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Dáil Éireann debate -
Tuesday, 9 Nov 2004

Vol. 592 No. 1

Private Members’ Business.

Health Care: Motion.

I move:

That Dáil Éireann:

—acknowledging the hard work of all doctors, nurses and healthcare professionals in the North Eastern Health Board (NEHB);

—noting that:

—there have been a number of tragic events in the NEHB that have contributed to a crisis of confidence in the health services provided in the NEHB;

—there is a need to look at the provision of health services in the NEHB and to find solutions to restore patients' confidence in the provision of healthcare services in the NEHB region;

—steps must be taken in the NEHB to ensure that the new Dublin/north east regional area does not encounter the same difficulties after 1 January 2005 when the new health service executive structures are in place;

—calls on this Government to:

—explain the circumstances in which the recommendations of the Bonner report were not implemented;

—explain why this Government has failed to review the NEHB in light of a number of recent revelations;

—explain the mechanism by which the Dublin/north east regional health office and all other regional health offices will be accountable to Dáil Éireann and to commit the Tánaiste and Minister for Health and Children to answer parliamentary questions on behalf of the regional health offices;

—consult with all stakeholders in the new Dublin/north east regional area and all regional health areas to provide both primary, acute and non-acute hospital care that is acceptable to the people and is medically safe;

—properly resource the Cavan-Monaghan group of hospitals so that acute and elective care can be provided to the people of Cavan-Monaghan;

—properly resource the Louth/Meath group of hospitals so that acute, elective and regional specialties can be safely provided at those hospitals;

—properly resource the Beaumont hospital to provide acute and elective care to the local, regional and national tertiary services that it is responsible for providing to the people of the NEHB and the rest of the country; and

—properly resource the Navan hospital to provide acute and elective care to the people of Meath.

I wish to share my time with Deputies Crawford and O'Dowd.

Is that agreed? Agreed.

This motion acknowledges all the hard work by doctors, nurses and other health care professionals in the North Eastern Health Board region. However, there has been a number of tragic events in the north east that the House should discuss because there is a need to restore patients' confidence in what is happening in the North Eastern Health Board region and in many other health board areas. The Opposition is afraid that when the new health authorities come into place on 1 January 2005, they may have even less accountability to the House.

I am calling on the Government to explain fully its intended role in the operation of the new health service executive. I also wish to see all stakeholders in the north east having a say in such future services. It is also intended to discuss the resourcing of the Cavan-Monaghan and Louth-Meath hospital groups.

In two months' time, the North Eastern Health Board, like all other health boards, will cease to exist. My fear is that the transparency, accountability, value for money and the role that public representatives have as watchdogs of the health care system will disappear under an increasingly careless, arrogant and uncaring Government.

Doctors, nurses, other health care workers, hospital administrations and local community groups have worked together to try to maintain health services without adequate Government funding. At one point or another, all these groups have endured attempts by the Government to blame them for these problems. Health board officials have been a particularly soft target for scapegoating since they cannot defend themselves in public. They are obliged to remain silent as they are pilloried by members of the Government for the current Administration's failings.

The manipulation of facts by spin-doctors was accepted by many in the community who felt they would never need health services. Now, however, everybody knows someone who is unhappy with the health services. The Government has failed totally during the past seven years and we are concerned and fearful that our families will be affected in the foreseeable future by the health crisis.

By focusing this debate on the North Eastern Health Board we will try to deconstruct the myth that the Government cares about the health services. During a visit to three hospitals in the north east, I found everybody saying that it is a question of resources. That major issue in our health services was referred to repeatedly by nurses, administrators and others we met on that visit. The Government will have to face the fact that the health services are not properly resourced.

If there are other difficulties — or inefficiencies as they are being described — and if millions can be saved from the health budget, then I would like to hear Government Deputies talking about that. They should indicate all the areas where millions can be saved. I do not want to hear a reiteration of what has been done since 1997. They should simply point out where this money can be saved. Every time there is a health crisis we get a knee-jerk response from the Government with Ministers indicating where money was spent. However, one of the last jobs undertaken by the former Minister for Health and Children, Deputy Martin, before he left that portfolio, was to announce an expenditure of €85 million to commission €400 million worth of hospitals and health centres that have been left idle for years.

In a recent speech to her own supporters, the Tánaiste and Minister for Health and Children, continued this deception of the Irish people, stating:

It is fair to say also that we have not had the more widespread improvements that all might have expected from tripling health spending in our health services since 1997. This is because our health services are not nearly as efficient or effective as they could be in using this additional investment.

This is a real kick in the teeth for nurses and hospital administrators who are trying to keep the health service going. I wish to focus on the two major issues to which the Tánaiste has referred, namely spending and inefficiency. As regards spending, Ireland reached the EU average on what we call health spending in 2001. If we are to believe a recent ESRI report, 20% of the health budget is actually social welfare spending. If that is true, then we have never reached the EU average on health spending during the lifetime of the current Government. If that is so, it puts to rest the argument that the health service is well resourced. It has not been well resourced at any stage of the Government's term of office.

Today, there are patients lying on trolleys in Cavan Hospital, Our Lady of Lourdes Hospital in Drogheda, and Beaumont Hospital in Dublin. They are too sick to contemplate why our accident and emergency crisis has become an all-year-round affair, when even four years ago it was simply a winter crisis. The number of patients on trolleys continues to grow every day. That is one statistic that has been increasing annually. At one time, 20 or 30 patients were in A & E departments overnight, while the figures now exceed 150, with patients spending two or three nights on trolleys

When Government Deputies reply to this motion, they should discuss the inefficiencies of the health system. They should indicate where the problems lie. I think many of the difficulties are due to a lack of focus and coherent Government policies. Government Deputies should also explain to taxpayers where their money is being wasted in the health services. I do not believe that is the major problem.

Blatant mistakes have been made by the Government. Since 1997, for instance, up to 30 new statutory and non-statutory health service organisations have been established by the Government. Within seven years of their establishment, however, the Department of Health and Children's own "Prospectus" report recommended the disbandment of most of these statutory bodies. One of Deputy Martin's first jobs as Minister for Health and Children was to establish the Eastern Regional Health Authority and three new health boards. One of his last jobs in that portfolio was to disband the Eastern Regional Health Authority and the three health boards he had previously established. This is a Monty Python approach to health policy.

The only consistency we have seen so far came from a Progressive Democrats Minister's wife. When she wrote a report on behalf of the Department of Finance, she was consistent in so far as she continued the Government's tradition of blaming those who work in the health service for all the problems that exist within it.

I visited Cavan General Hospital on a bank holiday Monday and saw an elderly man waiting there who had broken his hip the previous Saturday. He was still waiting to be transferred to the acute trauma unit in Drogheda. The words "acute" and "trauma" indicate that patients should be moved for treatment faster than three days but that is what seems to be happening in Cavan. A Fine Gael councillor told me about a lady who had survived cancer treatment and now has to thumb a lift from Cavan to Drogheda in order to attend for an outpatient's appointment there.

