Some relevant letters, documents and statements
Irish Medical Times
Points of View
The End
Game play
Times
Wasting Money
General
Residents Society
To Business
Minister Michael Martin
Rory O'Hanlon
NEHB

Irish Medical Times Response October 25th, 2002

Mr. F. Lennon,
Consultant Surgeon,
Our Lady of Lourdes Hospital,
Drogheda,
Co. Louth.

Dear Mr. Lennon,
As you appear to be the PRO for the North Eastern Health Board, we would like to respond to your letter in the Irish Times and to the interview in the Irish Medical Times.

We will take your letter first of all:
At long last a member of the North Eastern Health Board has admitted that Monaghan Hospital has been neglected by that authority, when you state that physical infrastructure and facilities on-site as well as equipment and personnel resources are all vital components in maintaining proper standards to provide safe and viable health care to patients. Since this was not provided for by the NEHB in Monaghan, the medical and professional regulatory authorities have advised the withdrawal of services from that hospital. The solution of course is that the NEHB would provide the necessary requirements to satisfy these bodies so that acute emergency services can be offered in Monaghan.
Your letter is contradictory in that you state that 'only a certain number of hospitals can offer an acute emergency service' and imply that Monaghan is not one of these but you go on to suggest that our energies should be focused on re-establishing Monaghan as a hospital with acute services. Even the word 're-establish' denotes that downgrading has taken place but we have been constantly told by the NEHB that there has been 'no downgrading'.
You state that 'professional medical considerations' indicate that Monaghan cannot provide 24-hour emergency services. We know that but once again we state -- the NEHB brought about this situation by not investing properly in Monaghan. We would also point out that professional medical opinion in the NHS in England and of many eminent medical personnel in Ireland would not agree with you and would claim that the provision of these services in the local hospital is the best way to ensure quality and safety for the patient. Common sense and logic tells us that it must be better to receive treatment for any emergency as soon as possible. How can the Health Board convince the people of Monaghan that it is better for them to travel to Cavan or Drogheda when they have an accident or heart attack or similar emergency? It is impossible and defies logic. How would you like to move home to the North Monaghan region and live under these conditions?
We are delighted that you agree that we have 'understandable and legitimate concerns' but your proposals do not allay those concerns but rather adds to them. Our fears and anxieties will ease when we have proper 24-hour emergency services in Monaghan. We are not looking for a return to the status quo ante - we are looking for a proper hospital to meet our needs - something which the NEHB has taken from us over the past twenty years and since it is not politics or economics but questionable medical imperatives, which is preventing this, we do not think our demands unreasonable.
As for your interview with the IMT, we would say:
We have no objections to the idea of re-defining the roles of the hospitals in the region and working towards a situation where a better health service is available to the people. However we do object to the haphazard way in which this is being organised and worked through by the NEHB. We have no objections to the placing of specialist services in various hospitals and using the resources in these to bring down waiting lists but there is a level of service, which is required in Monaghan, which your proposals do not provide nor do they take the human being into account. As we have said above – how would you like to live down here with a young family or ageing parents knowing that the nearest emergency service is over 1 hour away? You do not seem to place any import on the fact that many here cannot afford to travel to Cavan and Drogheda to be with loved ones who are ill. You do not seem to realise the disastrous effects these proposals will have on the economy of the area. You do not seem to understand the fear we are living with because we have no emergency service within a safe distance. You say we have ‘ understandable and legitimate concerns’ but the HB has not offered us any solution as to how we are supposed to deal with these concerns other than to bully us into accepting the grandiose plan. You state in your letter that it is not economics that is driving these changes but yet in your interview you quote an _11m over run as a major factor. What and who is really responsible for causing us such fear, anger, heartache, anxiety, anger, worry, fury, apprehension, alarm, anger, or as you call it – concern.
As to the fact that you claim these changes are in keeping with international trends we would ask you to show us where they have delivered a better service. Those countries, which have moved in this direction, have discovered that their health services have suffered greater damage and they are now questioning the benefits. More mistakes are being made followed by more litigation. Do we have to follow suit and prove to ourselves that it won’t work for us either or have we no intelligent planners who can come up with an innovative approach, which would make us leaders instead of copiers.
Regarding your statement that the HB is working with the RCSI to retain recognition for training, we ask why it is necessary for all hospitals to have such recognition? Surely some of them can be run with fully registered staff where training is not a requirement?
We welcome your admission that the current difficulties are in part due to the failure of the Board to be clear about its plans. We ask – had the Board got a plan? What has happened since July in Monaghan gives a clear indication that the Board, which knew of the impending crisis, took no steps to have an alternative in place to deal with the consequences and we refer to the overload in Cavan and Drogheda and the confusion as to where patients could be sent by GPs and taken by ambulance personnel. However we would also point to another failure of the Board – to engage with the people who were going to be effected by the changes. The tactics used to bring about the changes are those of bullies, where discussion is blocked and answers not forthcoming. Many of the concerns and much of the anger could have been avoided had the Board been willing to openly discuss the future with those representing the public, who in turn could possibly have allayed some of the fears. Instead they allowed those fears to grow into anger - an anger, which will now be much more difficult to appease. We are treated as unimportant in the scheme of things and dismissed in an arrogant manner as being ignorant gombeens, who deserved nothing and are to be ignored. We still have our dignity. Making statements like – ‘ it is not going to work’ , ‘ the health board has held out’, do nothing but add to the fury and are further examples of the type of tactics, which solve nothing.
In your reference to the 1998 Framework Document you claim that it was not sufficiently prescriptive and that one could not identify what each hospital would do. Our comprehension is not faulty as it states very clearly what Monaghan will do and that is not what the HB is offering to put into Monaghan now. There is no ambiguity about it in the document but the HB has not adhered to the proposals made there. They have now set their own agenda.
Regarding the closure of the Maternity Units at Dundalk and Monaghan – please respect our intelligence, the HB was not the victim or caught by circumstances. If you want your car to pass the NCT test you repair any faults to ensure it passes. The HB made no effort to maintain Monaghan Maternity Unit so that it would pass the Insurers. The only victims in this are the people of Monaghan and especially those families who have to trek to Cavan, if they have time - Otherwise let them have their babies on the roadside.
Our final words of advice – if the HB is going to continue to blame the ‘other bodies’ for the new proposals, then it should be willing to let the public know that it is encouraging them to take the action they are taking and in some cases even suggesting new regulations.
Yours,
______________________________.
Peadar McMahon, Chairman.

