We now come to Private Notice Questions. I will call on the Deputies who tabled questions to the Minister for Health and Children in the order in which they submitted their questions to the Ceann Comhairle's office.
Private Notice Questions. - Maternity Services.
Acting Chairman
asked the Minister for Health and Children what inquiry is to be held into the circumstances surrounding the death of a new born baby shortly after its mother was refused admission to Monaghan General Hospital; the steps which will be taken to ensure that such tragic circumstances do not recur and if he will make a statement on the matter.
asked the Minister for Health and Children if he will address the ongoing failure of the North-Eastern Health Board to provide an acceptable service at Monaghan General Hospital in view of the tragic circumstances when an expectant mother was refused admission to Monaghan General Hospital and did not have a nurse or doctor accompanying her on the journey to Cavan General Hospital.
asked the Minister for Health and Children if he will address the issue of the closure of maternity services at Monaghan General Hospital and the tragic death of a new born infant yesterday after its mother was turned away from the hospital.
asked the Minister for Health and Children if he will make a statement on the death of a premature baby as a result of refusal of admission of the mother to Monaghan General Hospital.
asked the Minister for Health and Children if his attention has been drawn to the lack of adequate accident and emergency services at Monaghan General Hospital and to the transfer of the lady in question who gave birth on route and whose baby subsequently died at Cavan General Hospital; if his attention been drawn to the fact that the health board's medical adviser has stated that such a situation has the potential to occur in 5% of transfers from Monaghan General Hospital and if he will make a statement on the matter.
asked the Minister for Health and Children to outline his plans to resolve the current dispute in Monaghan General Hospital and to outline his plans to provide replacement services for those that have been run down there.
I would like to take this opportunity to offer my deepest sympathy to the mother and family concerned on their sad loss. On becoming aware yesterday of this matter, I immediately instructed the North-Eastern Health Board to carry out a full review of the incident and to provide me with a detailed report of all the circumstances surrounding this case. This review will be evaluated externally and independently of the board. I also met with the chief executive officer of the board today to discuss the matter. I expect to receive a full report from the board as a matter of urgency.
I do not propose to comment in detail today on the specific circumstances surrounding this case. However, I have been informed by the chief executive officer of the North-Eastern Health Board, that contrary to reports, the mother in question was seen in the treatment room at Monaghan hospital, prior to transfer to Cavan General Hospital.
I would like to take this opportunity to clarify for the House the background and present position in regard to the provision of obstetric services at Monaghan General Hospital. The Institute of Obstetricians and Gynaecologists is the professional body representing the speciality of obstetrics and gynaecology in Ireland, and is the advisory body in Ireland for education, training and administration in the speciality. The institute advised all health boards in 2000 in regard to the levels of consulting staffing required to provide an appropriate level of consultant care in the maternity and gynaecological service and on the consultant supervision of trainee specialists. The institute considered that a viable unit requires in the region of 1,000 births per annum to enable consultants to maintain their expertise and trainees to develop their skills.
The North-Eastern Health Board established a review group on maternity services in its area, under the chairmanship of Mr. Dermot Condon, which issued its report in November 2000. The terms of reference of the review group were:
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, midwives and representatives of user groups in the local communities; and to seek appropriate expert advice from outside the region.
The report, having examined the level of obstetric activity at Monaghan General Hospital, which in 1999 recorded 344 births, advised that consultant-led maternity services at Monaghan should be discontinued as the provision of such services was no longer supported by the recommendations of the Institute of Obstetricians and Gynaecologists. The North-Eastern Health Board was informed by Irish Public Bodies Mutual Insurances Limited at the end of February 2001, that insurance cover was being withdrawn for maternity services at Monaghan General Hospital. As a result, the board was forced to temporarily suspend maternity services at the hospital.
Subsequently, the board agreed to establish a further review group to investigate all the options fully in relation to maternity services in the board's functional area. This review group, which was chaired by Mr. Patrick Kinder, reported in October 2001. The group engaged in widespread consultation with medical, nursing and other expert professionals, as well as the widest possible consultation with the public users of the service. The board adopted the Kinder report and established a task force in early 2002 to implement the recommendations of that report. Care process groups have now been established at the Cavan-Monaghan and Louth-Meath hospital sites to develop protocols for the delivery of maternity services in accordance with these recommendations. In essence, Kinder recommended midwifery-led units.
