Yesterday in this House, Opposition Deputies exercised their rights to ask questions about the death of a man in Monaghan General Hospital last Friday. In doing so, Deputies reflected the outrage of people all over the country at the fact that a man could die in hospital from a condition which was treatable by the medical staff around him. Far from receiving satisfactory answers, we got a drip-feed of incomplete information. It is incredible that four days after this tragic death, the Tánaiste and the Taoiseach did not know that beds were available in Drogheda hospital. It is perfectly obvious that the health services and the competence of the health authorities in the north east are now in a complete mess. The Government has been warned repeatedly about this, but no action was taken politically to accept responsibility and see that competence was delivered. Deputy Crawford produced a letter in this House on 4 October which was sent out to GPs in the Cavan area. It stated that no patient should be sent into the hospital for emergency treatment because of trolleys and an inability to deal with them. It is incomprehensible that a man could have been allowed to die when personnel and medical staff were available with the necessary skills to carry out a vital life saving operation on him.

Does the Taoiseach accept that the protocols laid down for Drogheda, Monaghan and Cavan hospitals impose limitations on what can be done and the procedures that can be carried out? Does he accept that these protocols cause great confusion about what actually can be done? Does he accept that what is needed here is political direction to bring clarity to the situation? Yesterday, I raised the fact that under section 10 of the 2004 Act, the Minister for Health and Children is entitled to give a directive to the Health Service Executive in circumstances like this to the effect that no administrative procedure should prevent skilled surgeons and competent medical people from carrying out a life-saving operation. Will the Taoiseach see to it that such a directive is given under the law by the Minister for Health and Children to bring clarity and certainty to a situation like this? Skilled people in Monaghan General Hospital had to stand around and watch a patient die because of an administrative blockage. That is a scandal, which rests politically with the Taoiseach and the Government. Under the Act, he is entitled to bring clarity to the situation and I ask him to confirm that this morning.

We had a long debate about this yesterday, but I wish to express again our sincere sympathy to the family of Patrick Walsh, who died tragically in Monaghan last week. Deputy Kenny is right in that all the facts are not known. That is precisely why the Tánaiste announced yesterday — I reiterated it later — that Mr. Patrick Declan Carey, consultant surgeon at Belfast City Hospital and an honorary senior lecturer at Queen's University Belfast will carry out an independent and external review of the circumstance surrounding Mr. Walsh's death. That review will be completed, a report will be issued and will be made public. I look forward to the review finding an answer to the question as to the beds available in the region and what the circumstances were in Monaghan General Hospital. Deputy Kenny has come to his conclusion about the circumstances, but I would rather wait to see what happens.

There was an examination of this matter last year. A report was prepared by a steering group established by the former health board in the area. That steering group was representative of all the key stakeholders, including consultant representation in surgery, medicine and radiology from the hospitals. The recommendations of that steering group were unanimously approved by the members of the group. It recommended that major and emergency surgery should be carried out in Cavan General Hospital and that Monaghan General Hospital should provide selective, elective surgery. The recommendations refer to advice from the Royal College of Surgeons.

There are protocols in place, but no protocols prevent doctors doing what is right for patients. They never did and never will.

They did earlier last year.

Who was in the hospital at the time, who was watching and monitoring will all come out in the report. I will not comment on that. Professor Drumm has already stated that the issues around the hospital have been the subject of some considerable debate and that the HSE is working to solve them.

My view is that to give political directives on these issues is wrong. It is not for us to direct. If there are issues of resources or policy required, the Tánaiste and the Department will do whatever they can in that regard. She and her officials are dealing with all these issues. If I came in here every morning announcing or defending political directives for individual hospitals, or interfering with protocols governing the running of hospitals, that would be entirely wrong.

Hear, hear.

It is very sad when anyone dies, but it is wrong to intervene politically. It is right that we provide resources and staff, and we have a policy unit in the Department that works with the HSE. However, although Deputy Kenny might believe that the solution to every problem is to give political directions, I will not go down that road.

Deputy Kenny should be allowed to reply without interruption.

Consultants have stated the system is not working.

Deputy Kenny without interruption. It is leaders' questions.

The system is not working.

