A "huge chasm of mistrust" exists between the community served by Monaghan hospital and the North Eastern Health Board(NEHB) which must now be addressed, the Bonnar report published today concludes.
The report says there is a need to develop a "mutually trusting relationship" for the overall good of the hospital.
"There have been a number of reports and reviews of services in the NEHB area over the past few years and these have added further to a view in people's minds that there is an agenda to close or downgrade the hospital," the report says.
The first principle in developing a new trust must be an acceptance by all involved that the hospital is not going to be closed.
"It should also be recognised that the pattern of delivering services is changing world-wide and that Monaghan's best guarantee for the future is to participate in and accept changes which will ensure its viability and sustainability."
Mr Bonnar says the Baby Livingstone case and the general debate surrounding the future of the hospital had "not surprisingly" given rise to considerable debate in the media. While this had served to highlight the problems involved, it had also had the effect of portraying a negative view of the hospital that was "not in the long term interest of staff or patients".
In addition, Mr Bonnar says there is a great need for more consultation and involvement of staff in the management the hospital.
While his report acknowledges the sense of community at the hospital,the extent to which staff are willing to support each other and the "excellent" standard of patient care, it states that staff are frustrated as they believe they are "not able to get their point of view heard".
"There is therefore a requirement for increased an appropriate involvement of staff in the running of the hospital, as well as more delegation and empowerment," Mr Bonnar says.
"The new management structures for the hospital group [that I am recommending] will help to achieve these goals here, but to allow maximum cooperation and involvement a more open attitude is needed at all levels."
Mr Bonnar states that delegation should include delegation of budgets and resources.
He recommends changes to management at the hospital as the "energies which exist" at all levels are not being properly channelled. Greater involvement of medical staff and the establishment of a Joint Medical Committee are also among the report's recommendations.
Mr Bonnar says he has been told a revised protocol for dealing with emergency obstetric cases presenting to Monaghan hospital is almost finalised, in line with the reports published following the baby's death.