Northern Sound Interview - September 25th, 2002

Mr. Declan Breathnach,
Annaghs McCann,
Knockbridge,
Dundalk,
Co. Louth.
Dear Mr. Breathnach,
Since our last letter to you we have received a copy of your statement re. Monaghan General Hospital and we heard your interview on Northern Sound Radio. We wish to make the following points:
1. You state that it is the function of the NEHB to discuss, debate, develop and adopt policy. You adopted the Framework Document as policy in 1998. Where is it now? You pay large sums of money to develop policies, which are discarded or overpowered by other agencies. That makes them worthless. So you are left with debating and discussing. It is a great price that the people pay to give the HB an opportunity to discuss and debate.
2. You say that the blame should not be laid at the door of the HB. You are the statutory body set up to provide us, the people, with health services. If you cannot do that why is the HB in existence?
3. Has the HB done all physically and legally possible? Did the HB do anything to ensure that services stayed in Monaghan? Did they take any action to ensure that the hospital would pass the various ‘Reviews’ visited upon it? NO, they allowed the reviews to proceed knowing that the hospital would be rejected. How was Gynaecology taken from the hospital and please do not tell us that the gynaecologist had a hand in it. How was paediatrics removed – and don’t tell us it was unsafe. We know the part played by the gynaecologist and we know the story behind paediatrics. Now if the HB is serious about the development of Monaghan hospital why has it not included A & E, Major Surgery; Acute Medicine, return of Gynaecology and another service in its proposals to the ‘Professional Bodies’? Is it because they might accept it and accredit the hospital once again?
4. On what grounds and with what qualifications can you say that you believe the present proposals are the best solution? If you lived in the Monaghan area or one of the many isolated areas of the county we wonder if you would have the same belief? If your family were depending on emergency services, would you like to live in Monaghan? What is the acceptable mortality rate for Monaghan? You will likely say again that it is not the Health Board. If you offer the proper conditions to the Colleges, Comhairle, whoever, then they have to be accepted as they are in other hospitals. Indeed other hospitals are treated more leniently than Monaghan and solutions are found much faster.
5. We are not asking the HB to put forward proposals to restore Monaghan to its position prior to July this year. That will not be satisfactory to the professional bodies. Isn’t that why the hospital was taken ‘off call’. We want it back to where it was prior to the downgrading.
6. You refer to the demands of the ‘people of Monaghan and its local politicians’. Please add ‘and senior medical authority’. We have had medical advice from senior medical personnel, not in Monaghan or Cavan. Could we call that ‘ independent medical advice’ and it contradicts what appears to be the medical advice given to the HB. Is it any wonder then when we do not agree with the outside agencies. Again we must add that what is OK for one hospital should be OK for Monaghan.
7. We must ask how you are so sure that these proposals will ‘last scrutiny from these outside agencies in the future’. Our medical advice does not agree. For example – Acute and Emergency Medical will not be sustained without acute surgical on the same site. Therefore within six months the Medical Board will withdraw Acute Medical from Monaghan and what are we left with then? Moreover it will be impossible to recruit staff to fulfil the functions as outlined in those proposals. And it is for these reasons we believe the plan is to make Monaghan a convalescence home and Nursing Home for old people who are not sick. Once this has been established the sights will be set on Dundalk and then Navan. It will be your fight then.
8. You say that anger and frustration will achieve nothing. Come and live with your family in Monaghan and experience the fear of sudden illness or accident with no services within an hour and a half to two hours of your home, listen to the horror stories of the suffering to be endured through lack of local services, hear the strain in the old lady’s voice as she relates how she lay for 48 hours on a trolley in Cavan waiting for attention, look at a hospital here in Monaghan with equipment, accommodation and wonderful staff under-utilised and long waiting lists throughout the country. We are sure that more people would then pull more strings to change the situation.
9. You say that it is through dialogue that both sides can appreciate the constraints etc. Tell us then why the CEO would not engage with us when we met on Monday last. Why was there no dialogue? Why were we made to feel we were entering God’s Chambers, when we went into the Board meeting? It was you yourself who said that there could be no discussion on our presentation at the meeting, which we can appreciate but that is the way doors are being closed in our faces.
10. You say that Monaghan Hospital can reach its potential. The potential of Monaghan Hospital is much greater than that proposed by the Health Board. The constraints can be much wider if a wider and fuller band of services are proposed to the agencies. If the case is made by the Health Board that these services are vital for the people of the area, cognisance must be taken of that stance. If it is widened even further and the benefits to the health services in general are noted, then it can become a very attractive proposition for all concerned. But those services must include the provision of a 24-hour Accident and Emergency, Acute Medical and Surgical and then whatever services are needed to bring in the volume of work. Anything less is putting the lives of the people of Monaghan, and those who might visit it, in jeopardy. That is what we have been told by our medical advice and that is what we know we need to remove the fear and trepidation for our families.
As a representative of the people of your area we know that you would have similar demands if you were representing us. This is a humanitarian issue and we hope that you can understand the reasons for our fear, anger and frustration. We have no clout but we are asking that those who have should use it to remove our fear. The Health Board must fight our battle for us and with us rather than appear to support those who are putting our lives at risk. We thank you for your time in reading this but we would plead for your understanding and help.
Thank you for your time.
Is mise le meas,
________________________________.
Peadar McMahon, Chairman.

‘The end is nigh’ October 23rd, 2002

Minister Michael Martin TD.,
Minister for Health and Children,
Hawkins House,
Dublin.

