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Presentation To Minister Michael Martin T.D. - January
2002
Monaghan General Hospital was founded in the 1930’s.
the hospial was built by the people of Monaghan, through the
levying of an extra sum on their domestic rates bill over
a number of years. The hospital was like many other County
Hospitals managed by Monaghan County Council and was regarded
in it’s early years as being one of the premier medical
facilities on the island of Ireland. Indeed this proud tradition
remained largely unchallenged until the hospital was merged
as part of a Cavan Monaghan Hospital group. This is somewhat
significant as the people of Cavan were offered the same opportunity
to build a hospital at the time the Monaghan people funded
their own, but they chose rather to wait and some years later
and the state eventually built a modern facility in Cavan.
Many had hoped that at the time of the development of a new
Cavan Hospital that it might be situated in Cootehill and
thus would serve equally the needs of both counties, however
it is felt that political will swung the day and a new facility
was built in Cavan Town as an ‘equal partner’ to
the Monaghan Site. Since the establishment of the new facility
in Cavan attempts were made to close down Monaghan Hospital
as it was seen as being surplus to requirements. A successful
legal campaign halted this challenge to the Monaghan Hospital
and one might have been forgiven for believing that the unit
had been secured.
The last number of years have proved that that is not the
case and the NEHB through their actions have indicated that
they intend closing services in Monaghan General Hospital
down on a systematic basis. It appears that if the hospital
could not be killed quickly, then the powers that be will
let it die slowly, by increment and through stealth and deviousness.
In the last twelve months the following steps have been taken
to ensure the long term downgrading of Monaghan General to
the role of a glorified Doctors surgery.
‘Suspension’ of Maternity services on foot of a
letter from NEHB to Irish Public Bodies.
A cessation of services in the hospitals Operating Theatre.
Closure of the Post Mortem Facility at Monaghan General Hospital.
Reduction in A & E services at the hospital.
Imminent Cessation of Gynecological Services at Monaghan Site.
The reason behind many of these decisions has been spurious
at best. All were carried out by the NEHB in the name of ‘protecting
the best interests of the people of Monaghan’. However
with the instance of A & E, it appears that different
rules apply here to other hospitals in the country when it
comes to supervision of non – EU doctors. Even more damning
has been the boards decision to axe Gynecology on the basis
of insufficient staff, when a number of doctors were placed
on short contract and despite requests did not have those
contracts renewed. In addition to this a number of senior
doctors have been instructed that they may no longer offer
a Gynecological service at Monaghan despite their wishes to
do so. In total 6 doctors have been ordered for one reason
or another not to offer a service and yet the NEHB cannot
staff this service.
More bizarre in the case of Gynecology was that for the majority
of the time in which this service was operating in Monaghan,
it was doing so with greater efficacy and with higher output
than was the case of the same service at our sister hospital
in Cavan. Yet the cuts were made at Monaghan General. Absolutely
nothing strange about that?
At the end of last week it was pleasant to note that Monaghan
General was receiving an allocation of ten new beds. What
soured this happy note for many was to find out on Friday
that five beds were being removed from the Gynecology Unit.
This kind of thing has a habit of happening in Monaghan.
The NEHB called on the Department in 2001, for funding to
improve facilities in the A & E Unit in Monaghan and were
indeed granted a sum of money to do this. In the last fortnight
despite this grant we lost part of our A & E service.
Last year when we were facing the closure of Maternity Services
at Monaghan General, we were as a community given assurances
that other services were not under threat and indeed that
over _7 million (that’s in old money), was supposed to
be invested in developing services at Monaghan. A brief trip
around the facility indicates that there may have been some
difficulty in drawing down that money, or that whoever is
spending it doesn’t seem to be getting fantastic value
for money.
One thing in all of this stands out, that is that some one
or some body has a specific agenda regarding the long term
future of Monaghan General Hospital. It also appears that
whoever this is, is not being entirely frank with the elected
representatives from Monaghan on the NEHB or with the people
of Monaghan as a whole. Finally it is clear that the actions
of this body are set against the best interest of this County.
This is indeed an act of betrayal of trust.
Planning In The Twenty First Century. Guiding Principals.
Rural Proofing
Poverty Proofing
Spatial PlanningMonaghan A Brief Check Up.
A Business Perspective.
Whereas we as an organization recognize that other bodies
and groups within this community can speak with more authority
and more experience on the subject of healthcare provision,
we feel that there is an aspect to this debate which in terms
of the bigger picture must be analysed by government, one
which we are uniquely placed to put forward. The argument
in question relates to the economic fallout for Monaghan given
the continuing reduction in service at Monaghan General Hospital.
There are two principal issues at stake with regard to the
economic fallout from closure of services at Monaghan General
Hospital. The first of these refers to the highly topical
area of Health and Safety in the workplace. While many improvements
have been made in this regard in the last decade and while
best practice is becoming more widespread, accidents will
happen. Often with disastrous consequences for those involved.