Comhairle na nOspidéal is currently reviewing obstetric and related paediatric, anaesthetic and gynaecological services for the population of the North-Eastern Health Board area, with particular reference to consultant staffing, in the context of current best practice, in order to facilitate high quality and safe services to women and children. It is expected to report in the new year.
Maternity services are characterised by the complexity of their provision, particularly at time of delivery. While it is generally accepted that the majority of pregnancies end normally, without complication, no antenatal screening procedure can guarantee an uncomplicated delivery. In discussions with the board today I have been assured that, following the cessation of obstetric services at Monaghan, protocols were put in place to deal with cases of this type. A key element of the inquiry will be the extent to which these protocols were followed in this case.
I wish to assure the House that this matter is receiving priority attention within the North-Eastern Health Board. I will review the position in relation to these issues on receipt of a comprehensive report from the board and an external evaluation. I expect to receive that report as a matter of urgency.
Acting Chairman
I will call on Deputies in the order in which their questions were submitted. Deputy Shortall is first.
I extend the sympathy of the Labour Party to the family of Bronagh Livingstone who lost her life tragically yesterday in circumstances that give rise to serious concern as to the adequacy of our health services. The Minister's comments will provide cold comfort to the family bereaved by this awful tragedy. I have three questions to put to the Minister. First, does he find it a shameful situation that when a young woman with a medical emergency approached a hospital in which there were people who were in a position to assist her, those people did not provide the required emergency assistance early yesterday morning? When that young woman was referred to Cavan hospital and sent there by ambulance, why was there no nurse available to accompany her on that difficult journey? One can scarcely imagine the awful circumstances in the ambulance on that journey to Cavan hospital without the assistance of a nurse. Why was that the case?
Second, why was the promise by the North-Eastern Health Board to provide a specialist maternity ambulance not kept? It is reasonable to expect that if such an ambulance, fitted with an incubator, had been available as promised, the outcome of this case may have been different. Why was that undertaking not kept? Third, undertakings were given by the North-Eastern Health Board, in relation to the reconfiguration of services, to provide a midwife-led maternity unit and out-patient services in gynaecology and obstetrics. That would have ensured that the necessary equipment to assist this mother and her baby would have been available. Why were those undertakings not kept and what is their status at this stage?
In relation to the Deputy's first question, I agree the situation is unacceptable. In my initial reply, I referred to the fact that protocols were in place and were available for perusal. Those protocols envisaged that when events of an emergency nature occurred, whether in case of advanced pregnancy complications or other types of emergencies, the hospital should be in a position to respond. I do not wish to pre-empt the actual inquiry and report which will have to go into detail, step by step, as to what happened in this particular situation. However, I agree it is unacceptable that a person would not receive emergency treatment. The basic underlying tenets of the protocol would include proper assessment of the patient on arrival at the hospital, stabilisation of the condition and referral onwards to the most appropriate location for treatment of the person concerned. The inquiry will have to ascertain to what degree the protocols were adhered to in this instance.
I also find it disturbing that, for whatever reason – and again I do not wish to pre-empt the inquiry – there was no accompaniment on the ambulance. I have been informed by the board that the emergency medical technicians on the ambulance were trained in the specific area of emergency pregnancy deliveries. Nonetheless, the issue has to be investigated in the context of this case. From my discussions with the board and its preliminary inquiries, the young mother in this case was seen in the treatment room at Monaghan hospital and a decision was taken to refer her on to Cavan. The nature of that process remains to be ascertained in greater detail.
With regard to the special maternity ambulance, there is only one such ambulance in this country. The board has stated that no such specific undertaking was given in relation to a specialist maternity ambulance. On the question of a midwifery-led unit, the board has referred to the situation following the Condon report and the withdrawal of insurance. It should be noted that the maternity unit which had existed in Monaghan had just one obstetrician. There was no special after-care baby unit and no neo-natal unit in Monaghan. The unit never operated at the level one would normally envisage for major maternity hospitals. In that context, while the Kinder report recommended midwifery-led units, it was never envisaged that there would be an overnight facility. Indeed, the North-Eastern Health Board, in its policy following adoption of the Kinder report, recommended that the midwifery-led units should commence in Drogheda and Cavan, to be followed by Monaghan and Dundalk. That was the policy position adopted by the board.
In my view, one of the key issues is the degree to which the relevant protocols were followed. As to the issues surrounding maternity services generally in Monaghan, the medical advice at the time was strong. Condon had all the requisite experts on the review group, as did Kinder. The Institute of Gynaecologists and Obstetricians issued strong safety guidelines on the basis of international best practice and evidence as to what should constitute a maternity service, how many obstetricians are required and what the birth throughput should be. It is in light of those recommendations and guidelines the board takes its decisions and that is also what we would recommend.