Dear Minister,
‘The end is nigh’ - yes Minister despite all your promises and your ‘commitment’ to Monaghan General Hospital, it is two months away from closure. You ask someone to tell you what is going on – we have been telling you for the past six months but you were not listening, or if you were, you did not want to hear.
Lets not get into the meaning of words – if the hospital is not available to save me in an emergency then it is closed. If an ambulance cannot take me to the nearest hospital to get treatment then it is closed. If I die on the road to another hospital then my own hospital is closed. If, like my own neighbour last Saturday, you get a second heart attack in the ambulance on the way to Cavan, then Monaghan is closed. You should ask his wife whom she blames. Tell the children of an 89 year old lady suffering from heart problems, who fell in her home and broke her hip, that it was best for her to be taken by ambulance to Cavan without any pain-killers than to be taken to Monaghan first, to be made comfortable, and then transferred to Navan for her operation. Ask them who made her go through that suffering and endangered her life even more.
Now we know there is ‘an acceptable mortality rate’ for Monaghan – we just do not know the exact number, but the deaths and suffering, which is and will be suffered by the people of this county, will rest on you. You will have to accept responsibility for it – you cannot pass it off to others – you are the Minister – the elected one to govern. You will never know just how much damage you have done to so many people because you are so far removed from this ‘isolated and backward place’ but someone somewhere will keep note.
It has been a game all along for politicians. Peoples’ lives and well-being are involved but that does not matter – winning the game is more important. When the local elections and others come up in future the people of Monaghan will remember this year of 2002 for what it was – the year we were disserted by our Government and our representatives in power. When we publish the story of this period of life in Monaghan we will record it for history how we were abandoned for other agendas. However we have not yet yielded in our struggle to have emergency services available in Monaghan.
I await your reply,
Is mise le meas,
________________________________.
Peadar McMahon, Chairman.

Letter to An Taoiseach, October 2nd, 20002

An Taoiseach
Dáil Eireann,
Dublin.

Dear Mr. Aherne,
Once again we call on you to intervene and instruct your Minister to sort out the mess that is Monaghan General Hospital. What a fantastic game is being played - if only it were not so serious we could enjoy it too. The political football is being passed around from one to another and those who should be making decisions are sitting in the wings. Meanwhile we, the people of an industrious county, are made pay for the pleasure of others playing the game. We are like the Christians in the ancient Roman arenas facing the animals and the gladiators, with no hope of defence. There was no where for them to go, no sudden arrival of the army to rescue them, and while they were in their final throes they awaited the Centurion or the Emperor to give the ‘thumbs up’ or the ‘thumbs down’ to decide their fate. That’s us alright. We will all get sick and need a hospital but we will have nowhere to go - just like our neighbour this week for whom the surgeons of Monaghan could not find a hospital to perform urgent surgery to save his life. Eventually the Health Board gave permission for the operation to go ahead in Monaghan but the delay will reduce his chances of survival or a quick recovery. And we are told this is ‘safe practice’!! Now there is a bug in Drogheda – what happens if they have to close wards there and restrict intake? Where will we be taken then? Will you accept responsibility for any deaths and extra suffering or will you give the thumbs down and condemn us to the ‘acceptable mortality rate’ for Monaghan?
The manner in which this whole affair is being handled is going to have disastrous consequences for all involved and it is not necessary to be so. Simple decisions can resolve the situation but they need to be made immediately. We are pleading with you again – please make that decision as is your duty as our leader.
Thanking you and looking forward to an early reply,
Is mise le meas,
________________________________.
Peadar McMahon, Chairman.

In response October 23rd, 2002

Dear Editor,
Permit me, on behalf of the Community Alliance to respond to the letter from F. Lennon in yesterdays' edition.
At long last a member of the North Eastern Health Board has admitted that Monaghan Hospital has been neglected by that authority, when the Medical Advisor states that physical infrastructure and facilities on-site as well as equipment and personnel resources are all vital components in maintaining proper standards to provide safe and viable health care to patients. Since this was not provided for by the NEHB in Monaghan, the medical and professional regulatory authorities have advised the withdrawal of services from that hospital. The solution of course is that the NEHB would provide the necessary requirements to satisfy these bodies so that acute emergency services can be offered in Monaghan.
F. Lennon's letter is contradictory in that he states that 'only a certain number of hospitals can offer an acute emergency service' and implies that Monaghan is not one of these but goes on to suggest that our energies should be focused on re-establishing Monaghan as a hospital with acute services. Even the word 're-establish' denotes that downgrading has taken place but we have been constantly told by the NEHB that there has been 'no downgrading'.
He states that 'professional medical considerations' indicate that Monaghan cannot provide 24-hour emergency services. We know that but once again we state -- the NEHB brought about this situation by not investing properly in Monaghan. We would also point out that professional medical opinion in the NHS in England and of many eminent medical personnel in Ireland would not agree with F.Lennon and would claim that the provision of these services in the local hospital is the best way to ensure quality and safety for the patient. Common sense and logic tells us that it must be better to receive treatment for any emergency as soon as possible. How can the Health Board convince the people of Monaghan that it is better for them to travel to Cavan or Drogheda when they have an accident or heart attack or similar emergency? It is impossible and defies logic. How would the Health Board members like to move home to the North Monaghan region and live under these conditions? We are delighted that F. Lennon agrees that we have 'understandable and legitimate concerns' but his proposals do not allay those concerns but rather adds to them. Our fears and anxieties will ease when we have proper 24-hour emergency services in Monaghan. We are not looking for a return to the status quo ante - we are looking for a proper hospital to meet our needs - something which the NEHB has taken from us over the past twenty years and since it is not politics or economics but questionable medical imperatives, which is preventing this, we do not think our demands unreasonable.
Yours sincerely,
Peadar McMahon, Chairman Monaghan Community Alliance.

Statement issued Tuesday, October 8th 2002.

