Caoimhghín Ó Caoláin
Question:83 Caoimhghín Ó Caoláin asked the Minister for Health and Children the discussions he has had in relation to the crisis in Monaghan General Hospital since Dáil Éireann last met. [15652/02]
Priority Questions. - Hospital Services.
The provision of services at Monaghan General Hospital is a matter for the North-Eastern Health Board. As the Deputy is aware, I visited Monaghan General Hospital earlier this year and engaged in extensive consultation with hospital management, staff, local representatives and members of the general public. I have maintained regular contact with the board with regard to service issues at the hospital and have been briefed on its efforts to find agreement on a safe and sustainable future for the hospital.
The board is engaged in continuing dialogue with the hospital consultants in the Cavan-Monaghan hospital group and with the professional bodies in relation to the future configuration of services at Monaghan hospital. The board is of the view that the resolution of the current difficulties will require input from the relevant professional bodies, including the Royal College of Physicians, Royal College of Surgeons, the College of Anaesthetists and the Medical Council as well as that of Comhairle na nOspidéal. It will also require the co-operation of the clinical staff of the Cavan-Monaghan hospital group. I have recently had discussions with the chief executive officer of the board regarding the proposal for a forum on the future configuration of services at the hospital and I have also spoken to local Deputies.
I would also like to advise the Deputy of a number of important service developments which are being progressed at Monaghan hospital. Project teams have been recently established to advise on development of all five acute hospitals in the North-Eastern Health Board area. The primary role of the Monaghan hospital project team is to prepare an outline planning brief for the development of the hospital site.
My Department has approved a number of new services at Monaghan hospital in recent months. These include new consultant posts in dermatology and geriatric medicine. Other developments recently approved include additional investment in consultant-led surgical and anaesthetic services. Approval has also issued to the board for the recruitment of five additional medical support staff. 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, a new modular theatre and extension to the 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. I recently issued approval to the North-Eastern Health Board to the funding of the boiler plant upgrade. A significant level of capital investment in Monaghan General Hospital is proposed in the short-term. Plans are being advanced by the 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 emergency treatment unit and the development of a midwifery-led unit. The associated capital cost is of the order of €7 million.
The Minister's reply comes as no surprise. Last week he stated, "It is a matter for the board ultimately to determine the nature—
An Leas-Cheann Comhairle:
As the Chair has pointed out on many occasions, it is not in order to give quotations at Question Time.
I was quoting from a reply the Minister gave on this issue.
An Leas-Cheann Comhairle:
I accept that, but it is still a quotation.
In that case I will take a different tack. The Minister previously referred to the commitment of boards to the provision of a high quality, efficient and cost-effective service. Does he really believe the North-Eastern Health Board is actively involved in the provision of a high quality, efficient and cost-effective service in terms of acute care services at Monaghan General Hospital? The reply he gave to my original question has been given on many previous occasions. Is he aware of the devastating hardship visited upon the people of Monaghan – primarily its women and children – following the loss of its maternity unit and all in-hospital gynaecological services, and is he aware that there is now no in-hospital paediatric care available in the county?
Is the Minister also aware of the effect of the off-call diktat of the North-Eastern Health Board executive in respect of the status of Monaghan General Hospital and the fact that people who should be brought there by ambulance are redirected to other hospital sites? Is he further aware the College of Surgeons will withdraw accreditation for all surgical training posts from 31 December? Does he realise the effect this will have in terms of the future delivery of services at Monaghan General Hospital? This is a serious matter which warrants and merits a much more hands-on and direct intervention on the Minister's part and that of the Government than has been in evidence since his visit to Monaghan on 22 January last. The Minister has not returned to meet the locally elected and accountable representatives of Monaghan County Council and Monaghan Town Council, who have never had the opportunity to follow-up on his commitment to meet them in the intervening period of now eight months.
Eight months?
It is, in fact, nine months since the Minister visited Monaghan.
I thought the Deputy was referring to the period since the general election. The time for flag-waving and holding meetings with various delegations is over. It is time we moved to find a solution to the impasse that arose following the report of the College of Anaesthetists with regard to what was and was not accreditable within the hospital. The Deputy and everyone else knows that it was an issue of accreditation which caused the most recent crisis in the hospital in terms of the employment of junior doctors. The Deputy is a member of the North-Eastern Health Board and well placed to form his own judgments on its executive.
Certainly.
The executive of the North-Eastern Health Board has made it clear to me on numerous occasions that it is doing everything possible to try to resolve this matter in the context of meeting the requirements of the professional bodies. On 18 September significant proposals to allow for the full restoration of medical services and at least 70% of surgical activities in Monaghan General Hospital were discussed. The chief executive officer and senior management from the North-Eastern Health Board met consultants from the hospital in that regard. I regret, however, that the proposals were rejected. If they had been accepted, it would at least have staved off the scenario which the Deputy indicated will come about in December and we could then have considered how we could either enhance or improve the situation.
People appear to be locked into particular positions in respect of this matter and it will be difficult to get them to sign off on a resolution at this stage. I have spoken to Deputies and I am open to dialogue, but not with up to 25 delegations. I know that the depth of feeling in Monaghan is significant and sincere, but we need to draw up concrete proposals with regard to how these matters might be resolved. We have been providing more assistance than the Deputy might think in terms of trying to bring this issue to a successful conclusion and getting services and, in particular, surgical activities back up and running.
An Leas-Cheann Comhairle:
I will allow Deputy Ó Caoláin a brief supplementary.
My original question referred to the discussions the Minister has had in relation to this crisis since the summer recess. He did not outline in any substantive form what discussions – geared towards a resolution of the difficulties at Monaghan General Hospital – he has had. Since the summer recess, the situation has become worse.
An Leas-Cheann Comhairle:
A brief question, please, Deputy.
The Minister stated the primary responsibility lies with the North-Eastern Health Board in the first instance. What is he doing to seriously address this issue? It is not good enough to trundle out information about the North-Eastern Health Board executive and the various colleges, faculties and institutes. The ultimate responsibility lies with the Minister who is democratically accountable.
An Leas-Cheann Comhairle:
We must proceed to the next question.
People's fury and frustration will increasingly focus on him.
An Leas-Cheann Comhairle:
A brief final comment from the Minister.
Deputy Ó Caoláin knows that is not the statutory position. Leaving that aside, however, when I visited Monaghan, I was asked to do certain things. I sanctioned many of these, some of which have to be approved by Comhairle na nOspidéal while others have already come on-stream.
The Minister undertook to—
The second point—
An Leas-Cheann Comhairle:
That concludes the debate on Question No. 83 and priority questions.
With respect, I wish to make an important point. There was a proposal on the table in September and a great deal of behind the scenes work went on between the colleges, the North-Eastern Health Board executive to try to reach a workable solution, in terms of accreditation, which involved the Cavan hospital. I believe Cavan and Monaghan hospitals working together will be crucial in respect of resolving this issue. We have reached similar accommodations in different campuses such as that between Naas and Tallaght. If people continue to resist such resolutions, further problems will occur.
An Leas-Cheann Comhairle:
That concludes priority questions. We must proceed to Question No. 84.
The Minister must take the matter in hand.
We are taking it in hand.
There is no evidence of that.