Acting Chairman
I am anxious that all the Members who tabled questions and others who wish to speak have time. I call Deputy Crawford.
I wish to express my sympathy and that of my party to the Livingstone family on their tragic loss. If the Minister's wife advised his insurance company he was an alcoholic and not fit to drive a car, would his cover not be withdrawn? That is what has happened in this case. The insurance company was notified about the difficulties in no uncertain terms and that is part of the history of this tragic situation.
This is my home hospital. My mother gave birth to my eldest brother in 1939 in my own home where doctors gave them a 40% chance of living but they were brought to Monaghan General Hospital and survived because of the treatment available to them. There was no protocol, the staff just did their job and made sure people were looked after. My mother died in the hospital in 1999, having been looked after exceptionally well by the staff, so I have personal knowledge of the hospital and I am angry at what is happening there now. I am sure the Minister understands that. Since 2 July, the hospital has been off-call and there has been rancour between the consultants and the administrators whom the Minister met today. Can the Minister not resolve the situation so the groups get together, the hospital is re-opened properly and this type of thing never happens again?
For obvious reasons, I do not want to make any statement on this tragedy because I know the trauma the family is going through and I do not want to be seen to be jumping on the bandwagon – this is too serious an issue. The Minister told us the patient in question was seen at the hospital but by whom was she seen and who made an effort to deal with the situation there? Can he explain how an ambulance from an under-worked hospital was sent at that hour of the morning to Cavan General Hospital without a nurse or doctor to accompany it? It could not have been too busy to organise that.
I beg the Minister to get the situation at Monaghan General Hospital resolved once and for all – it has gone beyond a joke. Consultants, administrators and others are standing on their pedestals but something must be done before more lives are lost. At a recent public meeting, I said that as long as a person died outside the hospital, it did not seem to be an issue for some administrators and that we cannot allow that to continue. The Minster said he would keep this matter under review but I question whether that is now sufficient. We need action now. Will junior doctors be in place on 1 January 2003 and will the hospital be reopened on-call?
I think today of John Sherry, who lost his lovely daughter and who would himself be dead but for the hospital's intensive care unit, yet that too is now under threat. If I sound emotional, it is because I am. Others may shout about this, but I live with it on a daily, weekly and monthly basis and I have seen the eyes of people in the wards begging me to try and secure the long-term viability of the hospital. It may not be perfect but for God's sake let us make what is there workable.
I agree with much of what Deputy Crawford has said. He referred to insurance cover being withdrawn and it is no secret that, of all the specialities in medicine, obstetrics is one that has become uninsurable to the degree that the State has had to take over insurance cover for individual obstetricians because of the high level of litigation. The inadequacies in Monaghan, as perceived by the institute, the Condon report and the medical advisor to the board, were highlighted and the insurance company watching and reading those reports took action on foot of them.
In respect of the wider issue, my view is known. I have met with the consultants again and there is a basis in the proposals tabled in September for a resolution of the situation in Monaghan regarding emergency, surgical and medical services. Those proposals are still on the table and I appeal to all parties involved to at least take them as a starting position, get them implemented and build on that base. In essence, the September proposals would provide 24 hour, seven day cover at the hospital, elective surgery from 9 a.m. to 5 p.m. and a treatment room from 9 a.m. to 9 p.m. There has been much debate, discussion and controversy surrounding all of that in terms of major trauma cases but only 2% of cases are diverted to the bigger hospitals which is normal in any case. After patients have been stabilised from a trauma situation they are referred to Drogheda, Cavan or further afield.
Since I went to Monaghan, I have sanctioned all the consultant posts I said I would. The outstanding one relates to surgery and is with Comhairle na nOspidéal so it is between it and the health board. The posts have been sanctioned, the money put in place and the other funding for geriatric medicine, dermatology, anaesthesia and so on have been sanctioned. The Deputy asked what the position will be at the end of December. I have, over the past month, been particularly concerned by the December turnover of junior doctors. I have been meeting with the chief executive officer and his team on this and they have reached an understanding with the Royal College of Surgeons in respect of cover for surgery and the emergency treatment room from January onwards.
