The reason for asking for permission to raise this matter is a most extraordinary letter, probably one of the most extraordinary from any Department, which was presented to the North Eastern Health Board yesterday. The basis of that letter was that before permission would be given to the health board to build a hospital in your own town of Cavan, Sir, the board would have to give a commitment that the county hospital in Monaghan would be closed and disposed of. I shall quote one or two relevant passages from the letter:
It was intended initally that these three hospitals would close when the new hospital was commissioned.
The three hospital in question are Lisdarn, the surgical hospital in Cavan and the county hospital in Monaghan. There is no basis in fact that I can find for that. The last time a Minister wanted to downgrade the Monaghan hospital was when another Coalition Minister was in office, Mr. Corish, who is no longer in the House. In February 1976 he wrote to the health board stating that the county hospital, so designated, could commence to function as a community hospital. There was no question of closing the county hospital at that time. The letter presented to the North Eastern Health Board yesterday goes on to state:
Accordingly it is necessary for the Minister for Health to have a firm commitment form your Board that the three hospitals which were intended to be replaced by the new hospital will be closed as acute hospital facilities. The Minister also wishes to be informed of the Board's plans for the disposal of the properties.
In other words, the board were asked to get rid of these properties. As far as I am aware there was never any suggetion that Lisdarn should be got rid of: indeed it was to be incorporated as part of the new hospital complex in Cavan.
This is an extraordinary decision. It is extraordinary that a Coalition Government, just six months back in office, again have decided not alone, this time, to downgrade Monaghan County Hospital but to close it down and to sell it. It is a political decision and one could lay a lot of blame at the door of the Coalition Government for it, but I do not think that would be a correct thing to do. Our priority must be at all times to ensure good health care for all the people for whom we are responsible.
When the health board sent out the agenda, with the letter from the Department, the six Members of the Oireachtas from the area, Cavan and Monaghan, met the Minister and an official and pleaded with him in the interest of the good health of the people in the area to withdraw the letter, that it was totally unnecessary to have sent such a letter to the health board, passing the death sentence on the hospital. If the death sentence is passed on the hospital it will leave the area without hospital facilities, apart from those in Cavan, and it is fair to say that the surgical hospital in Cavan is probably the worst hospital building in the whole of Europe. Indeed, it is a tribute to the staff that they are able to carry on a surgical hospital there.
It is not my intention to go into the social and economic implications of the Government's decision. I believe the request of the elected representatives to the Minister to withdraw that letter was prompted by good sense to see that the needs for good medical care in the area are met. The immediate effect of that letter is, one, it will undermine public confidence in a hospital which is providing an excellent service for the community; two, it will demoralise the staff, nursing and ancillary; and three, if the excellent consultants there decide, because the death sentence has been passed on the hospital, to look for more secure employment in hospitals which the Minister does not intend to close — we do not know how many there will be — Monaghan County Hospital will not be able to attract the kind of staff necessary to ensure the good health of the people who use that hospital.
The Minister's letter also stated that subsequent commitments were given that Monaghan hospital would continue in use on the completion of the new hospital. That is correct. The present Leader of the Opposition, Deputy Haughey, when he was Minister for Health came to Monaghan to see for himself what was happening. He met the local county health committee. He told them, and I will use his own words:
I would like to avail of this opportunity to state categorically to the members of the Monaghan Health Committee that Monaghan County Hospital will be retained as a general hospital providing the full range of appropriate services for the people of County Monaghan. The status of Monaghan hospital will not be affected by the development of Cavan Hospital. Monaghan County Hospital will provide the following services — general surgery, general medicine, obstetrics and gynaecology, with the necessary back-up of radiology, pathology and laboratory services.
Later in that statement the then Minister stated:
I would like to remind everybody concerned that when I assumed office Monaghan County Hospital was scheduled to be downgraded to what was described as a Community Hospital. I reversed that decision. I have implemented the measures necessary to maintain a full-scale County Hospital in Monaghan. The future of Monaghan as a county hospital has been secured beyond doubt and I would like to suggest that everybody concerned should now devote their attention to building up and perfecting the community health services.
There is no word about closing it in that statement. We should contrast that with the letter which arrived at our health board offices yesterday. Following that message from the then Minister for Health, new appointments were made to the staff in Monaghan. In the Official Report of the Dáil for 27 June 1978, at column 1941, Deputy Haughey, the then Minister, is reported:
I have asked Comhairle na nOspidéal, and they have agreed, to provide the level of staffing necessary in both hospitals to satisfy the needs of their areas.
The two hospitals referred to were Tullamore and Monaghan. Since then, a second physician has been appointed. There are now two surgeons in Monaghan Hospital, there is a new full-time radiologist and two anaesthetists, and there is a full working laboratory. Monaghan County Hospital has become one of the finest hospitals in the country.
The bed occupancy is very important to statisticians and it is true that it has dropped over the last five years, but it is wrong and grossly unfair to take bed occupancy as a statistic on its own. If one looks at the medical unit alone in that hospital one sees that the number of patients treated increased by 4,000, the length of stay was reduced from 14 days to seven days, and the number of outpatients increased from 368 in 1977 to 2,233 in 1982. These are the significant figures. It is easy to keep beds full all the time; just keep people lying in them, but I would not recommend that. It would be wrong if the hospital were to be penalised because the bed occupancy dropped when one looks at the other figures which show this is a very active and improving unit.
The second physician was appointed. One of the physicians left the hospital two years ago. Last year a new appointment was made. The physician offered that appointment did not take it and the health board requested that they advertise again. Now, two years later, again with the Coalition in power, the answer I received to a question in this House on 14 June explained that a candidate was selected for appointment to this post following a competition by the Local Appointments Commission last year and he indicated to the health board that he did not wish to take up the appointment. In accordance with normal practice, because of the lapse of time since the last competition, the Minister said it will be necessary to readvertise the post and his Department will be writing shortly to the board in the matter. Has the Minister written to the board? What is the reason for the delay in making this very necessary appointment? The development of the Cavan hospital is at a very late stage. Tenders are due to be returned to the health board on 23 July. It is hoped that the hospital will commence in the autumn, probably September. Previous Minister for Health were satisfied to continue with this project because they know there is a need for a hospital in Cavan and it is important that the project should not be hindered.
The effect of the Minister's most extraordinary decision is to undermine confidence in Monaghan County Hospital, to demoralise the staff and to ensure that if for any reason a consultant leaves or transfers there will not be any replacement because no consultant will take a post in a hospital on which death sentence has been passed.
The members of the health board at a meeting yesterday, like the Members of the Oireachtas who met the Minister last week, were unanimous in their decision that Monaghan County Hospital should not be closed or downgraded. They asked the Minister to withdraw that letter and to visit both Monaghan and Cavan to meet the members of the health boards so that we could discuss in a rational and sensible way the needs of both Cavan and Monaghan and ensure that there will be proper health services in the area. It is extraordinary that a Minister would not listen to all the elected Members from Cavan and Monaghan representing the two major political parties. I hope the Minister will listen to the North-Eastern Health Board who have a major responsibility in this matter. As I said earlier, while this is a political decision for which the Government will have to accept responsibility we must be concerned primarily with the health of the people. Looking at this from any angle, certainly from the point of view of health care and as a political move, all I can say is that this decision was completely mad. Again I appeal to the Minister to withdraw that decision, allow Monaghan County Hospital to continue as a viable unit, and ensure that Cavan Hospital will commence on target this autumn.