Over the past few weeks the situation at Monaghan General Hospital has changed little and the North Eastern Health Board plays the waiting game. Very soon now they will be able to blame the College of Surgeons for withdrawing the Junior doctors and this will put an end to surgery at the hospital. With acute surgery gone the next step will be to blame the Medical Council for withdrawing the Acute medical services and what are we left with – what they have wanted all along – a nursing home for senior citizens who are not sick.
They might tell us they are awaiting ‘independent medical advice’ as to what services they can have in Monaghan but that is a foregone conclusion. They are going to be told that Monaghan should be a 9 to 5 day hospital. They will tell us that this is in the best interest of patients and ‘safe medical practice’. We still do not accept that and never will. No one can convince us that it is safer to wait two hours for treatment in an emergency than to receive treatment within the hour. No – there are other reasons for these decisions but no one is prepared to state what those reasons are. However we are getting closer to the truth and the truth will come out eventually.
It seems to be acceptable to ‘the powers that be’ that so many people from Monaghan can die and thousands more can suffer severe hardship before there is a change of heart. Monaghan is a tiny little place on the periphery where they set up their own businesses, work hard and provide huge returns to the exchequer but they are unimportant in the greater scheme of things. It is an ideal place to test regionalisation of our Health Services and if it can be forced upon Monaghan then the same plan will be put into operation somewhere else. This has already started and we said it would six months ago. Dundalk is now on the same downward slope. They are losing services there over the past few months and the Health Board says they are not downgrading the hospital nor have they any plans to close it. Does that statement sound familiar? Did we not hear it many times before? The Staff in the Dundalk hospital now realise that they are about to become a Nursing Home as well. The Navan people may get ready – they are next on the list. The Alliance has been trying to gain support among Health Board members over the past couple of weeks and it is now beginning to happen. Some of the representatives from other counties have promised to support the Monaghan cause at Health Board meetings. They now see the validity and need for our proposals and agree that it must be the way forward for Monaghan Hospital. However, we still need more support and we will continue to strive to get that.
We were supposed to get great consolation last week when Senator O’Brien announced news from the Minister that _473,000 had been allocated for a new boiler/heating system at Monaghan. The Minister claimed this was a clear indication of his support for Monaghan hospital. We are not fooled so easily. A Nursing Home needs heat and the 1930s system in Monaghan cannot function much longer. As well – it is one thing for the Minister to promise the money, it is quite another thing to get the Health Board to spend that money in Monaghan. After all, look at all the other promises the Minister made since last January and what has been done with these? Nothing.
The Health Board placed adverts in papers some time ago looking for registered non-consultant anaesthetists. We believe there were three applications and from our investigations all three were employable and willing to work in Monaghan. However we are told that the Health Board is not going to interview them or appoint them. Why waste money on adverts when it is intended to ignore replies? The excuse from the Health Board is that by December they will have to be withdrawn because the College of Surgeons is withdrawing the Junior Doctors and the anaesthetists will have to be taken out of Monaghan again. Again – lay the blame on someone else, instead of trying to get services in place to satisfy the College so that the doctors will be left in place.
We are not despondent about the outcome. Democracy can still win the day, democracy must win, otherwise it will be a sad day, not only for Monaghan, but for Ireland as a whole. We still call on all the people of the county, we call on all businesses, we call on all organisations and we call on all our Public representatives to apply the pressure on ‘the powers that be’ to stop these silly games, to stop playing with peoples’ lives, to sort out the mess and provide the people of Monaghan with the necessary health services. We call on the Colleges, Comhairle na nOispideal, Medical Council and the Department of Health to do what is needed in Monaghan. We call on the Taoiseach and the Minister to take an interest in Monaghan and restore the services we are legally and morally entitled to.
When the pages of history record this episode in the life of Monaghan and its people it will be a sad tale and there are those for whom there will be little honour for the part they have played.

Statement from the Staff Action Group,
Monaghan General Hospital.

The following is a summary of the points made by the Minister and the North Eastern Health Board during the meeting with the Minister on March 27th 2002:

• A Consultant Physician with special interest in Rehabilitation Medicine will be appointed. (This was promised in 1998).
• A Dermatologist service will be given to Monaghan General Hospital.
• A replacement Consultant Surgeon will be appointed with administrative responsibility for A/E Department and with that appointment comes 5 NCHD (Junior Doctors). (This is to fill the post left vacant by the death of the late Mr. Moore.)
• A part-time Anaesthetist post will be made full-time.
• There will be NO in-patient Gynaecological Services in Monaghan General Hospital. Out-patient and Day services will undergo a further review by the Kinder Group.
• There will be NO in-patient Paediatric Services in Monaghan General Hospital.
• There was No commitment to give Monaghan General Hospital a designated Accident and Emergency Department, despite the appointment of Junior Hospital doctors. In other words the ‘Treatment Room’ designation still applies and this is to be reviewed by Comhairle na nOispideal. That report is due out in mid-April.
• There will be NO Post-mortem facilities at Monaghan General Hospital though there is a promise to upgrade the Mortuary.
• There was NO commitment to provide a CT Scanner for Monaghan General Hospital.
• A North Eastern Health Board brochure was produced, which had been circulated to all GP’s in Cavan and Monaghan, outlining the outpatient services and waiting list times for all hospitals in the NEHB region but Monaghan General Hospital was not even mentioned.
• While the delegation to meet the Minister was en route to Dublin the proposals were faxed to

Monaghan General Hospital.
P. McMahon

Statement from the Staff Action Group,
Monaghan General Hospital.
Following the meeting with the Minister of Health and the subsequent letter from Senator Ann Leonard in the Northern Standard, we would like to issue the following statement in order to inform the public and answer some of Senator Ann Leonard’s comments:

1. The ‘New’ Consultant Posts:
The Consultant Physician post, with special interest in rehabilitation medicine, was promised in 1999 and its effect is to bring the current number of physicians up to the minimum standard of three. There is nothing new in this proposal.
The Consultant Surgeon is merely a replacement post and is nothing new.
The Consultant Dermatologist is a split appointment with, we believe, six sessions in Monaghan, three in Drogheda and two in Navan, although this has not been confirmed. This has been given to Monaghan in lieu of an ENT Department, which the Minister said, when he met us previously, he would try to get for Monaghan General Hospital. This Department has now gone to Cavan. We would point out that, although welcome, this Dermatologist is not a Department of Dermatology.
Finally the half-time Anaesthetic post has been converted to a full-time one. This brings us up to the minimum standard of three Anaesthetists.
Thus of the three and a half ‘new’ consultant posts, one should have been there three years ago, one is a replacement and one, although welcome, was not asked for and will be of minimal benefit and a ‘half’ Anaesthetist post had to be given to bring the Anaesthetic Department up to minimum standards. Grouping all of these posts together as ‘new appointments’ or as an example of generous largesse towards Monaghan Hospital should be seen for what it is – a slight of hand. Nonetheless we are grateful to the North Eastern Health Board, the Department of Health and the Minister.
2. Non Consultant Hospital Doctors (NCHD):
At the meeting two extra NCHD posts were offered. Five are needed to run an Accident and Emergency Department. After a long and intense discussion, it appeared to us that three extra posts would be granted.
However the NEHB, in subsequent discussions, appears to have a problem with the interpretation of the meeting and also claim that the money is not available from the Department. This is despite the fact that Dr. McLoughlin, CEO of the NEHB, Kells, and Mr. Molloy, General Manager of Cavan/Monaghan Hospital Group, were present at the meeting.
The title of the Treatment/A & E Department was specifically raised at the meeting. NO guarantee was given to call it an A & E Department. As we have repeatedly pointed out, without the appellation ‘A & E Department’, no definitive development can take place. The NEHB consistently and pointedly keeps referring to a ‘Treatment Room’. We would point out that there is no such title or definition in medical literature. Thus its size, equipment and staffing can be anything the NEHB sees fit. However, were it to be called an A & E Department, it would have to be of a very particular size and design and would have to be equipped and staffed to a high level – including A & E Consultants. Furthermore, repeated references, during this part of the meeting, were made to:
(a) The Comhairle na nOispideal report on the A & E Services (Countrywide), which has just now been published.
(b) The NEHB/RCSI Review Group of Surgical / A & E Services in the NEHB Area (Just started).
The NEHB officials, who were present, made it clear that there was nothing that would be done until these reports and reviews were completed. Thus, the title ‘A & E Department’ has not been granted. The staffing, although apparently agreed at the meeting, has not been confirmed to date by the NEHB Personnel Department. The fact is that the Advertisements for these A & E non-consultant hospital posts have not been placed in National or Medical publications to date. We can only draw one conclusion – we fail to see how anyone can draw any other conclusion.

3. Development Plans for the High Dependency Unit / ICU:
We were told that these were to be ‘fast-tracked’. We would gently point out that the plans and the funding for this project have already been signed off – before the meeting with the Minister. With respect, the development cannot go anymore quickly – there is nothing new here, but we look forward to its opening.

4. The meeting ended with confirmation of an end to in - patient gynaecology and obstetric services, an end to in - patient paediatric medicine and surgery, and that a CT Scanner will not be provided (by today’s standards, acute trauma and/or geriatric rehabilitation medicine must have an on-site CT Scanner). Senator Leonard did not allude to these facts in her letter.

5. Also in her letter, Senator Leonard says she was given a positive response by the Hospital Deputation after the meeting – We would point out that we had no time to digest the details of a two hour meeting, discuss it among ourselves, and give any type of a response to her or anybody else, minutes after the meeting took place. The contents of this statement should make it abundantly clear how we feel about the meeting. However we would like to thank Senator Leonard for her courtesy and efficiency during our meeting with the Minister.
We agree with her that the grave situation at Monaghan General Hospital should be above politics – that is why, no doubt, it was seen fit not to invite representatives from any other party or political persuasion to this meeting with the Minister. The only politicians represented at the meeting were from her own party. Yes indeed, Senator Leonard, to quote your own words - we all have a duty to put Monaghan General Hospital first and politics second.

Yours sincerely,
Staff Action Group.

County Community Alliance to Restore Acute Services at Monaghan General Hospital.

Press Release issued Tuesday July 30th 2002.

Patients from counties Tyrone and Armagh, who were due to have elective surgery carried out at Monaghan General Hospital, were disappointed to learn that, as and from July 2nd last, Elective Surgery has been cancelled at the hospital.
Through CAWT initiative, spearheaded by a Consultant Surgeon in Monaghan, patients on waiting lists in Craigavon Hospital were travelling to Monaghan to have surgery, while patients in Monaghan were receiving treatment in Craigavon. Due to new regulations introduced by the College of Anaesthesia in Dublin regarding the status of Monaghan as a training hospital for Anaesthetic Registrars, anaesthetic cover was withdrawn from the hospital, which means that all Emergency and Elective surgery procedures have ceased there. Indeed a number of patients from Northern Ireland received notification on the evening prior to the cessation and two, who could not be contacted by the hospital, actually turned up at the hospital, only to be turned away.
The withdrawal of services at Monaghan General Hospital has been going on piecemeal over the past few years. Monaghan has now no maternity services, no gynaecology services, no paediatric services, no accident & emergency, no medical or surgical emergency admissions, no post-mortems, and no guarantee that acute services will be restored. At the moment there are 300 staff looking after 13 patients and when these are discharged no one seems to know what is going to happen. The people of Monaghan are going en masse to the Department of Health on Wednesday, July 31st to demonstrate their rejection of the downgrading and demanding a restoration of full acute services. On numerous occasions recently, the Minister of Health has promised action but his promises have not been implemented by the North Eastern Health Board, who are responsible for the management of the Hospital.
The location of the hospital is ideal for the continuance of and the further development of Cross-border CAWT initiative, which would bring benefits to patients of both regions, but this latest blow to the hospital has ended the initiative in its infancy, and again it is the people in need who must suffer. The County Community Alliance, which was elected by over 2,000 people at a public meeting in Monaghan last week, would be very anxious to see this initiative developed. However in order for this to happen they demand that the Minister takes direct action to ensure that the Health Board provides the necessary infrastructure and resources to satisfy the regulations laid down by the professional bodies like the College of Anaesthesia. A proposal to have day-surgery on a 9 to 5 basis five days per week in not acceptable to the Alliance as it will not allow the CAWT initiative to resume nor will it provide for emergency admissions. The Alliance reminds all people from Northern Ireland travelling through County Monaghan that, while in the county, emergencies must be taken to Drogheda, almost two hours away.