Despite the fact that most people do not want to hear the truth, much of what is accredited is undertaken by external authorities and bodies specifically established to make decisions and recommendations on accreditation and the requisite manpower to ensure the proper training of junior doctors. These bodies are established to do just that and part of the reason we have not resolved some of the issues is that some people in the debate have tried to oversimplify it by riding roughshod over the likes of the RCSI, the Royal College of Anaesthetists or Comhairle na nOispidéal. These groups have a statutory remit to make recommendations and we must work with them. I have worked with them to make sure that we get pragmatic solutions to problems like this. There has been resistance to the Cavan-Monaghan axis yet, in other areas, hospitals have linked up to provide accreditation and training so that one set of junior doctors—
Has the Minister put anyone in to try to co-ordinate this matter because there is aggravation there? People are not talking to each other and they should be. Will the Minister promise that that will be done?
Yes, there is facilitation going on.
Acting Chairman
There are a number of other speakers and I am anxious to facilitate them.
On that wider issue, the board has assured me that facilitation is going on across the board.
Is the Minister overseeing that?
The Green Party would like to be associated with the expressions of sympathy to the Livingstone family. In his reply the Minister said the woman in question was seen. I have no doubt that she was seen in the hospital but she was not treated there. Clearly, the reason she was not treated was because there is no insurance cover. The Minister said the rug was pulled by the insurance company and I have no doubt that is the case, but there are reasons why that was done. The buck stops with the Minister and it is up to him to ensure that an adequate policy is pursued so that maternity facilities are available in this hospital.
This tragedy comes as a direct consequence of the policies pursued by the Department of Health and Children where resources are centralised into larger hospitals and smaller hospitals are then downgraded. The Minister is familiar with the cases in my constituency where the Meath and Adelaide Hospitals closed down, and people are now expected to attend Tallaght Hospital. It has been said repeatedly that this policy means people have to travel longer distances and that it will result in fatalities. Will the Minister undertake a review of this strategy as soon as possible in light of this tragedy? We will await the outcome of the inquiry but will the Minister review his policy?
I do not accept the basic tenet of the Deputy's assertion. It is a rather cheap assertion to suggest that the policies pursued have given rise to this particular incident. I do not accept that. Nor do I accept that the Department and health boards have been pursuing such positions. The policy of developing centres of excellence – be they for cancer, cardiovascular care or obstetrics – is based on international evidence. Politicians have to represent people in terms of providing convenient access to services but we must also be cognisant of best outcomes. If health policy becomes just a basic function of politicians, no matter what part of the country from which they come, we will not get a coherent national policy for the development of services or best patient outcomes in the end.
In my reply I said that a key issue is the application of protocols. I accept Deputy Crawford's point but in the vast majority of cases babies are born without complications. I doubt if anyone in this House would say that a maternity service with one obstetrician, no neonatal unit or even a special care unit, and no paediatrician on site or on call, is a safe unit in which to deliver a baby. Is the Deputy saying that a politician like me should ride roughshod over all that and make a general statement that it is safe, and to hell with the institute of gynaecologists and international medical views? Am I supposed to ignore what they are saying?
No, I am not saying that.
That seems to be the implication of what the Deputy is saying.
No, I can explain what I said.
Acting Chairman
The Minister, without interruption.
The key point to remember is that the Condon process did not start with the Department. The North-Eastern Health Board itself initiated the Condon review, which carried out all the consultations with local communities and expert international bodies. Kinder was a subsequent initiative of the North-Eastern Health Board, which informed policy. The Department of Health and Children did not ring up the North-Eastern Health Board and say, "Please close down the maternity service in Monaghan." We did not do that. In fact, we subsequently approved an application from the board for additional consultants. That went to Comhairle na nOspidéal which initiated a review. Comhairle na nOspidéal will examine international benchmarks to determine what standards are acceptable.
Acting Chairman
I am afraid the time allowed for Private Notice Questions has now elapsed. We were allowed 30 minutes, although I know that some Members were not heard.
That is absolutely disgraceful.
I am willing to facilitate the House if more time is required by Deputies.
We were told it would be an hour.
Acting Chairman
I was told it was half an hour.
I also wish to convey my condolences to Ms Livingstone, her partner and their families.
What was the qualification of the person who saw Denise Livingstone when she visited the hospital? Will the inquiry into the infant's death be completed by the health board or by people who are independent of the board? Will the Minister accept that for the sake of credibility, the investigation should be independent of the health board? The Minister referred to the recruitment of necessary personnel to develop the hospital but will the embargo on recruitment have any effect on that?
Acting Chairman
Will the House agree to take more questions?
