Bunting across the town's main street exhorts passers-by to help "Save Monaghan Hospital". The issue excites such passions in the county that thousands have been turning up at meetings to see how they can help, reports Kitty Holland from Monaghan
People who care about health services across the State should watch what is happening in Monaghan closely, warns one of the more passionate campaigners for the local hospital.
Mr Peadar McMahon, chairman of the Monaghan Community Alliance (MCA), helped erect the bunting across the town's main street. It exhorts passers-by to help, "Save Monaghan Hospital".
The issue excites such passions in the county that thousands have been turning up at meetings to see how they can help. At one such, in February, Mr McMahon was elected to chair a 22-strong MCA, mandated to speak on behalf of all those concerned about their hospital's fate.
Thousands travelled to Dublin in the summer to march with banners and loud-speakers, while for the past month up to three at a time have been taking it in turns to stage a bread and water fast outside the Department of the Taoiseach to draw attention to the issue.
Local Independent TD, Mr Paudge Connolly was elected on a health ticket, polling over 7,000 first preference votes, while local Sinn Féin TD, Mr Caoimhghín Ó Caoláin is one of the most passionate campaigners on the issue and his party's health spokesman.
As local GP, Dr Ilona Duffy explains, the fight has become about more than just the hospital. "Monaghan has always been a thriving, fiercely independent, industrious town. But then, over the past few years Monaghan Poultry closed last year, infrastructure has not been developed, there's a real sense that Monaghan is just being drained, left, ignored." If the hospital were to close, she says, "it would be like the beginning of the end".
CEO of the North Eastern Health Board, Mr Paul Robinson, is adamant the hospital will not close. However, "it is going to change radically".
Mr McMahon warns the "radical" changes planned by the NEHB, amount to plans to downgrade the hospital to little more than a "day centre for the elderly". Early last year the hospital lost its maternity, gynaecology and post- mortem facilities. Since July it has been taken off-call and surgery has been severely reduced because of difficulties recruiting anaesthetists.
Its A&E department has been open only from 9 a.m. to 5 p.m. and only as a "treatment room" for patients who "self-present". Ambulances are being diverted to Cavan, Drogheda or even Dublin. And from December 31st, unless something radical is done, NCHD surgeons will no longer be permitted to work and train there by the Royal College of Surgeons.
"Is it any wonder we say our hospital is being down-graded?" asks Mr McMahon. "And the health board says it's not. How can we believe a word out of their mouths?" The manner in which the "radical changes" are being implemented seems to produce as much ire as the changes themselves, with the board seeming to initiate changes - or the withdrawal of services - after being apparently compelled to do so by other bodies.
Maternity services were "suspended" in February last year "for insurance reasons".
Full maternity service has not been restored because additional obstetricians sought by the insurance company were not recruited.
So despite the fact that the birth rate in the Monaghan area exceeds that in Cavan, women must now travel the extra 30 miles, on bad roads, to Cavan General Hospital to have their baby. Gynaecology was suddenly withdrawn from Monaghan to Cavan, also last year. Now a consultant gynaecologist travels from Cavan to hold a clinic in Monaghan once a week while Monaghan's obstetrician-gynaecologist, Dr Alphonsus Kennedy, is not allowed to practise.
The situation with the anaesthetists is complex and has its roots in regulations laid down by the College of Anaesthetists, which last year stipulated that only hospitals with a critical "volume and complexity" of case would be accredited for training purposes.
The majority of NCHDs working in Irish hospitals are non-EU nationals finishing their training here, who get temporary registration until they sit necessary exams. To be allowed employ such doctors a hospital must have training accreditation. Monaghan General does not have required "volume and complexity of cases".
It is argued that if full-time gynaecology - which brought about 800 cases through annually - had not been withdrawn the hospital would have got accreditation.
True or not, the result of Monaghan's not being allowed to recruit non-EU NCHD anaesthetists has been that emergency and elective surgery were cancelled on July 1st. Elective day surgery, which does not require an over-night stay, was restored but the hospital remains off-call with Monaghan ambulances sent elsewhere.According to Monaghan's sole consultant anaesthetists, Dr Paul Kenny, two more anaesthetists are needed to restore full cover. These are not going to be recruited from the non-EU NCHD pool, he concedes. "But we were able to line up three fully registered EU NCHD anaesthetists for interview, who would not be subject to the RCA's regulations. That is what Naas Hospital, which also didn't get accreditation, did and the crisis there was averted in a matter of days."
However, the NEHB refused to allow the interviews take place, arguing that Mr Kenny's plan would be just a short-term solution, with the EU registered candidates liable to leave Monaghan after six months.
Dr Duffy, however, rebuts this argument, calling it disingenuous, given that all NCHD contracts are of six-months' duration. "It would have gotten us over the hump."
It would appear the NEHB is determined that its plan, to have anaesthetic cover for Monaghan provided from Cavan, should prevail. It is a plan being resisted by the Monaghan consultants.
While refusing to use the term "downgrade", Mr Robinson says some services, such as full obstetric will not be restored.
The NEHB serves a population of 310,000 people, he says, with five hospitals. New guidelines from the medical regulatory authorities stipulating that hospitals must have "a sufficient complexity and volume of cases to maintain skills of the doctors" mean certain services must be concentrated in a small number of centres. In the NEHB the main centre will be Our Lady Of Lourdes Hospital in Drogheda.
It is planned that Monaghan will have gynaecology, urology, ENT, a mid-wife led maternity unit as well as full elective day surgery. It will be a hospital providing day services with the level of A&E cover yet to be established.
Changes and the "reconfiguration" of services are "being forced" on the board faster than it anticipated, said Mr Robinson. "People have to adapt quickly, with staff having to adapt most quickly," he said. But the "reconfiguration" of hospital services in the north-east would be implemented despite opposition.