Patients in the north east, and those who treat them, should be made aware that money is being wasted due to inefficiencies in the service, rather than the fact that we cannot afford the required investment.

At this stage, people at Monaghan hospital can think of only one useful purpose for the piece of paper listing the last of the promises of the former Minister for Health and Children, Deputy Martin, to the people of that county. Those promises all seem to have gone by the wayside within the past four weeks.

We have been told about the huge amount of money that is going into health services but what expenditure is being made? Let us focus on the Northern Eastern Health Board. In researching the provision of services in that health board region it became obvious that the north east has suffered from an unimaginative Government response to the crisis in that area. In the last three or four years the Department of Health and Children has been advising the North Eastern Health Board and other health boards that the initial allocation of their annual budgets will only cover what they did the year before. In other words, for a number of years Government funding for health and children has operated on the principle of an existing level of services. Government Deputies will say that the way to get extra health board services is through revised Estimates. That is where the extra money comes from, they say, but it is difficult to obtain facts and figures from the North Eastern Health Board in order to compare them.

What we got for 2003 were details on how the north east fared on big issues which we are told are very close to the Government's heart. With a population of 350,000 the region got an additional €2 million for cancer services. It got €1.8 million for services for older people. For the primary care strategy it got €400,000. We can understand why people get annoyed about €50 million spent on e-voting and €15 million on the equestrian centre at Punchestown. The amounts allocated for additional services in the region are minute in comparison.

I will again quote from the Tánaiste, who has set out her stall to be a reforming Minister for Health and Children. She said: "It's entirely appropriate that we should measure health service progress not by spending levels or reports and analysis, but by visible improvements seen by the public." This is certainly not a quote that would be attributed to her predecessor, who was a great man for reports, analysis and putting off everything until tomorrow. The Tánaiste is correct in one respect. Health spending is not the same as service delivery. The Government has allowed spending to go out of control without any idea as to how it will increase the services it is supposed to deliver. I ask the Tánaiste to show us how these millions are being spent and show us the great progress that has been made in recent years.

I am particularly interested in primary care, which I would like to make a cornerstone of Fine Gael health policy. What is happening to primary care in the area under discussion is a good example of how patchy the services are. Parts of the catchment area of Beaumont Hospital have one GP for every 2,500 patients. The national average is one GP for every 1,500 patients. One success story in the north east is the GP out-of-hours co-operative, NorthEastDOC. Unfortunately, it does not cover the area with the highest proportion of patients to doctors. No out-of-hours co-operative operates in any part of north Dublin. Even though some people have tried to link problems in accident and emergency departments with primary care, which is true, it is the lack of availability that is causing these problems. The Government has been aware of this issue and sat on it for some time.

The Government is still struggling to get its first primary care centre fully operational in the North Eastern Health Board region. The primary care strategy promised 600 primary care centres, and three years into a ten-year programme we are still struggling to get the first ten off the ground. In recent years, to try to save money, health boards have been forced to cut home help allowances and funding for primary care projects that do not make the national media every day. Unfortunately, this is the price some elderly people with the opportunity of staying in their own homes must pay. Proper provision of sheltered accommodation and recognition that primary care services must become more focused on our increasingly elderly population is an issue on which the Government can talk the talk but has failed to walk the walk.

Now that the Tánaiste is in the House, I ask her when she became aware of the problems of primary care and what she plans to do about them. Some of my colleagues will talk more about the Cavan-Monaghan hospital group and the Louth-Meath hospital group. The North Eastern Health Board has been vilified for the reorganisation of some of the health services carried out in the north east. The health board fully accepts it is not perfect but it was left with no choice because of lack of funding. Continually starving the health board of the resources to allow it deliver quality medical care, has led to it making some very hard choices to the detriment of the hospitals in question.

While my colleagues will go into more detail on these hospitals, I ask the Tánaiste to answer three specific questions. How does she intend to provide a five-day surgery at Monaghan General Hospital when a different surgeon is expected to be on duty every day? This is an unworkable procedure, which shows a clear lack of understanding of how the health services work. It is not possible to bring a different surgeon from Cavan General Hospital to Monaghan General Hospital and expect to have a five-day surgery unit that runs without hiccoughs.

Why has one third of Cavan General Hospital not been commissioned since 1997? It only recently received approval for an extension to its accident and emergency department even though the accident and emergency department of Monaghan General Hospital has been downgraded and practically closed for a number of years. Despite the extra workload, Cavan General Hospital did not get increased funding for acute beds when services were withdrawn from Monaghan General Hospital. This is why the health board has been forced to take decisions, which have, in some respects, been to the detriment of patient care.

Why has Our Lady of Lourdes Hospital in Drogheda not received its designation as a regional hospital? Why have the regional services not been properly organised for the north-eastern region? What will happen to Our Lady of Lourdes Hospital, which needs expansion immediately? It is amazing how doctors can work in that hospital given that it is so crowded and under-resourced.

The credibility of the Tánaiste is riding on her having taken the health portfolio. She should be commended for making such a brave decision. To show that she has the health services at her heart, I ask her to release the minutes of the Cabinet meeting held at Ballymascanlon. While most people here have forgotten about the meeting at Ballymascanlon, I have not. The media have a duty to revisit that fateful day in May 2001. The then Minister, Deputy Martin, brought some of his officials from the Department of Health and Children to give their views on the health services.

After the meeting the Taoiseach said the health services were well resourced. The then Minister for Finance, Deputy McCreevy, believed that putting more money into health services was like pouring it down a black hole. What did the officials from the Department of Health and Children say that day, given that their advice was completely ignored by the Government? An element of hypocrisy is creeping into this matter. Five months after the Ballymascanlon meeting, the health strategy became Government policy. Three years on, when we expected an additional €1 billion per year to be spent on the strategy, we find that this was also rich on aspirations but poor on delivery.

Despite the primary care strategy and the health strategy, no progress is being made. While this is true throughout the country, it has been particularly poor in the north east. The primary care service has not been developed in the way one would expect. The acute hospital services have undergone serious reorganisation, which has created huge conflicts in communities.

While Monaghan General Hospital has almost given up on maternity and accident and emergency services, I am sure the Deputies from Cavan-Monaghan will fight hard for that. The former Minister for Health and Children, Deputy Martin, wrote a letter outlining details of CAT scanners, extra beds, minor injury units and five-day surgery, which was called selective elective surgery. Even the commitment to that seems wishy-washy. The people in the region understand that a different surgeon is supposed to drive from Cavan every day to man this unit. However, a post like that is simply not workable.

