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Dáil Éireann debate -
Thursday, 27 Jun 2002

Vol. 553 No. 7

Adjournment Debate. - Accident and Emergency Services.

Thank you, a Leas-Cheann Comhairle, for the opportunity of raising this important issue on the Adjournment. I thank the Minister of State at the Department of Health and Children, Deputy Brian Lenihan, for coming in to reply. Next Monday is 1 July and that is why I have raised this issue in the House once again. In February or March of this year the Minister for Health and Children, Deputy Martin, made a commitment to the consultants of Monaghan General Hospital, in the presence of GP representatives, Dr. Ambrose McLoughlin from the North-Eastern Health Board and a number of the Minister's party and Oireachtas colleagues, that five junior doctors would be appointed and in place by 1 July 2002 to make sure that accident and emergency services could continue. I understand that as of today no doctors are in place and none have been advertised for by the health board. What is the Minister playing at?

The Minister spent 11 hours in Monaghan in January and he knows first-hand the needs and requirements of Monaghan General Hospital. Fianna Fáil candidates stated in election literature that three new consultants and five junior doctors would be supplied to the hospital. I have Deputy O'Hanlon's literature here. It states that 80% of accident and emergency cases will be treated in Monaghan.

It also states that all medical and surgical emergencies as determined by surgeons on call would be treated in Monaghan. These were the election promises and commitments from the Minister, Deputy Martin.

The facts are different. Following discussions with the Minister in December 2000, Comhairle na nOspidéal undertook a review of the structures, operating staff and accident and emergency services and departments nationally. From that study, the review of the North-Eastern Health Board area recommended Drogheda as the regional emergency centre with two additional consultants based there and one additional con sultant in Cavan. None was to be based in Monaghan General Hospital.

On 3 January 2002, Professor Arthur Tanner, on behalf of the Royal College of Surgeons, stated that it was the view of the college that Monaghan hospital should not accept emergency surgical cases. It is also on record that Professor Tanner had a meeting with the consultant surgeons in the Cavan-Monaghan hospital group in December 2001 at which a template for the future development of surgical services for the hospital group was agreed and the consultant surgeons felt that the template agreement was workable. As the Royal College of Surgeons will not recognise the training of young doctors in an emergency department unless an emergency medicine consultant is based in that department and as Comhairle na nOspidéal has not recommended that consultant for Monaghan, it is evident that no doctor will come to Monaghan unless the Minister changes this recommendation.

When the surgeon, Mr. Maloney, retired, the then Minister for Health, Deputy Noonan, ensured that he was replaced by two rather than one surgeon. The Minister, Deputy Martin, has increased the allocation to the health board over the past five years and has claimed credit for it, but the person who pays the piper should call the tune. I question whether the Minister ever intended to follow through with his promises and commitments.

I attended hospital information meetings organised by the staff of Monaghan General Hospital and they were chaired by one of the consultant surgeons, Mr. Liam McMullen, who advised that they were only information meetings and not ones at which politicians could speak. I question why he as chairman did not give us all the facts he knew. Despite statements to the contrary, he was involved in a political campaign.

All the activities concerning Monaghan General Hospital should be the subject of a full public inquiry. This is a serious issue. We were promised five years ago by health board executives that plans were in place for a major expansion and upgrading of Monaghan General Hospital, including the maternity and surgical wings and the mortuary. All that has happened since is downgrading and transfers to Cavan and Drogheda. Several sections are already closed.

It is vital in the short-term that the Minister or someone on his behalf acts as a mediator between the health board members from County Monaghan and the executive of the health board because the current lack of trust is leading to the worst possible results for Monaghan General Hospital and the people of Monaghan. Insurance companies, Comhairle na nOspidéal and the Royal College of Surgeons are being used as excuses to take away services which were originally put in place by Monaghan County Council and the people of Monaghan. Action is needed now because 1 July is next Monday.

On behalf of my colleague, the Minister, Deputy Martin, I thank Deputy Crawford for the opportunity to clarify the position of accident and emergency services at Monaghan General Hospital. I remind the Deputy that the North-Eastern Health Board is responsible for the provision of services at the hospital. 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.

Approval from my Department has recently issued to the North Eastern Health Board for a consultant surgeon post at Monaghan General Hospital. Approval has also issued to the board for the upgrading of this temporary post to permanent status. Comhairle na nOspidéal is the statutory body with responsibility for regulating the number and type of appointments of consultant medical staff in hospitals which provide services under the health legislation. I understand that this post is under active consideration by Comhairle na nOspidéal in consultation with the North Eastern Health Board.

In addition, five medical support staff have also been recently approved by my Department to support the NCHD team attached to this post and to support the recent extension of the opening hours of the hospital's accident and emergency treatment room. On receipt of approval from Comhairle na nOspidéal for the consultant post, the North Eastern Health Board will proceed to advertise for the recruitment of the additional medical personnel.

I wish to refer to the recently published report by the Comhairle na nOspidéal committee on accident and emergency services undertaken at the Minister's request. The report not only deals with the staffing of accident and emergency departments at consultant level but also explores factors which affect the efficiency and effectiveness of hospital emergency services. It links reform of accident and emergency departments with the need to look critically at hospital processes and the flow of patients through hospitals.

An increase in consultant in emergency medicine posts is one of a number of wide-ranging recommendations contained in the report. All the reports and recommendations, including the recommendation on increased consultant medical staffing levels are, as the report states, designed to be implemented on a phased basis. The report also states that their implementation will require detailed planning by health boards, hospitals and others involved in emergency services.

In the context of geographical and demographic factors, the hospital network, specialty distribution and international best practice, the committee recommends that a regional emergency department be established in the North Eastern Health Board area, based in Drogheda. The regional emergency service co-ordinator, who would be the director of the regional emergency department, would be based in Drogheda. The regional emergency department would co-ordinate accident and emergency services at the hospitals in Cavan, Monaghan, Dundalk, Drogheda and Navan.

The committee also recommends the creation of three additional posts of consultant in emergency medicine – two in the Louth-Meath hospital group and one in the Cavan-Monaghan group – with access to the regional emergency department in Drogheda. The recommendations of the committee's report will help to inform the development of accident and emergency services in the North-Eastern Health Board area.

I am pleased to inform the Deputy that plans are being advanced by the North-Eastern Health Board for the development and upgrading of the high dependency unit at the hospital in addition to substantial upgrading and refurbishment of ward accommodation, the development of the treatment-minor injuries unit and the development of a midwifery-led unit. The associated capital cost is of the order of €7 million.

In addition, approval has recently issued for a replacement consultant anaesthetist and an increase in the number of sessions for this post from six to 11, all to be held in Monaghan General Hospital. This post will further support service developments at the hospital.

My Department has recently agreed to the selection and appointment of a design team to prepare a development control plan for the Monaghan site and to advise the board on the future development potential of the site in line with the board's policies. The North-Eastern Health Board is in discussions with hospital management with a view to ensuring the continuation of accident and emergency services at Monaghan General Hospital. The health board is confident that this issue will be resolved soon.