LIAM J. McMULLIN,
Sir, - The problem in Monaghan General Hospital has nothing to do with the training of junior doctors. For 10 weeks this hospital has not taken "acute" calls for want of three non consultant hospital doctors in anaesthesia.
These three NCHDs must be fully registered with the Medical Council, as fully registered doctors do not need to be in training posts and therefore do not require the imprimatur of the College of Anaesthetists.
The North Eastern Health Board says these fully registered doctors are hard to find. That might be, but the NEHB had been slow to look. A routine advertisement for anaesthetic NCHDs appeared on February 26th. Under pressure, advertisements re-appeared last Sunday week - eight weeks after the crisis broke.
Why is the NEHB slow to look for these doctors? Because to find them would mean putting Monaghan General Hospital back on full 24 hours call. The NEHB does not want this to occur. The NEHB and the Department of Health want a five-day, minor surgery unit established at Monaghan with major, major/complex and acute surgery at Cavan. The NEHB will not admit to this plan because to do so is to admit that funding, and not training, is the problem.
This is the kernel of the matter. It appears that the NEHB does not have the resources to fund two district general hospitals in the Cavan/Monaghan area. But the CEO and those before him refuse to state this fact. This refusal leads inevitably to two further trains of action. Firstly, the slow, incremental and stealthy removal of services from one hospital and secondly, an elaborate pretence that this removal of services is not occurring.
This strategy also requires that as the NEHB cannot say that it is removing services because of funding, it must set up a situation where other agencies are forced to intervene. It does this by removing, or failing properly to staff, key services. Hence the involvement of the College of Anaesthetists, College of Surgeons, the insurance companies, the Kinder Report, the Condon Report, etc. etc.
Eventually, someone will have to state that the Exchequer is not prepared to fund two district general hospitals in Cavan and Monaghan. Had this been admitted in 1990 (when the new hospital in Cavan was opened), there would have been a political storm then. We are now witnessing tha't same storm, but in the interim we have added 12 bitter and distressing years of chicanery and double-speak.
Why will the NEHB not admit that this is purely a funding problem? Why will it not admit that the plan has always been to move acute surgery, obstetrics, and gynaecology and paediatrics to Cavan? Why is it allowed to persist with this style of management? Why despite the enormous waste of public money in the past 10 weeks at this hospital does there appear to be no urgency within the Department of Health to force a resolution one way or the other? What is the responsibility of the Department of Health? And will the NEHB specify exactly what services it requires at Monaghan General Hospital?
Finally let me nail the training argument. If we had a fully equipped and fully staffed hospital at Monaghan, there would be no shortage of patients for our care and I can assure you that the royal colleges would be queuing up to send us their trainees. - Yours, etc.,
LIAM J. McMULLIN, Consultant Surgeon, Monaghan.