The same applies to the way the hospital in Drogheda operates. It needs to get its designation, to be upgraded dramatically and to function as a regional centre. The population in the corridor between Dundalk and Dublin is growing at a huge rate. The accident there last week sadly shows why it needs upgraded acute services such as ambulances. We have neglected some core areas of the health services in the past seven years. We have seen developments in just one section of the health services to the detriment of others, which has led to poor value for money. I look forward to hearing what the Tánaiste has to say about these figures. The Progressive Democrats has always taken great pride in being the watchdog for the taxpayers' billions. Fianna Fáil gave up on justice a long time ago and has now given up on the health services. We will have to warn the voters with VHI that there is no point in voting for Fianna Fáil, and I wonder if they are any safer voting for the Progressive Democrats.

I thank my party leader, Deputy Twomey and the front bench generally for bringing this important issue to the attention of Dáil Éireann. The crisis in the north east, especially in Cavan and Monaghan, has been documented extensively by the media. While it is sad that was necessary, the crisis there is a reality. I was delighted that the Cavan-Monaghan area was one of the first regions visited by Dr. Twomey, particularly on a bank holiday. What we saw, however, was not encouraging. There were people on trolleys and frustrated staff who wanted to deliver a service were unable to do so because of mismanagement and a lack of funds. I respect the Tánaiste, although she did not deliver jobs to the Border area, and she must deal with the North Eastern Health Board. This area has suffered significantly in past years and deserves at least its fair share of money and services.

The seriousness of the situation was highlighted by a man who lived all his life a few hundred yards from Monaghan General Hospital becoming ill a few weeks ago. Instead of going to Monaghan General Hospital, where his life might have been saved, he was put in an ambulance to bring him to Cavan. The previous Minister for Health and Children made a commitment before the local elections that medical emergencies would be brought by ambulance to Monaghan General Hospital, as would those needing other treatment. We were also promised that Monaghan General Hospital would stay open, with a new consultant surgeon and five junior hospital doctors, a consultant dermatologist, a consultant geriatrician and ten new beds. A commitment was given during the general election that all medical and surgical emergencies, as determined by the consultant on call, and 80% of accident and emergency would be treated at Monaghan General Hospital and substantial funding would be made available. I know the value of political commitments but people's lives are at risk. This cannot continue indefinitely.

The funding of the North Eastern Health Board is another question. Last year, the funding for the board was €1,516per capita against a national average of €2,018. What have we done to deserve such treatment? As a result, the elderly cannot be looked after. Two and a half years ago, subventions for nursing homes were paid for 256 patients in the Cavan-Monaghan area but that has since been cut to 214. Are there fewer elderly people in the North Eastern Health Board area? Statistics show that between 1996 and 2002, there was an increase of 31.4% in those aged 85 or over. Those people needed more care and help but the budget in that area was cut so drastically that bed numbers were cut while beds are lying empty in high quality nursing homes.

Home helps and carers have had their budgets cut, resulting in the number of hours for home helps being halved compared with two and a half years ago and many are only getting minor expenses for travelling. This is not the treatment to which those who built this State are entitled. People living in the North Eastern Health Board region must get the same as everyone else. I recently highlighted a case where a person had to go into a home in the west. It was the first time that the nursing home owner found it difficult to get a subvention for a person who had nothing. For six weeks the family had to pay for the care in spite of all the efforts I and others made.

The hospital in Cootehill has been open for surgery for the last two and a half years but the unit for the elderly is still not in use because we cannot fund its everyday work. This is no way to spend capital. I know of an old age pensioner with no means who wants to get a toilet and other items into the house. The total cost is €2,950 and the pensioner is being asked to pay €537. This is ridiculous.

As a member of the British-Irish Interparliamentary Body, I was part of a group that went to study hospitals in isolated areas, such as Wick in Scotland, Wales and the Isle of Man. Above all else, we learned that primary care is vital. The Tánaiste has made the right noises about the need to extend medical card cover but so many have been removed that we must talk about re-introducing them. We were promised 200,000 extra at the election but in the last seven years, 100,000 cards have been removed. In County Monaghan, 6,035 have been taken away in that time. Some people say that is not as bad as Cork, but that figure is being taken from a total population of 52,000 while Cork lost 8,000 medical cards in a population of 500,000. Much of the overcrowding in accident and emergency units could be avoided if people could visit their GPs using the medical card.

In May, a letter from the previous Minister for Health and Children to members of the Fianna Fáil organisation — not to the people of Monaghan — promised that 24 hour medical cover will be provided at Monaghan General Hospital. The Minister hoped the letter would clarify the Government position and assist in silencing the rumours on Monaghan General Hospital. Then the Minister wrote a letter on 29 September to tell us that all was well and he had suddenly got agreement that 24 hour, seven days a week medical cover would be restored, five junior doctors recruited immediately at a cost of €750,000 and a larger emergency room that would be open 24 hours a day would be provided. That was not decided that day, the planning had already been done and the contract signed. He promised ten additional beds, although he did not say how many beds had already been closed, and the provision of a CAT scanner. When I asked the Tánaiste about this, the CAT scanner was missing.

The problem is that so many commitments and promises have been made. The North Eastern Health Board called in the five Deputies from Cavan-Monaghan to tell us how the new structures would work. Cavan-Monaghan General Hospital would be a single unit but would operate on two sites. However, all services went to Cavan, but now services are being taken from Cavan as well. It is an extremely serious situation. People are isolated and must go to Drogheda in emergencies. Nobody questions serious trauma having to go to Drogheda. However, I came across cases at a meeting the other night where people had to travel to Drogheda for minor matters. The families concerned had to travel back and forward, yet there was no bus service. Surely, when one closes a service such as that provided by Monaghan General Hospital, one provides the services necessary to enable people to travel.

Cavan-Monaghan General Hospital is still in crisis. My colleague, Deputy Twomey, who is a doctor, said he was not prepared to stand over something that was not right but he made it absolutely clear that a five-day surgical service was workable in Monaghan General Hospital, although not in the way the steering committee suggested whereby surgeons would travel on a daily basis. I ask the Tánaiste and Minister for Health and Children to meet the people there as quickly as possible and to ensure a realistic, logical and workable system is put in place before more lives are lost. I could highlight several situations but I do not want to be dramatic. My party, either in Opposition or in Government, will work to ensure a logical and workable structure is agreed.

I congratulate Deputy Twomey on tabling this motion on behalf of Fine Gael. I welcome the constructive comments made up to now on how the North Eastern Health Board will develop in the years ahead. I congratulate the staff in all the hospitals and the community care teams, both voluntary and statutory, in communities who work so hard in the North Eastern Health Board area to provide a better service for everyone. That is what a health service is about — it is about people working together in the statutory and voluntary areas to get the best service possible for the people.

