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Seanad Éireann debate -
Tuesday, 7 Nov 2000

Vol. 164 No. 7

Adjournment Matter. - Hospital Doctors.

I thank the Minister of State, Deputy Moffatt, for taking this matter on the Adjournment. This relates to the appointment of a paediatrician to the Cavan-Monaghan hospital group and the fact that the paediatrician should be based in Monaghan general hospital.

The Minister of State will be aware that the Minister for Health and Children, Deputy Martin, gave approval for a third paediatrician to be based at the Cavan-Monaghan hospital group in September. This matter has now gone to Comhairle na nOspidéil for sanction. This is an opportune time for me to speak on the issue, given that the appointment of a third paediatrician to the Cavan-Monaghan hospital group will be on the agenda of the meeting which is taking place this week.

The current population of Monaghan is 51,000 and Cavan has a similar population. In 1994 the two hospitals were joined in one hospital group to provide a service to the people of Cavan-Monaghan. This was to ensure that services and facilities would be provided equally to the people of Cavan and Monaghan. Unfortunately, this has not been the case to date.

The Minister, Deputy Martin, will be aware of the case I put to him on a number of occasions in relation to the poor physical infrastructure in Monaghan general hospital, an older hospital in which, until last year, money had not been invested for 20 years. Thankfully, £1 million has been spent on the hospital in the past year to upgrade its physical structure. The paediatric ward has been refurbished and upgraded.

In May of last year the then Minister for Health and Children, Deputy Cowen, promised the Monaghan Hospital Development Committee, in my presence, that the next paediatrician appointed to the Cavan-Monaghan hospital group would be based in Monaghan. This is where our problem lies. Two paediatricians are based on the Cavan side of the Cavan-Monaghan hospital group. These are supposed to provide some paediatric service to Monaghan, but this consists of a visit by a paediatrician to Monaghan hospital on one morning and one afternoon per week. This is not an adequate service.

Monaghan hospital has an 18 bed paediatric unit and an obstetric unit which caters for between 300 and 350 births per year and which is led by one consultant. Comhairle na nOspidéal is not in favour of one consultant-led units but the people of Monaghan and I have confidence in the facilities and the service provided by the obstetric and paediatric units. The care given in the obstetric unit is second to none and is superior to that given in many hospitals which have several obstetricians.

Expectant mothers are now choosing to go to units in Cavan or Drogheda where paediatricians are based. For women in north County Monaghan the journey to Cavan is 50 miles and the journey to Drogheda is almost 70 miles. This is unacceptable, particularly when Monaghan hospital has an obstetric unit. However, women are quite rightly choosing to go to hospitals which have paediatricians. General practitioners and parents of sick children in the area are also, quite rightly, choosing to bypass Monaghan hospital in the knowledge that they will probably eventually have to go to Cavan or Drogheda to avail of the services of a paediatrician. If the services in Monaghan are not used, they will not continue, but patients cannot be expected to use their local unit when superior care is available elsewhere.

Since 1994 I have been told repeatedly that services would be shared equally between the Cavan and Monaghan hospitals. If two paediatricians are based in Cavan it makes sense to base the third paediatrician in the group in Monaghan. It is expected that the appointment of the third paediatrician will be made later this week. I understand Comhairle na nOspidéal will appoint a community-based paediatrician who will provide clinics in the community and in the acute hospital. The provision of a paediatric service would allow people in the north Monaghan area to avail of a proper service within their own hospital. Some facilities are in place. The Minister is aware of the problems faced by Monaghan hospital in getting all the services it requires. We expect the physical infrastructure to be provided in Monaghan but services must be improved.

I ask the Minister of State to speak to the Minister on this matter. I am aware that Comhairle na nOspidéal is an independent body. Nevertheless, the Department of Health and Children provides the funding for the appointment and the Minister must have a say in where the appointee will be based. There is no reason the newly appointed paediatrician cannot be based in Monaghan and interact with the paediatrician in Cavan. This arrangement works well for surgical and medical personnel. I ask the Minister of State to do everything he can to ensure that the newly appointed paediatrician is based in Monaghan. I look forward to hearing his reply which I hope will be positive.

I thank Senator Leonard for raising this issue. I am pleased to address the Seanad on behalf of my colleague, the Minister for Health and Children, Deputy Martin, and to clarify the position regarding the provision of hospital services at Monaghan hospital.

The North Eastern Health Board, at its meeting in June 1998, approved the framework for the development of acute hospital services in the north-eastern region and submitted a set of proposals for the development of all five acute hospital sites in its region, including Monaghan hospital, to the Department of Health and Children.

To ensure the highest possible quality of service for patients, the North Eastern Health Board is now providing acute hospital services on the basis of two integrated hospital groups – the Cavan-Monaghan hospital group and the Louth-Meath-Drogheda group. This approach, in addition to promoting quality health care on each site, underlines the fact that all five hospital sites in the region are secure. The establishment of an integrated Cavan-Monaghan hospital group has ensured that the population of the catchment area of both hospitals will have available to them a range of high quality, easily accessible medical and surgical services.

The North Eastern Health Board policy on acute surgical services is clear and explicit and the plans included in the framework will significantly develop the range and complexity of services in the region and allow the board to develop self-sufficiency in regional services. A project team, appointed by the chief executive officer of the North Eastern Health Board, with representation from the Department of Health and Children, is currently preparing a brief for the Cavan-Monaghan hospital group which will form the basis for instructing an architect and design team to advance the planned developments. Under the national development plan £80 million has been approved for the North Eastern Health Board's hospitals and ambulance development during the period 2001-06.

The North Eastern Health Board has established a joint department of paediatrics for Cavan-Monaghan. All the acute in-patient services are provided at the Cavan site and at present there is a limited out-patient service in Monaghan. Cavan provides for most of the out-patient and day facilities for the catchment at present. The Minister for Health and Children recently approved the appointment of an additional paediatrician with a community interest to the joint department at Cavan-Monaghan. The appointee will assist in the provision of in-patient services in Cavan and will dedicate a significant proportion of his-her time to the pro vision of day and out-patient services at the Monaghan site. The board has proposed that the new appointee will focus on the delivery of community-based services in Monaghan hospital for the Monaghan catchment area. All community-based paediatric services for County Monaghan will be based in Monaghan hospital.

The North Eastern Health Board is fully committed to the future development of Monaghan hospital and the brief being prepared by the project team will ensure that planned facilities at the hospital are in line with best modern standards in all respects.

I hope this gives some comfort to Senator Leonard.

The Seanad adjourned at 6.10 p.m. until 10.30 a.m. on Wednesday, 8 November 2000.

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