DETAILED PLANS have now been drawn up by the Health Service Executive to transfer all acute inpatient care from Monaghan General Hospital to Cavan General Hospital by November.
There are also plans to transfer all major emergency surgery from Our Lady's Hospital, Navan, and all out of hours emergency surgery from the Louth County Hospital in Dundalk to Our Lady of Lourdes Hospital, Drogheda, by July or September at the latest.
The plans are documented in a 69-page draft report drawn up by the HSE, dated April 15th last.
The report, seen by The Irish Times, states that the reconfiguration of services will require a wide range of changes for staff including changes in work location, hours worked, shift patters, type of work performed, earnings, reporting relationships and ways of working.
It says medical assessment units will have to be set up in Drogheda, Cavan and Navan to support the changes and these will require significant extra staffing.
There are also plans for extra ambulances in the region and the introduction of "intermediate care vehicles" to allow for speedy transfer of patients back to Monaghan hospital from Cavan after their acute episode of care.
Furthermore it says "a team of six appropriately trained advanced paramedics will be deployed in rapid response vehicles 24/7" to provide patients in Cavan-Monaghan with access to life-saving clot-busting treatments on the spot.
Monaghan Hospital, where beds will be used for rehabilitation, respite and day case procedures instead of acute care under the plan, will end up with a minor injuries unit open 12 hours a day and the A&E unit in Cavan will have to be extended. This is currently being looked at.
However, the report stresses that no additional resources have been provided to the HSE to effect the changes, which it says are being implemented in the interests of patient safety.
"The current financial constraints in the HSE present a very clear challenge in delivering these required improvements.
"Additional funding is not available to implement these service changes . . . In essence, the HSE must achieve these improvements by making the best use of its existing resources and funds," it says.
The report reckons that if the length of stay for patients is reduced in Cavan this will free up more beds for patients coming from Monaghan. "It is estimated that an additional 864 patients in a year will require packages of care in the community to facilitate early hospital discharge and admission avoidance," it adds.
Peadar McMahon, chairman of the Monaghan Hospital Action Group, said there were 11,000 attendances a year at the casualty unit of Monaghan hospital at present and 36 per cent of those required admission. Now these patients would have to go to Cavan where already there were patients on trolleys in A&E every day of the week. "They say that is a better service . . . it's madness, it's stupid and it's frustrating," he said.
He also said the plan seemed to be to run down services in one hospital first and then use the money that was saved to build up services elsewhere, rather than putting an alternative in place first.
He pointed out that the last time Monaghan hospital was taken off call for emergencies 17 patients from the county were dead on arrival at other hospitals. He also warned that what was planned for the north east was a blueprint for other regions and said it was time people around the country realised this and started campaigning against it.
Mr McMahon was speaking at a conference in Dublin's Liberty Hall on Saturday as part of the ongoing campaign by unions, patient groups and others for a decent public health service.
Prof Allyson Pollack, of the Centre for International Public Health Policy at the University of Edinburgh, told those attending they should not be afraid to question government claims that centralisation of health services was better. They should seek the evidence behind those claims.
She said the Government in Britain had claimed private hospitals built close to public ones - along the lines of the plan to build co-located hospitals here - would see thousands of extra patients a year and would give better value for money. But she said no figures had been produced to substantiate those claims.