We must look at the way the health service is developing under North Eastern Health Board. One of the main problems is that there is no transparency or accountability in regard to decision-making since the health boards were abolished. I know there is a proposal to introduce legislation to deal with this issue but it is significant that the Government went ahead with the abolition of the health boards, or the corporate bodies, without replacing them. I am concerned about that. A simple example of lack of transparency arose following the recent publication of a report by the health board on health gain in the North Eastern Health Board area. Deputy English and I had to telephone the health board to get a copy of the report sent to us. Deputies are no longer part of the cc list in the health board region. That is not good enough and is not acceptable in the case of such a major report.

An issue addressed by many people is community care. Keeping people out of acute hospitals is the way to go. The greater the investment in keeping people out of hospitals, the greater the health gain to the community, the better off such people would be, the more interaction they would have with society and the better things would be all round. There has been a major cut in home help services in the North Eastern Health Board area in recent years. In the last year of Deputy Martin's time in office, approximately 80,000 home help hours were cut. That was an appalling decision that impacted on the cutting edge of care in the community. Many elderly and sick people could not live properly or decently in their homes as a result. I hope the Tánaiste and Minister for Health and Children will reverse that decision during her time in office. Care of the elderly is one of the most important issues in our society and I note the Tánaiste spoke on it when appointed to this position.

A problem I face regularly, as I am sure do most Deputies, is the number of people in the community coming to see me about their elderly relatives in acute hospitals who are being discharged. There is not adequate or proper ownership of that issue — for example, a one-stop-shop for care of the elderly in each hospital area. If someone is in an acute hospital, one office should liaise with the family, the staff nurse, the nursing home and with everybody concerned to ensure the problem is dealt with efficiently, effectively and sympathetically. Some 99% of cases are dealt with in that way but some are not and they end up on my desk each morning. I am concerned that the Tánaiste and Minister for Health and Children insist proper protocols are put in place in each acute hospital in the North Eastern Health Board area whereby patients and their families would know to whom to go and to whom to talk so there would be no doubts and somebody from the administration would not tell people they must get their mother or father out of the hospital. People have concerns about that and about managing the care. Some people believe they must go out to find a private nursing home bed and that they may not have the capacity to pay for it. As people move towards the declining years of their lives, they need to feel wanted, esteemed and part of the system. In many cases, they feel upset and that they are not wanted. Their families feel nobody cares. That issue must be addressed and I hope the Tánaiste and Minister for Health and Children will address it.

There are approximately 1,700 private nursing home beds in the four counties of the North Eastern Health Board. I live in County Louth where there are only 350 private nursing home beds — the remainder is in the adjoining counties. There is a need for an initiative in regard to public private partnerships with the health board to provide proper and adequate private nursing homes perhaps on health board property. It is alleged that the Tánaiste and Minister for Health and Children is to sell off health board property left, right and centre. That would be a poor decision. She should examine the needs of society, particularly health care and private nursing home care in County Louth. There is no reason the health board could not allow an operator to build a 60-bed unit on, or adjacent to, a hospital site. Those beds could be block booked for the foreseeable future so that we would have proper and adequate beds in our county and elderly people would not have to travel distances. An elderly person might be in a nursing home 20 or 30 miles away from his or her home and there might be no public transport, so it is impossible for people to visit. It is a serious issue that I hope the Tánaiste and Minister for Health and Children will address.

Another issue, which has already been addressed, is the cut back in the number of medical cards. The percentage of the population of County Louth with medical cards is 35%. We have the most serious health problems in the North Eastern Health Board area — in fact, County Louth has the second highest rate of cancer in the country next to Dublin city. Many people who have serious illnesses do not have medical cards. A medical card should be available as a right to people with serious illnesses, regardless of income. Not everybody with cancer in the North Eastern Health Board area has a medical card, although they should have, especially if they have active cancer for which they are receiving treatment or are on drugs. That is a bad situation. I hope the Tánaiste and Minister for Health and Children not only reviews the income limit for a medical card but that she ensures people who are very sick get one as a right regardless of their income.

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"supports the North Eastern Health Board in its objective of ensuring the provision of a high quality, safe and responsive hospital service, commends the Government for the unprecedented increase in the level of investment in health services in the north east since 1997 and supports the early implementation of reform measures in order to deliver enhanced services in the region."

I propose to share time with the Minister of State at the Department of Health and Children, Deputy Tim O'Malley.

I am pleased to have this opportunity to respond to the Fine Gael motion on hospital services in the North Eastern Health Board area. I would like to put on record my support and acknowledgement of the work of many people in this health board area in providing a high quality, safe and responsive hospital service. This Government's health policy has two key elements, namely to invest in service developments and to bring about lasting reform, with the single aim of delivering quality health care to people in a way that is accessible and available.

We have taken action on both these fronts in terms of more investment and real reforms. We are taking action not just at a national level, but in each region. It is detailed work and it requires a unified effort from many people to make it happen. Change for the better is happening already. The task ahead is to ensure our economy generates the resources we need to invest in health, so that they are effectively channelled into better services and so we can implement decisions speedily as regards necessary reforms.

The House knows that this year the Government is spending over €10 billion in the health services. Over €900 million in additional funding has been provided in 2004 in respect of day to day spending. The Estimates for 2005 are being finalised by the Government and I am confident they will show again the consistent record of this Administration in giving high priority to health.

The overall increase in funding for all health boards between 1997 and 2004 has been €5.2 billion, a threefold increase. The increase for the North Eastern Health Board has been €383 million, more than three times the level of 1997. This is the largest increase in day-to-day funding of all health boards. It is, in part, an acknowledgement of the lower base level of funding in the North Eastern Health Board in 1997, but there can be no doubt that the Government has since then put substantial and unprecedented investment into the north east. This year, the funding provided for the North Eastern Health Board is €549 million, an increase of almost €66 million on 2003.

People rightly ask what we are getting for all this funding. For one thing, more people are being treated in our acute hospitals. Some 50,000 more people were treated in 2003 than in the previous year and 230,000 more were treated in acute hospitals in 2003 compared to 1997. The number of inpatients or day-cases in 2003 was more than a million. It will be higher again this year. Our hospitals are treating more people and are providing a broader range of treatment than ever before.

In the north-eastern region the number of patients discharged from acute hospitals has increased from 53,000 in 1997 to 75,000 in 2003. The number of day cases has more than doubled from 12,000 in 1997 to 28,000 in 2003. Some 49 new consultant posts have been added to the 75 that existed in the region in January 1997. This is a 65% increase and compares well to the national increase of 46% in the same period.

Hospital services in the North Eastern Health Board area are provided on an inpatient, day case and outpatient basis in two hospital groups. The Louth-Meath hospital group comprises Our Lady of Lourdes Hospital, Drogheda, Louth County Hospital, Dundalk and Our Lady's Hospital, Navan. The Cavan-Monaghan hospital group comprises Cavan and Monaghan general hospitals.