Following the meeting with the Minister for Health on March 27th, do you know?

You now have:

1. NO Maternity Services in County Monaghan.
   
2. NO Gynaecology Services in County Monaghan.
   
3. NO Children’s Ward in County Monaghan.
   
4. NO Post-mortems in Monaghan General Hospital.
   

You will have:

1. NO Accident and Emergency.
   
2. NO CAT Scanner.
   
3. NO guarantee of major surgery in the future.YOU HAVE THE POWER TO CHANGE THIS.Did you know that in the "Health Act of 1970" you, THE PEOPLE OF COUNTY MONAGHAN, are legally entitled to all of the above services at Monaghan General Hospital but all we seem to get are empty promises.
   We have been promised THREE NEW CONSULTANTS. The first is a Consultant Physician – we were promised that in 1999 and we still wait. The second is a replacement for the late Mr. Moore. The third is a Consultant Dermatologist, who will have a split appointment in other hospitals with SIX SESSIONS in Monaghan.
   

In order that we have an Accident and Emergency unit there needs to be A&E Consultants. It is also necessary to have a CT Scanner on site. That is not happening therefore we will have no A & E. Monaghan General Hospital should not be a ‘Political Football’ – it is too serious. We are talking here about the health, and perhaps the death, on Monaghan citizens. At the very least we are allowing someone to take away our statutory right. All Groups, Clubs, Organizations, Businesses, Industry, Schools, Congregations etc. etc. must let the Minister, the Department of Health and the North Eastern Board know, that we, the people of Monaghan, do not accept the demise of these acute services at Monaghan General Hospital.

Above is Press Release from the County Monaghan Alliance to Restore General Hospital Services at Monaghan General Hospital.

________________________.
Peadar McMahon, Chairp

Has Ireland lost all its humanity and christianity when the Celtic Tiger is now more important than the life, health and welfare of the people? Where has democracy gone when ‘the powers that be’ fail to listen to the voices of the people as expressed by elected representatives and by the people themselves at mass rallies and by 34,000 signatories to a petition in support of the hospital? The Northern Standard newspaper has for twenty years highlighted the hospital issue and carried the demands of the people of Monaghan but to no avail. Now we have reached a new low when our consultants, doctors, nurses and other hospital staff have to give up their free time to fight for the retention and restoration of a fully equipped, fully staffed and properly funded hospital in Monaghan.
In order to take some of the burden from them and to draw up a strategy to give the people of Monaghan an opportunity to ‘shout louder’, a Hospital Community Support Group is being set up and will announce its plans in the near future. Public support for this group will be sought from all quarters.
Over the years thousands can thank Monaghan General Hospital for the treatment received and, in many cases, lives saved. It has the most caring, most professional and most competent staff to be found in the country yet they must work in very difficult conditions. The threat of closure has become an every day topic but they carry on with their compassionate and expert caring for the sick in their wards. Reviews are being carried out on many of the services and it is obvious that, due to lack of funding and the will to give the people of Monaghan a proper hospital, offering full services as it has in the past, bit-by-bit these services will be withdrawn until there is nothing left.
Where will we be then? Will we erect signs at all approach roads to the county – ‘You are now entering a Hospital Free Zone – please do not get sick or injured while in the county’. What excuse will be given when a person dies because they did not reach one of these far away hospitals in time? When you are bumping along the road in an ambulance to Drogheda or Navan with your broken leg and no one to give you painkillers until you get there, I’m sure you will be comforted by the thought that you are saving the country money. County Monaghan has a Community Centre in every parish, National Schools in every parish, Second level Schools in every town, GAA clubs, Soccer clubs, Cycling Clubs, and sports clubs of all descriptions, major Motorcycle and Motor Sport events – all, at some time or other, provide accidents requiring hospital treatment. Are we happy to make the long journey to Navan or Drogheda? Is that what we want for our children? Farm accident victims will also have to make that tortuous journey to get treatment as will injuries sustained in our factories and workplaces. Can we attract industry and investment to a county with no hospital? That is the way we are heading unless we persuade the ‘powers that be’ to change their minds – now.
The Hospital Community Support Group will inform the public of developments and it is hoped that the public will join in whatever strategy is planned to achieve the end – a fully equipped, fully staffed and properly funded General Hospital in Monaghan with a designated Accident and Emergency Department. This includes a CT Scanner, which is essential for diagnosis, especially for stroke sufferers and those with head injuries. Even at the moment these patients must travel to Cavan to have the scan and, if they are being transferred to Dublin for specialist treatment, then they must come back to Monaghan first and then on to Dublin. The CT Scanner investment is not huge and having one on site in Monaghan would be cost effective, when one considers the cost of transport and accompanying personnel, not to mention the benefits to the patient in not having to undergo the perilous journey while dangerously ill.
Monaghan General Hospital is our hospital and we have a right to have one, capable of looking after our needs. It is up to you and me to ensure that we have one, for ourselves, our children and our children’s children.

Thanking you,
Peadar McMahon.

Mullan Road,
Emyvale,
Co. Monaghan.
Phone: 047-87239.

Manager,
Dunnes Stores,
Dawson Street,
Monaghan.

