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Navan Hospital

Closure of Navan A&E is 'built into' HSE's 'fresh look' review, say local TDs

A working group review into the planned closure of ED services at Our Lady’s Hospital Navan should be completed in a few weeks.

A REVIEW GROUP tasked to give a “fresh look” at the planned closure of the emergency department at Our Lady’s Hospital Navan will be completed in “a few weeks”, according to a HSE memo. 

Two Sinn Féin TDs as well as Aontú’s Peadar Toíbín have hit out against the wording of the terms of reference in which the review group is operating, saying the statement released by the Ireland East Hospital Group “make no reference to enhancing or even protecting existing services at Navan Hospital”. 

Health Minister Stephen Donnelly asked the HSE to carry out a review of capacity levels in light of a number of concerns being raised, particularly from consultants in Our Ladies of Lourdes Hospital in Drogheda, who said they had not been consulted about the plan. 

A letter, signed by 17 consultants, stated that the “transfer of risk from an unsafe ED in Our Lady’s Hospital in Navan to an under-resourced Our Lady of Lourdes Hospital in Drogheda will lead to poorer clinical outcomes for patients”.

With concerns that Drogheda could not take the additional patient load, the Taoiseach weighed in on the controversy, stating that Drogheda Hospital is already under pressure.

Thousands took part in a protest in Navan last month amid controversy after the HSE announced the final phase for the Co Meath hospital becoming a “model 2” facility.

The HSE insisted that the new Medical Assessment Unit (MAU) that would replace the emergency department (ED) service would still be able to facilitate around 80% of the current number of patients who present to the ED every day.

The remaining patients would be treated at Our Ladies of Lourdes Hospital in Drogheda. 

It has been confirmed that the planned MAU will be based on GP referrals 24 hours a day, seven days a week.

However, the GP out-of-hours service in the area stated it was not been consulted about the need for GP referrals, stating that its 24-hour service will be ending in August.

It is understood that this service is now in discussions with the HSE and is still operating its out-of-hours service at the moment. 

Confusion reigned as to who had signed off on the ED closure.

No Govt decision

When the HSE announced the downgrading of the emergency department, Health Minister Stephen Donnelly and Tánaiste Leo Varadkar both stated that no Government decision on the ED closure had been agreed with the HSE. 

However, Chief Clinical Director of the hospital in Navan, Gerry McEntee as well as outgoing HSE boss Paul Reid defended the planned closure of services, stating that it was being done for patient safety.

The terms of reference, which the review group is operating, sets out that capacity will be reviewed to ensure there is enough in place to “meet the additional demands that the proposed reconfiguration may place on services in effective locations”. 

The memo states that National Clinical Lead for Acute Hospitals Dr Mike O’Connor and the National Director for Acute Operations Dr Liam Woods will lead the process “to provide assurance in relation to the planned reconfiguration of services… and to ensure patient safety and quality assurance are central to any agreed changes”. 

No reference to retaining ED services

Sinn Fein TDs for Meath West, Johnny Guirke, and Meath East, Darren O’Rourke, have criticised the wording of the terms of reference, stating they make no reference to retaining the existing services at Navan Hospital.

They said the HSE and Minister for Health “remain hell-bent on closing its accident and emergency services”. 

The memo states that “prior to the confirmation of a date for proposed changes being enacted to services at Our Lady’s Hospital in Navan the working group will oversee a process to review and assess reconfiguration planning done to date”. 

As part of the review, the working group will conduct a “rapid review” of the reconfiguration plan and make recommendations on any additional capacity needs in advance of any transition of activity from the Navan Hospital to Drogheda. 

Ambulance services

It will also ensure that additional capacity necessary for ambulance services to meet the additional demands is in place. 

O’Rourke particular points to this commitment in light of recent reports this week of an urgent need to recruit more staff into the National Ambulance Service (NAS).

A HSE document states that at present recruitment efforts are being surpassed by service demands and warns that by 2027, less than 40% of life-threatening calls will be responded to within 19 minutes due to a lack of resources.

The terms of reference for the review group also sets out that it will need confirmation that there is sufficient staffing and “no diminution of services”, which includes the GP out-of-hours service not being curtailed.

While a number of local TDs hold criticisms of the development, Fianna Fáil Meath East TD and Minister of State of State for European Affairs Thomas Byrne told The Journal that he welcomed the review ordered by Health Minister Stephen Donnelly. 

“It includes a wide range of national and local medical expertise. I have always supported what is in the best interests of my constituents as advised by the experts. 

“However, when we met the HSE in June, the answers given about capacity in Drogheda and Connolly hospitals were simply not answered in any satisfactory way. 

“All three hospitals serve residents in Meath East. Each hospital must be safe and provide the best possible service to the people. I’m hopeful the review will answer some of the unanswered questions,” he said.  

Sources have said it is notable that the Ian Counihan, Clinical Director of Our Lady of Lourdes Hospital, who raised concerns about the reconfiguration, is on the working group.

It is understood that the key concern for the health minister is that Government needs to be satisfied that HSE has done what is required in terms of assessing capacity at Drogheda Hospital before any transition would take place. 

It is expected that targets may be set out in order for capacity to be reached over time, and this includes ambulance and out-of-hours service capacity.

‘Waiting times highest in years’

Meanwhile, Guirke said: 

“I am absolutely shocked that the terms of reference do not state where they will invest, enhance and protect our services at Navan Hospital.

“Though a working group has now been established, it seems that it is only in place to ensure the planned reconfiguration of services at Navan Hospital will take place.”

A&E waiting times are at their highest in years and moving patients from Navan to Drogheda will not improve times, it will just make things worse, he said.

“We have three sitting government ministers in County Meath – Thomas Byrne, Helen McEntee, and Damien English – all of whom have played hopscotch when it comes to the future of Our Lady’s Hospital,” he said. 

O’Rourke said the terms of reference are the final curtain call on the closure of Navan A&E. Nothing in the review terms of reference commit to keeping the emergency department open, he said.

“The whole process by the HSE and the Minister for Health Stephen Donnelly has been wholly unsatisfactory in relation to how they approached the closure of Navan A&E.

“It will take a spectacular challenge by the HSE to deliver more bed capacity and more staff for our hospital and ambulance services while trying to address long waiting times.

“Instead of being railroaded into removing necessary services, we need to see an urgent plan to invest, enhance and address any safety concerns at Our Lady’s Hospital in Navan,” he said. 

Meanwhile, Cathaoirleach of the Save Navan Hospital Campaign and Meath TD Peadar Tóibín also heavily criticised the terms of reference, stating that they have the closure of the emergency department “built into them”.

He called on the Government to include the logical option of strengthening A&E services at Navan with the provision of acute surgery services in Navan into the terms of reference.

“This is what the 200,000 people in Meath want and need. This is what tens of thousands of people marched for. This is our red line,” he said. 

The Journal sought comment from deputies McEntee and English.

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