The provision of acute hospital services in the north eastern region has been the subject of considerable debate over recent years, most of which has centred on the work undertaken by the health board in reorganising services, particularly across the Cavan-Monaghan hospital group.

The clear objective of the board has been to ensure the provision of a high quality, safe and responsive hospital service across all five sites in the region, for a population of approximately 350,000. The board has already made progress in reorganising services in a number of key areas such as trauma and orthopaedics, obstetrics and breast services. The recommendations and standards set by the regulatory and professional bodies, including the Medical Council and the Royal Colleges, have influenced the board in determining the future range and configuration of services across the region.

The decision of the board to plan services across two hospital groups was entirely appropriate. Most reasonable people accept that it is not possible to develop the exact same range of services in each of the five hospital sites in the region. We are investing on a regional basis.

Significant progress is being made in advancing the development of each of the five acute hospital sites under our capital programme. The Department of Health and Children issued approval earlier this year for site feasibility studies to be undertaken at both Our Lady of Lourdes Hospital, Drogheda and at Monaghan General Hospital. This work is designed to assess the development potential of both sites. The Department has also agreed that design teams be selected for Cavan General Hospital, Louth County Hospital and Our Lady's Hospital, Navan.

The site feasibility studies at Drogheda and Monaghan and the work of the design teams at the other three sites will inform the long-term development of the hospitals in the region. In the interim, I am pleased to inform the House that in August 2004, the Department issued approval to the board to implement a series of interim capital works. Specifically, the Department approved a design team to advance the provision of two modular theatres and for the upgrading of the kitchens at an estimated capital cost of €1.4 million. A design team was appointed to progress the development of midwife-led units at Drogheda and at Cavan General Hospital at a capital cost of €1.5 million. Design teams were approved to upgrade the accident and emergency department and the kitchens at Our Lady of Lourdes Hospital, Drogheda at a combined capital cost of over €4 million. Also, at Navan, a design team was approved to upgrade the existing orthopaedic operating theatre unit. The recent package of interim works will complement a significant level of capital investment in the hospital sector in the region in recent years, to which the Minister of State, Deputy O'Malley, will refer.

There has been considerable focus on the configuration of services to be provided across the Cavan-Monaghan group. In July 2003, my predecessor as Minister for Health and Children, Deputy Martin, published the report of Mr. Kevin Bonner setting out proposals for the future development of Monaghan General Hospital within the group. The report was commissioned by the Minister following the independent inquiry into events surrounding the birth and tragic death of baby Bronagh Livingstone on 11 December 2002. The Minister indicated at that time his acceptance of the main recommendation of the report that Monaghan General Hospital should continue to play a vital role in the delivery of acute hospital services to the local community within the Cavan-Monaghan hospital group. It was also accepted that additional services could be provided at the hospital to the benefit of the local community.

The current position as regards the two hospitals is as follows. The board proposes to recruit five additional non-consultant hospital doctors to facilitate the early restoration of 24 hour, seven-day medical cover to Monaghan General Hospital, at an estimated additional revenue cost of €500,000 a year. The Department is advised that the recruitment process is underway and it is anticipated by the board that these staff will be in place in early 2005. Work has commenced on the development of an expanded treatment room at Monaghan hospital. Capital funding of €750,000 has been approved for this purpose. We have also approved revenue funding of €500,000 to commission ten additional day beds at Monaghan General Hospital. The commissioning of these beds is to be progressed by the board and by the health service executive next year. I expect these beds will be opened next year as a priority.

The Department has also given financial clearance for the recruitment of three replacement consultant surgical posts to facilitate the development of surgical services across the Cavan-Monaghan hospital group. The health board has recently submitted details of the revenue funding and staffing required to commission an additional 19 beds at Cavan General Hospital as part of the reconfiguration of services across the group. The submission is now being examined by the Department.

Ireland has a population of 4 million. This is somewhat less than the population of the West Midlands in Britain, or Los Angeles in the United States. Our population is spread out over a greater area than either of these, although we are particularly concentrated on the eastern seaboard. We have to provide hospital services for the needs of our population, as we are doing in each region of the country, and in a way that ensures that best quality care is delivered. This cannot mean a few mega-hospitals in Dublin, nor a full service acute hospital in every town in the land. What is needed is in between those two extremes. It means a full range of hospital services on a regional basis working in a network, for all but the most specialised services.

Since I became Minister for Health and Children, many people have told me that hospitals and doctors can work in networks to provide patients with top quality care by experienced professionals. We can deliver top quality hospital care in each region if we build our services on a regional basis, which is the essential vision behind the Hanly report. The report is not about taking services away from people, much less closing down hospitals, it is about finding ways to deliver top quality services for people in each region. The report is not about centralising services, but involves removing the need for people to travel outside their region for services.

Balanced regional development involves regional hospital and health services as well as roads and factories. Far too many people must come to Dublin to have their medical needs addressed, including some from the North Eastern Health Board area. Anyone who truly favours balanced regional development will surely see the merit of developing hospital services for each county on a regional basis. The Government is not asking people to believe in a report, but intends to act to put in place the services people need on a regional basis. The Government intends to invest in and reform regional hospital services in a way which commands public confidence and support. When people see and experience what a 24-hour, seven days a week accident and emergency department staffed by consultants delivers, they will have much greater confidence in their regional hospital services. People do not want to page through technical reports on health service reform nor do they believe that drafting a report will deliver an improvement in services. People simply want services they can have confidence in, and that is what we intend to deliver.

The Fine Gael motion asks by what mechanism the regional health offices of the new health service executive will be accountable to the Dáil. Under the health service executive legislation, the primary, community and continuing care directorate will be organised into four regional health offices and 32 local health offices using the existing community care area structures. One of the four regions will be known as Dublin north east and will have a regional office in Kells in County Meath. While the motion assumes regional health offices will take over regional responsibility for all the services currently managed and delivered by health boards, this will not be the case. Regional health offices will co-ordinate services where they span more than one local area and will have responsibility for performance management, translating national policies through local areas and gathering and relaying information on a regional basis. Regional offices will ensure arrangements are put in place to engage with and consult members of the public, patients and elected public representatives on service provision. They will also ensure patients and service users receive a comprehensive and integrated response from the delivery system.

The interim health service executive has identified the local health office as the primary service delivery unit in each community. Local and regional offices will be accountable to the board of the executive through the national directorates and the chief executive officer. Legislation to establish the executive on a statutory basis will be published shortly and it will report and be accountable to me as Minister for Health and Children. I place considerable emphasis on the introduction by the executive of a robust, quality customer service and, in particular, the development of an effective system of rapid response to inquiries from Members of the Oireachtas and the public. The health service executive will be accountable at national level for the management and delivery of health and personal social services.

