Seanad Éireann debate -
Wednesday, 18 Dec 2002

Vol. 170 No. 25

Adjournment Matters. - Hospital Services.

Mr. O'Brien

I welcome the Minister of State, Deputy Brian Lenihan. I offer my deepest sympathy to the mother and family in Monaghan on the sad loss of an infant, which always touches the heart of the community. Coming up to Christmas, our thoughts are with the Livingstone family. I have been in touch with the Minister and voiced my concerns on the health service problems faced by the people of Monaghan.

The Minister for Health and Children instructed the North Eastern Health Board to carry out a full review of this incident and provide him with a detailed report of the circumstances surrounding the case. An external review group, independent of the board, has been established to evaluate the health board's report, which was completed on Monday, 16 December. The report and its findings are currently being evaluated by the review group. Will the Minister ensure that the review group report will be completed as a matter of urgency?

A report by the Institute of Obstetricians and Gynaecologists in 2000 advised all health boards in regard to the level of consultant staffing requirements to provide an appropriate level of consultant care in the maternity and gynaecological services. The institute considered that a viable unit requires in the region of 1,000 births per year to enable consultants to maintain their expertise. The report, having examined the level of obstetric activity in Monaghan 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 recommendation of the Institute of Obstetricians and Gynaecologists. If proper consultant and paediatric services were available at Monaghan hospital for the people of Monaghan, the birth rate would have been at a level that would have ensured that a viable maternity unit could have been maintained.

Comhairle na nOspidéal is currently reviewing obstetric and related paediatric, anaesthetic and gynaecological services for the population of the North Eastern Health Board region, with particular reference to consultant staffing in the context of current best practice. In considering this review, Monaghan's location should be examined. The medical experts inform us that while most pregnancies end without complication, no ante-natal screening procedure can guarantee a problem-free delivery. I understand that following the end of obstetric services in Monaghan there were protocols in place to deal with emergency cases like this. The inquiry should report on why this event occurred last week and how to prevent it in future.

The Minister will agree that it is unacceptable that cases like this should occur. I urge him to ensure that in future Monaghan hospital will be able to deal with such incidents.

Mr. B. Lenihan

I take this opportunity to offer my deepest sympathy to the mother and family concerned on their very sad loss. Their loss is a deep one that has caught people's imagination. It requires all of us to focus our energy on addressing this problem, which has persisted in recent months.

Senator O'Brien has sat on the Agricultural Panel of the Seanad for many years, but he is also a public representative for County Monaghan and has consistently raised the question of proper provision of services at Monaghan hospital with the Minister for Health and Children. He has put much effort into that area.

On becoming aware of this matter on Wednesday, 11 December, the Minister immediately instructed the North Eastern Health Board to carry out a full review of the incident and to provide him with a detailed report of all circumstances surrounding this case. He also established an external review panel, independent of the board, to evaluate this review. The group comprises Dr. Seán Daly, master of the Coombe Women's Hospital, Ms Maureen Lynott, project director at the national treatment purchase fund, and Ms Brigid Boyd, clinical midwifery manager, neo-natal, at the Coombe Women's Hospital.

The terms of reference of the panel are: to consider the report of the NEHB in relation to the incident and make such further inquiries and to conduct such interviews as it considers necessary; to examine the protocols and procedures in place for the handling of obstetric emergencies at the Cavan-Monaghan Hospital Group, having regard to prevailing standards of best practice, and to examine their application in this case; and to report to the Minister on the adequacy of the response of the hospitals and the ambulance service to the incident and make such recommendations as it sees fit.

The North Eastern Health Board completed its review on 16 December 2002. The report and its findings are currently being evaluated by the review panel. The Minister shares the Senator's concern that this review process be brought to a conclusion as quickly as possible. The Senator will understand that the Minister does not wish to dictate to the panel or take from it the power it must exercise to make findings in this case. The review panel's report will be completed as a matter of urgency for presentation to the Minister for Health and Children. I assure the Senator that this matter is receiving priority attention. The Minister will review the position in relation to this issue on receipt of the review panel's comprehensive evaluation of the health board's report.

The wider question of the appropriate provision of services in Monaghan hospital has been raised and the Minister is concerned that the best possible service is provided. It is of paramount importance at this stage, however, that we get a detailed account from the review panel of what happened in this tragic case.

The Seanad adjourned at 9 p.m. until 10.30 a.m. on Thursday, 19 December 2002.