Dear Sir / Madam,

Acute Services at Monaghan General Hospital have been suspended since July 2nd 2002. This means, among other things, that there is no Accident & Emergency service available. The North Eastern Health Board, in conjunction with the College of Anaesthesia, is proposing to have Minor Surgery on a 9 to 5 fiveday week basis. This will not restore A & E to the hospital and is unacceptable to the Community Alliance and to the Medical Board in the Hospital.
The absence of an A & E service in Monaghan has serious implications for the people of the county and also for the business community. Without it many employers will be faced with difficult problems in relation to Insurance, Health and Safety Regulations, and the work hours lost due to employees having to travel long distances for treatment. Some employers have stated that they will not be able to carry on their business in such circumstances. This will cause job-losses and will have a very negative effect on the economy of the county.
We are asking you to bring this situation to the attention of your Board and urge them to use all means at their disposal to impress upon the Minister, the Department of Health and the North Eastern Health Board the necessity for full acute services and A & E at the Monaghan Hospital site.

Thanking you,

Yours sincerely,

____________________________.
Peadar McMahon, Chairman of the Community Alliance.

To: Minister Michael Martin, TD.,
Minister of Health and Children.

The people of Monaghan demand that you ensure the implementation of the framework document adopted unanimously by the North Eastern Health Board in June 1998 for the development of acute services at Monaghan General Hospital, and that you ensure the implementation of the promises you have made, regarding the hospital, to the people of Monaghan on numerous occasions over the past few months, and the promises made by Dr. Rory O’Hanlon prior to the election this year.

The framework document states that the following programme of development and refurbishment will be required at Monaghan:

New A & E Department, Extended Out-patient and child care facilities, New Theatre suites, New Medical and Surgical wards, New High Dependency/Coronary care Unit, New Maternity Unit, New day Hospital, New Pathology Department, New Pharmacy, New Physical Medicine Department, New Radiology Department, New Central Sterile Supply Department, New Single/twin rooms, New Medical Records/Administration, New Catering and Canteen, New Concourse, New Education Centre, New Mortuary and Car Park.

This, according to the document, ‘would bring Monaghan up to the required standard of a modern hospital and provide the facilities outlined in the proposals contained in the document’, and that the funding for this was available through the £80m received under the National Development Plan.

Now, in 2002, Monaghan has:

NO Maternity Services
NO Gynaecology services
NO Childrens Ward
NO Medical or Surgical emergency admissions
NO Accident and Emergency
NO Post-mortems
NO Cat Scanner
NO Guarantee of the return of acute services to the hospital.

The people of Monaghan are legally entitled to these services at Monaghan and you have the power to ensure that these services are provided there. We urge you to act now.

These are our demands:

1. Three (3) Obstetric/Gynaecology Consultants and New Maternity Unit.
2. Three (3) Paediatric Consultants and New Paediatric Unit.
3. Three (3) Consultant Surgeons and a Second Theatre.
4. Three (3) Consultant Anaesthetists.
5. Fully equipped and staffed A & E Department including CAT scanner.
6. New Male Medical Ward and Separate Ward for Female Surgical patients.
7. More Medical Registrars.
8. Immediate provision of new ICU/Coronary Care Unit.
9. Facilities for Post Mortems.
10. New Management Structures at the Hospital, as proposed by yourself earlier this year.
11. New Boiler Heating provision.
12. General Refurbishment of Hospital.

We understand that this may mean investment in Monaghan but the benefits to the health service in general will be enormous:

• Waiting lists, not only in Monaghan but country wide, can be reduced by using the facilities available in Monaghan General Hospital.
  
• It will relieve the pressure on other hospitals, which are now overloaded.
  
• Cross-border arrangements, which had begun prior to July 2nd, can be renewed and increased, as Monaghan is ideally located and a sharing of health care resources will have knock-on effects in many other areas.
  

Acute and emergency services at Monaghan General Hospital are necessary for our industry, our businesses, our farmers, our schools, our sporting organisations and our people.
At the moment it is claimed that the volume of work in Monaghan Hospital does not warrant such an investment and could not sustain such placement of human resources. Our contention is that with such facilities the numbers will rise dramatically.
We would also claim that proper management of funding could yield a better value for money product, thereby reducing the total investment needed.

The people of Monaghan need these basic acute services at Monaghan.

We cannot accept the argument that the current plans being introduced are in the best interests of the patients or their families.

• We cannot accept that our health needs are best served by travelling to Cavan or Drogheda, especially when medical or surgical emergencies arise.
  
• We will not accept a 9 to 5 five-day week Day Hospital for minor surgery with 24hour service for convalescence.
  
• We do accept that specialist treatment will be required in Specialist Centres elsewhere but to remove our basic emergency services will never be accepted.
  
• We have serious concerns in the event of a serious disaster in the area. What is the Emergency Plan? Monaghan was a target for bombers in 1974 and there is no guarantee that a similar catastrophe could not happen again because of our location close to the border etc. Is it planned to ferry the injured to Drogheda? What if there is a major emergency in some of the many local factories?
  

The Department of Health and the North Eastern Health Board should not hide behind the Professional Bodies. The situation at Monaghan was brought about by the lack of investment in infrastructure and resources over the years and the Professional Bodies are now making decisions based on current volume and the present status of the hospital. These bodies would not have to make these decisions if the Health Board acted upon the Framework Document.

We beg of you Mr. Martin, intervene before it is too late. It is within your power to do so, it is your responsibility to do so, it is what the people f Monaghan want of
you and you must act now. The people of Monaghan havç begun this campaign for our basic rights and intend to continue until such time as a satisfactory solution is reached.

Signed: ___________________________________

on behalf of the County Monaghan Community Alliance.

Minister Michael Martin TD.,
Minister for Health and Children,
Hawkins House,
Dublin.

Dear Minister,

We are in crisis. Nothing is really happening to restore acute services to Monaghan General Hospital and from my conversation with an official of the North Eastern Health Board nothing is likely to happen in the immediate future. They are intent on changing the configuration of the hospital to a Geriatric Home with very minor surgery (or none) on a 9 to 5 basis five days per week. This is not acceptable and will not serve the needs of the people. How many will have to die to convince them that we need emergency services here. How many stories do we have to tell of the trauma, the hardship, the suffering, and the near disaster, which is being experienced by our people daily. Let no one say that this new plan is in the best interest and best medical care for us.

