, and he should provide the insurance, personnel and the new start necessary for Monaghan General Hospital.
Deputy O'Hanlon has been blamed by some of my colleagues for not applying enough pressure in this matter. However, the health board members are working together to save and upgrade the hospital. I have worked with Deputy O'Hanlon on this matter in the House and I now hand over to him.
I thank my colleague, Deputy Crawford, for sharing his time with me. Sometimes I am blamed in this regard but, as Deputy Crawford knows, Monaghan was fortunate in 1987 to have the Minister for Health as its representative, otherwise the hospital might have gone the way of some other hospitals, such as the North Infirmary in the current Minister's constituency.
In this instance, we are discussing the maternity unit in Monaghan General Hospital. Half the babies born to mothers in the county are born outside the hospital's catchment area because of the staffing levels. The executive of the health board gave the members no choices but just presented them with a fait accompli to close the units. Health board members, in their wisdom, decided to continue the maternity services in both units. They want extra consultants to ensure a safer service for the mothers and their children.
I will not discuss the changes over the past 15 years when there were no obstetricians in many of the hospitals. They were staffed by a county physician and a county surgeon who were responsible for care. I appeal to the executive of the health board to employ locums in Monaghan and Dundalk, to the Irish Public Bodies Mutual to withdraw its notice to the health board that it will not continue its insurance cover and to an comhairle to approve the necessary appointments. I ask them to give Monaghan and Dundalk a chance. The health board promised to build a new maternity unit in Monaghan less than three years ago. It should get on with that and give the hospital a chance to develop a viable, safe service for the families, particularly the mothers and their infants, in the area.
I thank the two Deputies for raising this issue. I acknowledge the strong representations they have continued to make, with other public representatives in this House and members of the health board, since before Christmas in relation to both the maternity unit and the future development of Monaghan General Hospital. The Deputies have been vigorous in their pursuit of me and the Department on these issues.
The provision of maternity services at Monaghan General Hospital is a matter for the North Eastern Health Board, in the first instance, which has statutory responsibility for the provision of health services in its functional area. The North Eastern Health Board is committed to developing acute hospital services in line with the needs and requirements of its resident population.
In 1998, the board adopted a policy framework for the development of its acute hospitals, North East Hospitals, The Next Five Years – A Framework For Continuing Development. This emphasised the need for high quality, safe and accessible acute hospital services, utilising all five hospital sites within the board's area. It confirmed the commitment of the board to developing each hospital site within the two hospital groups, Cavan-Monaghan hospital group and Louth-Meath hospital group. The framework document recommended that the maternity services in the region be reviewed.
The review group established for this purpose reported in late 2000. Briefly, the report indicated that: consultant-led maternity services at Monaghan and Dundalk should cease due to concerns about patient safety; a pilot centre for midwife-led obstetric services be established in Dundalk; and consultant-led delivery units should be located at Drogheda and Cavan. I have been advised that the health board decided "not to accept in full the recommendations" in the review group's report and it unanimously approved the establishment of a further review with a broader remit that will reflect on the potential for cross-Border co-operation and the requirements of spatial planning as anticipated in the national development plan. It is proposed that the board will finalise plans for this review at its next monthly meeting which, I understand, will take place next Thursday.
I am of the firm view that the way forward for maternity services is about putting in place services which comply with safety standards and internationally recognised best practice recommendations. I met the chairman and representatives of the board and emphasised the need to ensure patient and staff safety. I informed the board that it is imperative that it establishes and finalises a clear view on the services that will be provided at each hospital in the region, the new services required to be developed and the enhancement of existing services in light of the £160 million national development plan funding which has been notified to the board. I look forward to receiving the board's proposals in this regard.
I have been vigorous in making that point to the health board on a number of occasions since this situation developed. We want to see developments at each hospital site, clearly defined roles for each hospital and the trust that has broken down to be re-established so that people will see there is a future for Monaghan hospital. We have made the funding available in the national development plan and that funding is still secure.
I have been advised that the board further considered the question of maternity services at special meetings in January and February of this year. To avoid the suspension of maternity services at Monaghan and Dundalk, the health board mandated the chief executive officer to seek, as a matter of urgency, approval for the appointment of temporary consultant obstetricians to Cavan-Monaghan and Louth-Meath hospitals and to seek, in addition, approval for the immediate appointment of on-site paediatric cover at both hospitals.
The approval of any such posts is a matter for Comhairle na nOspidéal, which is the statutory body set up to regulate appointments of consultant medical staff in hospitals providing services under the Health Acts. My Department will have appropriate discussions with the board regarding funding for the posts following the decision of an comhairle in the matter. We have written back to the health boards. That will facilitate the health boards making the application to an comhairle in relation to additional consultant staff. Following consideration by an comhairle we will discuss the funding issues with the board.
It will be appreciated that insurance cover is an issue for the board and its insurers, who have a contractual relationship in this matter. With regard to the overall development and upgrading of Monaghan General Hospital, I understand from the board that this is secure within the indicative capital funding made available to it under the national development plan for capital development projects across its hospital groups. A project team is advancing a design brief for the development and upgrading of the hospital and I am assured that considerable progress has been made by the project team in this regard. I will keep a close eye on that.