HSE needs to come clean on Our Lady's

No satisfactory explanation has yet been forthcoming from the HSE concerning its indecent haste in removing acute surgery from Our Lady's Hospital, Navan. It has consistently refuse to reveal the reasons behind the sudden removal of services at the hospital, provoking an angry outcry from doctors, staff, politicians and members of the public. "The decision has been made in the interest of providing the highest quality of service to patients and following expert clinical advice" was the extent of the cryptic communication from the health executive in the wake of the controversial decision, and it has not been elaborated upon to date. And it is this cone of silence, more than anything, that has angered medical and nursing staff so much. During a meeting last Thursday, the HSE again insisted to the Irish Nurses & Midwives Association (INMO) that it could not reveal why the decision was taken. The result is that patients who were scheduled to have operations do not know when they are going to have their procedures carried out and where, and staff are unaware of what the future holds for them and their jobs. Morale among workers at the hospital is said to be at rock bottom over what has happened during the past few weeks. A lack of information and absense of clarity has certainly left a lot to be desired. As many as 1,500 patients could be affected by the cessation of surgical services at the hospital and these patients will now be asked to travel to other hospitals in Dublin, Louth and Cavan to undergo procedures and treatment. Relatively common operations like appendectomies, gall bladder and hernia surgery can no longer be performed in Navan, leaving the three Navan-based consultant surgeons apparently under-utilised at a time when over 46,000 adults and children throughout the country are awaiting treatment or procedures, according to the HSE's latest performance report. At present, it is understood the Navan surgeons are providing on-call expertise in the hospital's emergency department, assisting in assessing patients before they are transferred elsewhere for surgery. They have argued in a letter to hospital management that the HSE move on the removal of surgery was without basis and that there was no good reason to remove acute surgery from Our Lady's. The move in taking surgical services out of Navan also would appear to run counter to the 2006 Teamwork report which supported Navan as a centre for planned general surgery. A further external report last year stated that Navan would function very well as a treatment centre for the likes of hernia repairs and laparoscopic surgery. So what has changed in the intervening period? That is the question staff, patients and the public now need to know. Amidst claims that the emergency department at Our Lady's is unsafe as a result of the changes forced upon the hospital, clarity needs to be brought to bear on the situation facing the Navan hospital. In particular, there are real concerns about the future of the A&E in Our Lady's, with local GPs claiming that once surgery is lost, then the A&E, medicine and orthopaedic will go within a matter of months. With such claims now being predicted, the HSE must come out and state clearly what role Our Lady's Hospital will have over the coming years in the north-east. Persuasive arguments can, of course, be made for centralisation and specialisation of medical services in surgical centres of excellence but what has happened with Navan is contrary to what had been promised in the context of the new regional hospital being built. There is a high degree of suspicion that the reconfiguration decisions that have been taken by the HSE have been engineered as a result of financial pressures rather than from a patient safety point of view. If this is not the case, then the HSE needs to persuade everyone concerned otherwise. The news that the regional orthopaedic unit is to close for the rest of 2010 as it has run over budget will mean there will be very little activity at Our Lady's for the rest of the year and only adds to the suggestions that financial considerations are behind the recent move by the HSE. One way or the other, it is time for the health authorities to come clean and spell out its intentions for Our Lady's.