It would be too easy to dismiss the current controversy over Monaghan General Hospital as a matter of local people opposing best practice in medicine.
The issue is more complex than that; it also concerns the question of whether big is best and whether the needs of local communities are best met by remote hospitals.
In recent times the professional bodies which regulate the training of doctors, and the Medical Council, have implemented a more stringent attitude towards the level of training and of facilities in Irish hospitals - and they are entirely right to do so.
This exercise has seen the loss of consultant-led maternity services in Monaghan, on the basis of recommendations from the Institute of Obstetricians and Gynaecologists. This may be replaced, in two to three years' time, by a midwife-led maternity unit.
It has also seen the withdrawal of recognition from Monaghan, by the College of Anaesthetists, as a training hospital for anaesthetists. This means the hospital is no longer "on call" for emergencies and that elective surgery there has been severely curtailed. The College has suggested that a 9 a.m. to 5 p.m. surgical service be provided at Monaghan with the help of trainee anaesthetists from Cavan General Hospital five days a week.
All this is seen by many local people as a downgrading of their hospital. They argue that the proximity of a fully-functioning hospital is of enormous importance and that the resources should be provided to enable this to continue.
At a recent protest in Dublin one woman told the gathering that both she and her husband were alive only because of the proximity of the hospital. Her daughter, who died in the hospital, with her family around her, would have died alone in an ambulance had she had to be taken to a hospital further afield.
Whatever the outcome of the current controversy concerning anaesthetic services, it is important that the value of smaller general hospitals should not be overlooked and that their services, even if slimmed down, be configured in a way which enables them to provide a worthwhile continuing service to their local communities. This is not easy to achieve and the task facing the North Eastern Health Board is difficult and unenviable.