I ask Deputy Connolly to resume his seat. There are other ways in which Deputy Connolly can raise this issue. He spoke on the Adjournment last night. Deputy Kenny without interruption.

If the Taoiseach is not prepared to give political direction, that is a clear indication he is on his way out of office. The Taoiseach should note that I did not arrive at any conclusion about Monaghan hospital. I did not ask him to issue an individual direction in respect of any hospital. We are talking about the competence of the health service and the health authority and about 200,000 patients in that region.

Persons of skill and medical experience were unable to operate on Mr. Walsh, who bled to death in Monaghan hospital. They could not operate because of an administrative blockage which can be cleared for this hospital and for every hospital under section 10 of the Health Act. The Tánaiste and Minister for Health and Children is entitled to so do if she wishes.

As this matter is so confused, perhaps the Taoiseach will explain why a surgeon in Monaghan this year, the same person who could have carried out the operation on Mr. Pat Joe Walsh, was criticised by hospital management and the Health Service Executive for carrying out such an operation. If the Tánaiste wishes to give the Taoiseach a briefing, I will wait until she is finished.

The Deputy's time has concluded.

She will give Deputy Kenny directions.

It has not yet concluded because the Tánaiste is giving directions to the Taoiseach. Does the Taoiseach agree, as he did last year, that there should be independence and objectivity when assessing cases like this? If a train crashes or if a building collapses, a special investigative team is used. The Health and Safety Authority has such competence. There is no patient authority service and no health ombudsman who can act with complete objectivity and independence. While I do not decry Mr. Carey's qualifications, this should apply as a matter of competence and as a matter of course.

Will the Taoiseach see to it that a general directive is given under the Act so that this situation does not recur in any hospital for any patient, in other words, if someone is dying who can be saved, everything that needs to be done in a hospital to save that person will be done whatever the circumstances? Second, will the Taoiseach remove the confusion that exists because of protocols and other matters and put in place a health ombudsman and a patient service authority that will see to it that these situations can be investigated quickly, professionally, independently and objectively——

The Deputy's time is long over.

——so that competence can be achieved in the delivery of the health service? The Government lays down policy while Professor Drumm and the Health Service Executive are merely those who must deliver it.

As for the two points raised, while I do not take issue with Deputy Kenny, we should wait to find out what happened——

Wait until it happens again.

This is not the first time this has happened.

——in Monaghan that night. The Deputy has made an assumption and I do not blame him for so doing. He has assumed as he stated in his earlier contribution, that the consultants were present watching the man die. We should wait to find out what were the circumstances. We should wait to find out if protocols or a policy direction from either the HSE or the Department had an effect in this instance. We should wait. While I have learned of some of the circumstances, I am not prepared to state what I have heard until I see a report by an eminent person. I do not believe there will be any argument about that. I noted Deputy Kenny's comments about Dr. Carey.

What will happen then?

The second point has some validity and I have answered on this issue previously. As far as the hospitals of Monaghan, Cavan, Drogheda and Dundalk are concerned, for many years we have heard different people on the health boards as well as Members from all sides of this House talk about the issues, debates and occasionally arguments pertaining to that region. People have argued for their own hospital and area and about how the issue should best be handled. As far as policy is concerned and as to how Professor Drumm, his colleagues, the Tánaiste and I want to get services right in that region, I am sure the Deputy has heard what Professor Drumm and others have said about this issue in the past. We have also heard what the Royal College of Surgeons in Ireland has to say.

Some people have asked why the Royal College of Surgeons should have a role in dictating such issues. From a policy base, someone must make professional assessments as to what is the best way to give treatment to patients in an area, to have the units properly staffed with surgical and medical consultants, with backup ICU beds——

It is not the criterion used.

What does the Taoiseach think?

——given the population base and what specialties can deal with. These arguments have been fairly well thrashed out. As late as last year, a steering group unanimously approved the present basis.

Finally, there are no protocols or directions from the HSE, the Tánaiste, myself or the Department to prevent a doctor acting in the best interest of a patient——

The consultant was challenged the last time.

——in a certain set of circumstances. If the doctors were present and were challenged, I am confident they will explain that and the full facts will become available. I wish to end as I began, by stating that the tragedy is that Mr. Patrick Walsh is deceased, which I deeply regret.