Regional structures are aimed at enabling meaningful and sustained dialogue and consultation between the executive and local public representatives and will facilitate representation by locally elected public representatives in the context of the operation and development of health and personal social services. Members will be nominated to the consultative fora by local authorities in each forum's functional area. These mechanisms will complement and reinforce the role of the Joint Committee on Health and Children in reflecting the views of public representatives in the ongoing oversight of the health services. The health service executive will build on the existing strength of consumer panels and co-ordinating committees within the health system. The forthcoming legislation will enable the executive to establish advisory panels specifically aimed at effective consultation with local communities on the provision and development of services.

Our comprehensive programme of investment and reform is tangible evidence of the Government's commitment to the provision of high quality, cost-effective and responsive hospital services to all people in the north-eastern region. I acknowledge the work of the north eastern board in pursuing a programme of hospital reform in a challenging and changing environment. The new health service executive will soon take this work forward. This is a great opportunity to give additional impetus to implementing best practice and reform in hospital services in the north east. Our objective continues to be to ensure that a comprehensive range of services is available and accessible locally and that patients who require access to specialist care outside a region are in a position to receive high quality and timely care. I am confident we can and will deliver this service to the people of the north east.

The Fine Gael motion places strong emphasis on the need to properly resource the hospital sector in the north east and to invest in services at Beaumont Hospital. I welcome the opportunity to outline to the House on behalf of the Government some of the significant developments being progressed for the benefit of patients who reside in the north east. The product of this investment is reflected not just in terms of expenditure, activity and employment numbers, but also in the continuous drive to improve the quality of services provided. The Government is committed to the further development of services in the north east in line with available resources.

The Tánaiste has referred to the package of interim capital works approved for the north east pending the longer term redevelopment of each hospital group. The investment package will complement significant capital investment in the region's hospital sector in recent years. For example, a cardiac rehabilitation unit opened at Louth County Hospital, Dundalk, in 2002 while an additional 14 beds opened under the national bed-capacity initiative. The full-year revenue cost of these beds exceeds €1.4 million. Last year, the Department sanctioned the purchase by the board of 6.85 acres of land adjacent to Louth County Hospital at a cost of €2.6 million for development purposes.

Developments at Our Lady of Lourdes Hospital in Drogheda include the upgrading of the intensive care and coronary care units at a capital cost of €1.3 million. An additional four beds were commissioned in June at an additional revenue cost of €800,000 and an extensive re-equipping programme was implemented over three years costing in the region of €2 million. Furthermore, a new symptomatic breast care and palliative care service commenced in June 2004 with the commissioning of new modular accommodation and a cardiac rehabilitation service commenced in July 2004.

Capital developments at Navan in recent years have included——

That is a joke.

——the refurbishment of the accident and emergency department, rehabilitation department, outpatient department, medical ward and main hallways. All X-ray equipment has been replaced while X-ray rooms have been refurbished. An eight-bed day ward and a four-bed intensive care high dependency unit have been provided while the female medical ward has been refurbished. An additional 14 beds were commissioned under the bed-capacity initiative and car parking facilities have been improved.

The Tánaiste covered the development of services across the Cavan-Monaghan group which has been the subject of particular comment. The range of developments to which the Tánaiste referred occurred in addition to an investment package of €4.5 million which has been provided since 1999 to fund interim capital projects at Monaghan General Hospital. The main projects completed over the period were the provision of a new modular theatre, refurbishment of a female medical ward, the upgrading of the boiler plant and a car park extension.

Cancer and cardiovascular services in the north east have been developed significantly. Since 1997, there has been a cumulative additional investment of approximately €28 million to develop appropriate treatment and care services for people with cancer in the north-eastern region. This investment has enabled the funding of ten additional consultant posts together with support staff in key areas such as medical oncology, haematology, breast surgery and palliative care. The funding has also facilitated the appointment of 20 nurse specialists across the region. Cardiovascular services have received additional funding of almost €5 million to support a 32% increase in admissions since 1997. In the context of the Estimates for 2005 the Department will consider proposals for the further development of cancer and cardiovascular services in the north east.

The future resourcing of Beaumont Hospital is also mentioned in the Fine Gael motion. I take this opportunity to outline some of the major developments which are taking place at Beaumont Hospital and which are being supported by the Exchequer. In 2000, an extensive programme of general equipping and refurbishment was approved for the hospital. The equipment replacement component of the programme has now been completed. The refurbishment programme will allow the hospital to commence a wide range of improvements to its existing infrastructure. The combined investment in equipment replacement and refurbishment at Beaumont Hospital will be of the order of €40 million. Other developments approved in recent years at Beaumont Hospital include a capital grant of €1.3 million to upgrade electrical services, an additional 35 beds funded under the bed capacity initiative, recent approval for the provision of a second MRI scanner at the hospital, a capital grant of €1.5 million for the provision of an enhanced tissue-typing facility at the hospital and the provision of a purpose-built 44-station dialysis unit.

In addition, Beaumont Hospital has recently taken management responsibility for St. Joseph's Hospital, Raheny. Funding has been approved for the provision of a 15-bed rehabilitation unit at St. Joseph's for patients over 65 requiring rehabilitation following a stroke or other life changing-threatening condition. The Eastern Regional Health Authority has also approved funding for the recruitment of ten extra consultants who will provide additional services at Beaumont and St. Joseph's hospitals.

The level of investment in hospital and emergency services in the north east is impressive by any standards. The range of developments described is comprehensive. New developments are being put in place at each of the five acute hospital sites. This is being done in a planned way and is consistent with the national and regional policy framework. The Government will continue to support the development of services in the region which are responsive, safe and of the highest quality.

I seek permission to share time with Deputy Ó Caoláin.

Is the Deputy sharing time with Deputy Costello?

No. I welcome the motion proposed by Fine Gael which deals with specific problems in the North Eastern Health Board area but it also highlights important aspects of our health service nationally that have suffered severely from the ineptitude and lethargy of the Government. Fianna Fáil and the Progressive Democrats have had over seven years to improve the health service and to increase access to it, in the North Eastern Health Board area as well as everywhere else in the country. This Government has had more money than any other before it. The record shows that far from spending money wisely the Government has squandered money in the area of health to such an extent that many of the problems are getting worse rather than better. Thousands of public patients are still on hospital waiting lists while fewer patients enjoy the security of a medical card. There is a chronic crisis in our accident and emergency services, a shortage of nurses in key intensive care units and for the first time our national maternity hospital has imposed new and unprecedented restrictions on pregnant women availing of maternity care. The record shows — I say this with some regret — this is a Government with more money than sense.

Foolishness and fraudulence are the hallmarks of the Government. It is foolish in how the money was squandered and fraudulent in regard to what was promised to the people before the general election and what was actually delivered after it. It is important that the new Minister for Health and Children who has a reputation for honesty tries to keep to that reputation. The picture she painted of the Hanly report is grossly inaccurate. The Hanly report specifically proposes the closing of accident and emergency units on a 24 hour seven day basis in hospitals right across the country. That is set out unequivocally. If it was held as the letter of the law there would be no full-time accident and emergency department for the south east between St. Vincent's Hospital and Waterford Regional Hospital. That is the logic of Hanly and we had better refresh our minds in that regard because the Tánaiste is either deliberately woolly or is trying to say that Hanly is something other than it is.