The Health Board plan may be falling into place for them but they have a long road to travel before they can finalise the deal. We cannot sit idly by when we cannot even access some of the essential services within the North Eastern Health Board region. We are now joining the ever-lengthening waiting lists in Dublin. Isn’t that what the Dublin Consultants really wanted when they recommend the downgrading of Monaghan, and then Dundalk and then Navan and then wherever. Services, which were available within a matter of days in Monaghan two months ago, must now be accessed in Dublin, which has a two-month waiting list. Tell that to a lady with suspected Cervical Cancer and try to comfort her. Tell it to a man with suspected Colon cancer and tell him he will be all right.

Minister, you must act now. This is a crisis. The Health Board is unable to manage the Health Care of the citizens entrusted to it. It is your duty and responsibility. Letters of regret to the relatives of deceased or apologies to those who suffer are useless. Instruct the Health Board to revise their plans. Instruct them to manage the Health Services properly. Make the Health Service people-centered and with equity as proposed in the 2001 Health Strategy.

Is mise le meas,

________________________________.
Peadar McMahon, Chairman.

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Minister Michael Martin TD.,
Minister for Health and Children,
Hawkins House,
Dublin.

Dear Minister,

I am writing to you on behalf of the concerned people of Monaghan who fear for their lives and health due to the current situation at Monaghan General Hospital. As has been demonstrated over recent weeks the new configuration of services at the Monaghan site will cost lives for some and tremendous hardship for others. It is also going to impact heavily on employment in the area and the economic stability of the region. The North Eastern Health Board, through poor management and lack of planning, has allowed this disastrous scenario to develop and must be held responsible for the resultant outcomes. The executive of that Board does not seem to have the will to reconsider their actions nor see themselves as accountable to anyone. It is our contention that you, as Minister, must accept the ultimate responsibility as laid down in the Health Act 1970 and reiterated in the Health Strategy 2001.

We are asking you Minister, please, intervene before more lives are lost and more suffering is endured by the people of the county. We are aware of the many vested interests involved in this crisis but our concern is for the health and lives of ourselves and our families. We need Accident and Emergency with Acute Medical and Surgery services. To sustain these there will have to be other services available e.g. Gynaecology but a specific specialised service could be placed here which would relieve the many waiting lists throughout the country. By doing this you could achieve a reduction of those waiting lists and thereby fulfil the Government’s promise at very little extra expense. A decision to implement this would achieve a very popular response and would remove the dark and heavy cloud under which we live at the moment.

We urge you to treat our request with urgency as no one among us can be sure when we will require the emergency services and to have them available within the ‘golden hour’ that is so vital for survival.

In anticipation of a favourable and early reply,

Is mise le meas,

________________________________.
Peadar McMahon, Chairman.

Minister Michael Martin TD.,
Minister for Health and Children,
Hawkins House,
Dublin.

Dear Minister,

It is past time for you to take control of the Health Services in the North Eastern Health Board region. They are now in a shambles and the crisis, and the way it is being handled, is clear evidence that the Board is not capable of managing without assistance. Unfortunately it is the people of Monaghan who are suffering the consequences. We have reams of examples of the trauma, suffering and inconvenience being experienced by our population, not to mention the stories of those who are alive due to the proximity of Monaghan General Hospital. Hopefully we will not be able to give you the stories of those who have died as a result of the disastrous policies of the NEHB.

The latest Press Release from the HB is indicative of the reasons for our distrust of their intentions. Imagine the slur on the Irish Hospital Consultants Association, when one of their proposals had to be vetted by unknown ‘independent medical advice’. It says something for the professionalism of the IHCA in the eyes of the HB. The proposal was rejected by the Board because it was considered that the delays would be detrimental to patients. This is exactly what we have been saying all along when our patients have to travel to Drogheda, and now Dublin, which will take two hours at best. There is no logic to their arguments.

Now the Board is going to submit their own proposals for consideration. Will they get ‘independent medical advice’? This is their way of forcing a 9 to 5 hospital on us and we will not accept that in the interest of best medical practice for our people. Please, use your influence to sort out this mess and make our emergency health services people-centred and equal to those available in Dublin, Cork, Naas, Mullingar etc.

Thanking you in anticipation,

Is mise le meas,

________________________________.
Peadar McMahon, Chairman.

Mullan Road,
Emyvale,
Co. Monaghan.
Fón: 086-8156816

Dr. Rory O’Hanlon, TD.
Carrickmacross,
Co. Monaghan.

Dear Dr. Rory,

We would like to congratulate you on your re-election to Dail Eireann to represent our constituency and we wish you every success.

The County Monaghan Alliance is very concerned about the situation at Monaghan General Hospital and fearful of the consequences of the withdrawal of services from the Monaghan site. We are delighted to hear that you have called for a Public Enquiry into the Health Board and its management of the Monaghan Hospital. We, too, would like to know where the millions of punts have been spent and we hope that you pursue this demand.

A delegation from the Alliance would like to meet with you to discuss the Hospital and its future. The delegation would include: Mr. Joe Heron, Ms. Heather Graham and myself, together with one member of the Hospital staff. We suggest a meeting in the Hillgrove Hotel after 6.00pm. on a day best suited to you and at your earliest convenience.
Hoping that you can facilitate this and thanking you,

Is mise,
Le meas,

______________________________.
Peadar McMahon.

Mullan Road,
Emyvale,
Co. Monaghan.
Fón: 047-87239.

Dr. Rory O’Hanlon TD,
Ceann Comhairle,
Carrickmacross,
Co. Monaghan.

Dear Dr. Rory,

Members of the County Monaghan Community Alliance request a meeting with you to discuss the situation at Monaghan General Hospital. I would be grateful if you could contact me to arrange a convenient time and place for the meeting but we ask that it be held before Wednesday, August 14th 2002.

Thanking you,

Yours sincerely,

______________________.
Peadar McMahon.