I wish to answer those specific questions, otherwise we may lose the thread. The Deputy's first question was, by whom was the mother seen. I want to stress that I received preliminary information from the board just before I came to the House.
The family say it was the porter, but the Minister knows who it was.
Will the Deputy please allow me to preface and qualify what I am about to say? This is preliminary information but an investigation is under way and the full story will emerge in the context of the report. I have been informed that a senior surgical house officer at Monaghan Hospital saw the mother in the treatment room. A decision was then taken to transfer her. However, the full details of that are issues which the report will have to ascertain. I sought the report in order to try to get as comprehensive a body of information on this matter as quickly as possible.
The Deputy is correct in saying that such a report would have to be handled by external people with the requisite expertise in this field. I envisage perhaps two or three people with particular expertise—
Outside the health board.
—outside the health board and, indeed, outside the Department, to assess independently this entire situation and the report the health board will provide. The issue in this case is not affected by any number capping or anything like that.
Acting Chairman
I have been advised by the Clerk that we have exceeded our time. However, as the Minister is anxious to answer Deputies Connolly and Olivia Mitchell, who have put down questions, I will facilitate them if the House agrees.
Are you not taking questions from the other Deputies, Sir?
Acting Chairman
To be fair, it is not possible to take any other questions, apart from those Members whose names appear on the Private Notice Questions.
I appreciate the gesture the House has made in allowing me to speak. Following the tragic circumstances, I wish to offer my sympathy to the Livingstone family. This tragedy, however, was predictable and preventable. On quite a number of occasions, I have stated at health board level that incidents such as this one would occur. I am now saying that incidents such as this will recur if we do not do something about the situation. We are dealing with emergencies, close calls, and deaths at Monaghan General Hospital on a regular basis.
The Minister referred to protocols and high quality services but those issues will ring hollow for the Livingstone family today. I do not think the Minister would get much of a hearing from them. Protocols are put in place but nobody knows exactly what they are. Shortly after the maternity services were withdrawn from Monaghan General Hospital, a senior house officer saved the life of a non-national mother and baby. There was an inquiry as to why those people were treated at the hospital. We cannot have it both ways: accusing people of not treating people and then questioning them when they do treat somebody. The appointment of a paediatrician to Monaghan General Hospital would have resulted in people choosing to give birth there thus increasing the number of births at the hospital. The chief executive officer, following advice, decided to take the hospital off call. Will the Minister agree to put accident and emergency services at Monaghan General Hospital back on call immediately? The Minister has the power to do it and he should do so.
Monaghan General Hospital has an incubator – it cost approximately €40,000 – and the necessary facilities and equipment required to deal with emergency situations. What happened to that young mother was cruel. It is because of protocol that she was taken to Cavan General Hospital. If a similar emergency arises tonight the same protocol will be followed. The Minister should ensure that practise ceases immediately.
Following the withdrawal of maternity services from Monaghan General Hospital, we were given assurances that a specialist ambulance service would be put in place to ensure those in emergency situations would be safely transported to the nearest hospital. We must ensure people presenting with an emergency at Monaghan General Hospital are provided with a bed until a doctor can be called from Cavan General Hospital to provide them with necessary medical attention. Monaghan General Hospital has a role to play and any review of services should focus on its total service provision.
The people of Monaghan want to know that if they present at Monaghan General Hospital in an emergency, be it a woman in labour, somebody having a heart attack or a child having been involved in an accident, they will receive vital medical care before being transported to whatever centre of excellence is on call.
May I raise a point of order?
Acting Chairman
We are running over time. I am anxious to allow Deputy Olivia Mitchell make a contribution.
Nothing I say today will in any way console the Livingstone family. They have endured a terrible tragedy from which they may never recover. I accept the anger and great sense of grief and trauma they have experienced.
Following the reconfiguration of maternity services within the North-Eastern Health Board, a second ambulance cover was provided. The health board has stated that it never gave an undertaking to provide a maternity ambulance. It undertook to provide a second ambulance service and, as such, one was put in place.
I accept the Deputy's point regarding stabilisation. It is a matter of protocol. Many hospitals around the country do not have a full complement of services.
They should have.
The protocol should be one of assessing the patient in the first instance, stabilising him or her and then referring him or her to the appropriate location. In this particular case a transfer would inevitably have been effected for the new born baby given the absence of a special care unit in Monaghan General Hospital. However, we must await the report to see what happened from the time the mother presented at the hospital in Monaghan through to the death of the baby at Cavan General Hospital. I do not wish to pre-empt the details of the report at this time. A number of parties will have an interest in this matter but the key issue is to ensure an objective independent review is carried out. Statements made by various people in this regard will form part of the report which will hopefully provide answers to some of the questions raised by Deputies this afternoon.