I am also concerned about her views on the health service executive reforms. The whole purpose of the argument on transparency is to seek a better way to have accountability in the system because we all recognise the health board system was flawed. What is being proposed, as is clear from what the Tánaiste has said, is a regional level which does not have responsibility for the services being provided and yet is charged with providing accountability and consultation. That does not make sense. How will people impact on a service if they are dealing with a level of authority that, in effect, has no authority over the services at local level? She misses the point when she says county councils would select who would be on the consultative bodies. The great strength of accountability is direct reference back to the people. What she should do even at this 11th hour is to ensure that anybody that is providing accountability in the system is directly elected by the people. Had the health board members been directly elected by the people they would have been much more effective and focused in the work they did. The Tánaiste is introducing the same lack of clarity and lack of accountability into the new system which will make it inefficient. She does not appreciate just how closed the system has become because there is no media scrutiny of health board meetings as there are no meetings. There are no public representatives on boards because there are no boards. It is a virtual board and its only purpose is to provide a seal for the CEO to make all the decisions.

As the motion states we are blessed with the nurses, doctors and health care professionals who are second to none and who work to a standard of excellence even when the conditions within which they work militate against excellence. The INO has today again produced figures showing an increase in the number of people, 221 patients, lying on trolleys or sitting on chairs as we debate this issue. Certainly Dublin is in the forefront in receipt of the pressure but the experience in the North Eastern Health Board has not been good either.

In an unprecedented move this summer, 25 general practitioners in the catchment area of Our Lady of Lourdes Hospital in Drogheda wrote to the Minister for Health and Children outlining their grave concern at the pressures in the hospital resulting from the transfer of services from Dundalk and Monaghan hospitals as well as an increase in population and the policy in the hospital to expand specialist services. They said, "In the absence of a plan to either extend the hospital on its current site or build a new hospital lives are being put at risk, morale in the hospital is inevitably low". The doctors also claim that the accident and emergency department is inadequate and often over-crowded, that there is no space for proper X-ray facilities, not enough theatres to service the surgical teams, that general practitioners do not have access to basic diagnostic tools such as ultrasound or physiotherapy and that the flow of consultants locum coverage is such that there is no working knowledge as to who is to do what job on a weekly basis. They refer to the fact that there are no emergency referrals in gynaecology and paediatric departments and a four year waiting list for urology appointments. The Tánaiste has restated various commitments for the hospital as if they were some major achievements. Any improvements regarding this hospital are long overdue and they involve the provision of necessities. A little humility and honesty in this regard would be helpful. Let us remember that this is a flagship hospital in the North Eastern Health Board region and that it is to become a centre of excellence. It did not have the problems of other hospitals in the region. If it did, they certainly have not been as pronounced recently.

I will hand over to Deputy Ó Caoláin in a moment——

To clarify, I have not been granted five minutes of Deputy McManus's time.

That is all right, but the motion refers to the Deputy's area.

I understand. There was some confusion to the effect that there was an equal divide. That was all the time I had been——

The Deputy has eight minutes anyway.

I thank the Deputy very much.

Rather, I do not know how much time the Deputy will have at this stage because I am so confused.

I was only trying to be helpful so the Deputy would have more time.

How many minutes are remaining?

I reiterate the importance of having the debate in this Chamber. It could not be held anywhere else. The North Eastern Health Board has lost its accountability. I suggest that the Minister examine what has been happening in our health boards since scrutiny ended.

I get the impression that CEOs are availing of their considerable powers, including powers to buy and sell property. How much land is being sold at a time when the Minister for Health and Children is talking about selling lands? Unfortunately, I believe selling lands is for short-term gain. It appears that in some health boards, CEOs are ahead of the Minister in that they are making arrangements and doing deals to provide for various projects, which I have no doubt have been approved. These arrangements are making a nonsense of the Minister's talk of selling off lands to provide for certain services.

Let me refer briefly to the needs of Beaumont Hospital. There is a desperate need for additional posts in clinical neurophysiology at Beaumont and the Mater hospitals. These posts have not been sanctioned because there is some argument between the Eastern Regional Health Authority and the Department of Health and Children. As a result, both hospitals are extremely frustrated by the difficulties experienced and the gross inefficiency arising from reliance on locums. There has been a steady loss of qualified technical staff as a result of the delays. Beaumont has now stopped performing outpatient EEGs. There are long delays for other investigations, thus impacting significantly on patient care. I ask the Minister to address this issue as a priority.

It has been striking how both the neurology specialists and advocates of their patients have come together to make a strong case for the additional posts to be sanctioned and for resources to be put in place. Many patients are vulnerable and very often cannot articulate their needs, but in spite of the case being made for them, nothing has happened. The Oireachtas Joint Committee on Health and Children heard a very powerful case, but there has still been no progress. I urge the Minister to address this issue.

I thank Deputy McManus for sharing her time. I welcome this Fine Gael Private Members' motion and thank Deputy Twomey and his colleagues for tabling it. I recognise no small effort on the part of my constituency colleague, Deputy Crawford, in influencing its construction.

I was flabbergasted by the absolute gall of Government in the amendment it tabled to this motion. That members of Government can come into this Chamber and seek to commend the Government "for the unprecedented increase in the level of investment in health services in the north east since 1997" challenges every truth and reality that the people of the north east have known since 1997. In 1998 the framework document for the configuration of hospital care delivery in the north east was unanimously signed off by the North Eastern Health Board and political opinion across the north-eastern region, including me. I was not then a member of the North Eastern Health Board but I looked forward to the implementation of the commitments contained in the document. Little did I know the vista that lay before me when I became a member of the North Eastern Health Board the following year, 1999, after the local government elections. The document was already in flitters in litter bins in the CEO's office and every other office of the administration of health care locally, regionally and nationally.

It is timely and appropriate that we should focus this evening on the North Eastern Health Board area, which has experienced some of the worst results of what clearly have been the fundamentally flawed health policies of the Government. I have long and bitter experience of the neglect by successive Governments of the health service needs of the people of my constituency of Cavan-Monaghan and the north Louth area. The fight for the retention of Monaghan General Hospital did not begin today or yesterday. One should not mistake that it dates back to the 1980s, when the matter was in the hands of a previous manifestation of this Government, when the existence of the hospital was under threat.

Although the current configuration of Government was not in power at the time, the opportunities were there, and they were there subsequently. Those placed in responsible roles failed to match up not only the expectations of the local community but also the rights and needs of local people. The threat of closure was averted through the determined campaigning of the local community at the time. In that regard, I pay tribute to the late Paddy Turley, the then editor of The Northern Standard, who played a leading part in the campaign and continued in that role almost until his recent death. Ar dheis Dé go raibh a ainm dílis.

