The way in which surgical services are organised at Cavan and Monaghan general hospitals is to be radically changed. All acute surgery will be provided in Cavan hospital and day surgery only will take place in Monaghan.
The reorganisation at Cavan hospital stems from years of conflict in its surgical unit, followed by a series of clinical incidents over the past two years which dented public confidence. A year ago the surgical unit at the hospital was described as dysfunctional by the Royal College of Surgeons in Ireland (RCSI).
The Health Service Executive, which together with the RCSI outlined a new plan for the running of the unit yesterday, has recruited three new permanent consultant surgeons to replace locums at both Cavan and Monaghan surgical units from the beginning of January. This will bring to five the number of permanent surgeons in Cavan/Monaghan hospitals.
The surgeons, under the new arrangements, will all now be based in Cavan and will visit Monaghan hospital daily to provide day surgery for the region. At present there is one permanent surgeon and two locum consultant surgeons based in Monaghan. This arrangement is to end.
Under the new plan there will also be a surgical endoscopy session each weekday in Monaghan and access for GPs to outpatient appointments for urgent cases.
The move has been sharply criticised by the Monaghan Hospital Community Alliance which had been campaigning for the restoration of emergency surgery at Monaghan hospital, particularly in the wake of the death last month of Pat Joe Walsh (75) from a bleeding ulcer.
Alliance spokesman Peadar McMahon said he feared the people of Monaghan would be left to die in ambulances on the way to Cavan. "This is not a patient-centred service. It's a terrible day for the people of Monaghan."
Mr McMahon is concerned that without surgeons based full time in Monaghan, the hospital's emergency treatment room may no longer be able to open around the clock.
The RCSI and the HSE's National Hospitals Office said that in drawing up these arrangements, they had been guided by "the requirements of patient safety, good clinical care and service to the community".
Prof Niall O'Higgins of the RCSI said that if emergency services were spread over a number of sites in a region, patient care suffered. However he acknowledged there were issues around "enhancing quality of transfer services between the hospitals" and better communications.
Prof O'Higgins said the important thing was not that patients go to their nearest hospital, but to their nearest appropriate hospital, the place best equipped to deal with their needs.
The HSE and the RCSI said there had to be efficient use of scarce resources and it was essential to re-establish public confidence in the surgical unit in Cavan.
"The surgical service to Cavan/Monaghan must be perceived as being delivered by a five-surgeon unit and not by five individual one-surgeon units," they added. "All consultant surgeons should be enthusiastic in implementing this programme. It is scarcely conceivable that any would prefer a return to the status quo."