The September proposals provide us with a basis from which to move on. We need to accept them and agree to use them as a basis to enhance the service further. If Deputies could agree to accept what is on the table – there is a great deal of sense in doing that – we could move forward. Too many people are in different trenches on this issue.
The focus of the inquiry is too narrow. It should be widened to ask why the mother was put in such a situation and why there was a lack of services.
I welcome that the Minister has ordered a report which he says will concentrate on an examination of whether protocol was observed. To concentrate exclusively on that aspect of this case is to miss the point. The larger point is that the hospital in Monaghan has effectively been closed to business for the past year. Valuable and rare staff at that hospital have been sitting around twiddling their thumbs. Such matters come within the ambit of the Minister. He cannot blame the hospital, the health boards or the accreditation bodies. The decision on the role and designation of hospitals and where specialities are to be placed is a political one, albeit a difficult one. Such decisions rest with the Minister.
Services at Monaghan General Hospital have been allowed to run down; it is no wonder accreditation was withdrawn. Nobody expects one obstetrician to provide the full range of services necessary. Nobody expects every hospital to provide every range of service and speciality. What we do expect is that every patient has safe access to the full range of services. No alternative measures were put in place when services at Monaghan General Hospital were withdrawn. The regional hospital in Drogheda was designated as an alternative but no attempt was made to improve or expand services there despite the fact that it has one of the fastest growing populations in the country. Moves were made to put a fully equipped and staffed ambulance service in place but that never happened. Has there been any attempt to purchase emergency services from across the Border for the growing population in north Monaghan?
The reality is that there is no service in this area. We will continue to witness tragedies such as happened yesterday unless the Minister makes the political decisions necessary to deal with this situation. When I raised this matter on the Order of Business this morning, the Minister said no legislation had been promised regarding the setting up of a national hospital agency. I would like to refer him to his strategy which states, "An independent agency, the national hospitals agency, will be established on a statutory basis under the aegis of the Department of Health and Children." That body was to make decisions regarding the designation of hospitals. The excuse is being given that we have no agency to make such decisions. Is such an agency to be established or will the Minister make the necessary decisions?
What is happening in Monaghan is only an example of what is happening all over the country.
On a point of order, may I ask a question before the Minister replies?
Decisions have been taken by the North-Eastern Health Board regarding the configuration of services in the north eastern area. This House gave authority many years ago to that board to organise health services in the north eastern area just as the House, whether it wishes to face up to it or not, gave statutory authority to health boards to administer, organise and configure services across the country. That is statutory reality as things stand. We have sanctioned posts to back up that configuration of services as presented to us by the board. We provided resources to the respective hospitals within the north eastern health board area as per applications—
How are people to get those services?
—for resources from the North-Eastern Health Board submitted in accordance with the plans and configuration of services formally adopted by the board.
Acting Chairman
The Minister must conclude.
We presented our list of Bills to the House. That list does not contain a Bill called the national hospital agency Bill which is the issue raised by Deputy Olivia Mitchell on the Order of Business. There is, however, a process under way – I referred to it elsewhere – under the reform of health structures. An audit is under way – we expect to be in a position to report by the end of January – dealing with the establishment of a national hospital agency. There is a whole range of other issues, including health boards and a multiplicity of other bodies.
Acting Chairman
The Minister must conclude as I have allowed the debate to extend 15 minutes longer. Deputy Morgan, briefly on a point of order.
I need information on who is running the health service. Is it the health boards and consultants or the Minister?
Acting Chairman
That is not a point of order.
Is this not a parliament charged with responsibility for organising the health service? How can we have an active parliament which is not organising its affairs and—
Acting Chairman
The Deputy must raise that issue in another way. I am constrained by the rules of this House. The Minister, very briefly.
It is this House that ordained it to be such. Some 30 years ago when it established health boards, this House gave statutory authority to organise—
The Minister is washing his hands of the issue.
I am not. We are bringing forward proposals which will involve the form of the way we do things.
(Interruptions).
The people of Monaghan have not supported this board at any stage—
Acting Chairman
Deputy Connolly, I have been more than generous. I am aware this is a very important debate but I have allowed it to extend.
Written Answers follow Adjournment Debates.