Doctors and consultants in Co Monaghan have raised concerns that services at Monaghan hospital will be further diminished by proposals for a major reorganisation of how it and Cavan hospital are managed.
On Thursday, the North-Eastern Health Board (NEHB) published details of its plans to create joint medical departments for the troubled Cavan and Monaghan hospitals. The board says that this will "secure the future of both hospitals".
However, the Irish Hospital Consultants' Association (IHCA) has raised concerns that the plan will merely result in consultants at both hospitals being blamed for a reduction in services at the smaller Monaghan hospital.
Mr Paul Robinson, chief executive of the NEHB, issued a number of directives relating to the proposed reorganisation.
Joint departments for all specialities are to be created for both hospitals. These departments will draw up plans for the delivery of services in each area.
An overall steering group has been established. It will decide on the level of service to be provided in each hospital in relation to specific specialities.
According to the directives, major surgical services will be provided at Cavan, or at other hospitals in the region, with Monaghan offering only a "protocol-driven day surgery". Day-patient and out-patient services will continue to be provided at both hospitals, along with "appropriate" diagnostic and support services.
The limited emergency treatment service currently available at Monaghan "will be provided under agreed protocols" with the Accident and Emergency service in Cavan.
Mr Finbarr Fitzpatrick, secretary-general of the IHCA, said that it was a "matter for the North-Eastern Health Board to decide on the services to be provided and where they will be provided".
The level of services at Monaghan hospital had been a "political hot potato" for 20 years, he said, and the \ board was "anxious to avoid the political fall-out" as a result of the reduction in services. The consultants were also anxious to avoid being blamed for any reduction in services in Monaghan.
Under the plan, it had already been decided that all acute surgical services would be in Cavan, but the consultants overseeing the new joint departments would take the blame, according to Mr Fitzpatrick.
Dr Illona Duffy, a Monaghan GP, said that medical professionals were "disappointed" with the proposals. Local GPs were in favour of a joint management approach in relation to services, she said, and both hospitals had specific expertise in different areas which could be capitalised on. "What's hapenning is that clinical autonomy is being taken away from the consultants and it's forcing things to be moved to a hospital \ that is not working."
A spokeswoman for the NEHB rejected the criticisms, saying that the board was implementing recommendations from two separate reports. The reforms would "secure the future of both Monaghan and Cavan".