The profile of our economy makes accidents even more likely
than in other counties as the economy of County Monaghan is
comprised to a large degree of high labour intensity manufacturing
processes. These manufacturing facilities where heavy machinery
is commonplace tend to lend themselves more to accidents in
the workplace. The provision of a top quality medical facility
in the immediate hinterland can make the difference between
an accident being an inconvenience or becoming a tragedy.
The down grading of A & E potentially adds another hour
to the duration that it will take a victim to receive proper
medical care that hour might be critical in saving a limb
or a life.
The fact of having to travel a further distance for resultant
outpatient care, not only is a drain on the local economy
but is also a burden on the injured who can no longer rely
on a service close to home when they require it most.
Whatever burden this loss of service may cause to existing
companies, it will harm our economy in another potentially
more serious way. Monaghan has an unenviable record in terms
of inward investment over the decades. North County Monaghan
in particular is nearly unique in all Ireland in having failed
to secure one IDA supported job through direct foreign investment.
The principal reason for this over the years has been the
proximity of this town to the border and the perception of
those foreign investors that we were too close to ‘the
troubles’.
The IDA are beginning the process of developing an advance
factory in Monaghan with the aim of introducing much needed
new blood into an economy which has been rocked by the loss
of a number of major industries in the last years (Pattons
& Monaghan Poultry Products) and whose indigenous industries
are coming under increasing threat. The job of the IDA and
other economic development organizations such as Enterprise
Ireland, Monaghan Chamber and Monaghan County Enterprise Board
will become virtually impossible were the Monaghan General
Hospital facility to be further downgraded.
It is an oft quoted fact by the officials of the IDA that
facilities such as Healthcare facilities and Educational facilities
are primary determining factors which larger investors will
examinie in making their decision to locate in a given area.
The continued attack on Monaghan General Hospital is an assault
on the future economic survival of this town. This is the
bigger picture.
While we accept that the NEHB has no mandate to examine the
bigger picture the government has not only a mandate but also
a responsibility to do so. Decisions taken by government are
by necessity holistic if they are to be properly thought out.
Now is the time for government to see the bigger picture.
A Role in The Border Region.
We have already alluded in this submission to a need for proper
Spatial Planning, elsewhere we mentioned the consequences
(economically) of being in a border location. Now is the time
to re – visit these concepts because they offer in many
ways a role for the future of services at Monaghan General.
The Good Friday agreement and in particular the inception
of the ‘cross border bodies’ has opened up a range
of possibilities for co – operation between the two states
on this island. Monaghan is uniquely placed to play a part
in developing this co-operation in a meaningful way, not least
in the area of healthcare.
At present, as a result of centralization of services in
Northern Ireland, large areas of South Tyrone and Armagh remain
far from their nearest major hospital, that being Craigavon.
This significant body of people are in need of a solution
to their primary healthcare needs. In a number of cases, through
co – operation, this problem could be solved by developing
and utilizing the existing facility at Monaghan General Hospital.
Positive feedback has already come from politicians north
of the border, indicating that this idea could be made to
work if the political will existed on this side of the border.
The two government departments already seem to enjoy close
relations, there seems little reason why this can not be given
a tangible expression. However further moves to downgrade
facilities in Monaghan, will mean this opportunity will be
lost at it’s ,ost suitable venue on either side of the
bord.
A Gesture of Good Faith.
The time has come for the government and specifically the
Department of Health to nail it’s colours to the mast
and to declare what it’s stated policy is regarding Monaghan
General Hospital. This government has claimed to support the
development of facilities at the hospital in the past and
yet here we are again, fighting over the loss of services.
The Minister has the power under legislation dating back
to 1970 to intervene with the running of health services by
the NEHB. This is crucial, otherwise we would have to question
the nature of our democracy, where two civil servants can
decide policy against the wishes of the elected representatives
of the people. Even if this act were not there, the Minister
for Health is the pay master of the health boards and in such
matters only a naïve believes that money does not talk.
The people of our county now want action from the Government
on this matter. We are demanding that our hospital, the hospital
we built and gave in trust to the state to run be returned
to a state which is befitting the title General Hospital.
We are demanding that the government no longer condones the
manner in which trained and dedicated staff, who wish to protect
the health of the community in which they serve are undermined
by the body that employs them, through constant cuts. We are
asking the Government to act in good faith.
As a gesture of this good faith we are calling for the immediate
re – instatement of gynecology services at Monaghan General.
This re – instatement is not difficult and can be achieved
by re – appointing the doctors whose contracts were not
renewed by the NEHB and by putting back the beds removed last
week.
We are also calling for the restoration and promised development
of A & E services at the site. This will entail a modest
investment in developing a better facility and the hiring
of 3 Regustrars and 4 Senior Health Officers. All of which
can be achieved without the authority of Comhairle na Ospideal,
lest that be in question.
These two steps can be achieved within a matter of a few months
and would spell out the governments commitment to the Hospital.
Should such a commitment not be forthcoming, the government
of the day will be seen as complicit in the act of betrayal
cited above.
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