While our hospital remains a vital part of our community infrastructure, it has suffered successive losses of key services. Most serious of all these losses is the closure of the maternity unit and the accident and emergency unit. The axing of such vital services is neither forgotten nor forgiven. The community in Monaghan remains absolutely determined to ensure the return of these units. That demand has never been withdrawn and I reassert it tonight.

As a member of the North Eastern Health Board from 1999, I saw at first hand how the system worked, or did not work, depending on one's point of view. Elected representatives were effectively sidelined while all the real decisions were taken by Comhairle na nOspidéal, the other professional bodies, representative bodies of the various consultant interests, the Department of Health and Children, the CEO of the North Eastern Health Board and those who aligned themselves with his determination to reduce the level of service provision at Monaghan General Hospital. The community I represented then and now had little or no say in how health care was delivered. There was little accountability and minimal information. This is in no way to diminish the professionalism, courtesy and helpfulness of many health board staff with whom I worked over these years and whom I hold in very high regard.

We must examine what has happened under the Government's so-called reform of the health services. What little accountability there was has been taken away. The health boards, with their representation from elected bodies and sectoral groups, have been abolished. They will be replaced with bigger regional super bureaucracies and-or a health services executive. The centralisation of services, as well as bureaucracy, will put further strain on already over-stretched hospitals in the Dublin region. The motion refers to Beaumont hospital, which will soon be in the same region as the current North Eastern Health Board area. I know from my colleague in Dublin, Councillor Larry O'Toole, who represents the area where Beaumont hospital is located, that the hospital is already under severe strain. This is being reflected right down to the grassroots within the regions. Like all our hospitals, it suffers staff shortages and under-resourcing.

The motion refers to the tragic events that occurred in the North Eastern Health Board area. These include the tragic death of baby Bronagh Livingstone whose name will forever be associated with the closure of Monaghan maternity unit. More recently, an elderly resident of Monaghan town, Benny McCullagh, who lived close to the hospital, died en route to Cavan General Hospital. A lady from Clontibret also died in an ambulance en route to the Louth hospital in Dundalk. There have been many other tragic experiences, not all resulting in loss of life but tragic nonetheless, leaving a real and indelible mark in the memory of people relating to their hospital and health care experience within the north eastern region and, in the main, allied to the loss of critical services at Monaghan General Hospital. This is the common denominator in all these events.

We heard in recent days that maternity hospitals are warning they cannot cope, and may have to cap the number of admissions. What type of horrible prospect are we seeing painted before us? Even in the worst days for this economy, we never had such a situation, nor was one threatened. It is almost miraculous that a Government could so mismanage public services in this prosperous State that we cannot cope with the birth of children. It is an absolute outrage and demonstrates the folly of closing maternity units in local hospitals, and determining maternity provision on the basis of what I can only describe as arbitrary numbers of births per consultant per year. These are figures suited to other countries and they do not take account of the real needs of the people of Ireland.

I listened to the Tánaiste's contribution to the debate and am shocked and astonished. Even in terms of the short time from when the previous Minister, Deputy Martin, vacated his role and his eve of exit announcement, we can see that a significant part of what he then committed to is no longer a currency within the statement of the current Minister. The Minister of State is nodding his head, but can he tell me when the CAT scan will be introduced to Monaghan General Hospital? I support the motion.

I am pleased to have an opportunity to contribute to the important motion before the House. Like other Deputies from the Cavan-Monaghan area, I had reason on many occasions in the House to raise issues in regard to the delivery of health services in the Cavan-Monaghan area.

I disagree with Deputy Ó Caoláin's closing remarks on the Tánaiste's statement here this evening. Senator Wilson and I had meetings with the Tánaiste since she took office as Minister for Health and Children and she is committed to the implementation of the agreement announced in late September by the previous Minister, Deputy Martin. The Tánaiste did not have time in her contribution to cover each specific area.

The Deputy should listen if he wants to hear the truth. The Fine Gael motion does not refer to one area for which I would give credit to the North Eastern Health Board, and which other public representatives and I raised down through the years, namely, the need to provide proper care for the elderly. In recent years, modern state-of-the-art facilities for the elderly have been provided at Breffni care unit, Ballyconnell, and a 50 bed nursing unit and community health facility at Virginia, which were provided at substantial cost and deliver an excellent service to patients who avail of them. The health care unit in Virginia is an excellent example of how primary care should be provided. It provides one of the best services to patients from the area. I support fully the agreement announced by the previous Minister, Deputy Martin. The Tánaiste stated clearly that she is determined to implement these proposals, which will provide a much better standard of care and health delivery for the people of Cavan-Monaghan.

I am pleased that at last the North Eastern Health Board has put proposals to the Department of Health and Children in regard to commissioning an additional 19 beds at Cavan General Hospital. It will only take a reconfiguration of services within the existing hospital to provide the additional 19 beds. It is absolutely essential these are brought on stream and commissioned as soon as possible. Another issue other public representatives and I have raised is the need to use all Cavan General Hospital. Public representatives in the area are aware that a former Minister for Health, Barry Desmond, in decisions made in the mid-1980s, decided that part of Cavan General Hospital, which had been recently built, would not be commissioned. I am pleased that decisions were made some time ago to bring that area of the hospital, which was known as medical 3, into use. I have made strong representations to the Tánaiste that this area of the hospital be put to use. The design team is currently working on the proposal.

When we talk about health services in the North Eastern Health Board area, we must not just look at the north east as an area comprising only Meath, Louth and Monaghan-Cavan. We must think of our neighbouring counties north of the Border. There is no reason we cannot have greater development of services on the basis of Sligo-Enniskillen, Cavan-Enniskillen and Monaghan, with a number of hospitals north of the Border, and likewise the hospitals in County Louth, with their counterparts in Daisyhill and others north of the Border. We must examine the delivery of the health services on an all-island basis. We are living in a constituency that would be the greatest beneficiary of a development of services based on an all-Ireland context.

There have been excellent developments in the North Eastern Health Board area in recent years. I take the opportunity to highlight the renal dialysis service provided at Cavan General Hospital for Monaghan, Cavan, north Longford, south Leitrim and part of Westmeath and Meath. The service providers are doing an excellent job in providing a renal dialysis service of the highest quality. I am pleased that some months ago the Minister for Health and Children approved the appointment of a consultant nephrologist. The appointment will come on stream shortly and it will allow a further development of the renal dialysis service at Cavan General Hospital, in conjunction with Beaumont Hospital, which is a centre of excellence in the whole area of nephrology etc. This is the type of area that needs to be developed.

Monaghan General Hospital must be used to its full capacity.

Debate adjourned.
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