GAVAN REILLY: Hospital downgrade another sign of Meath becoming Dublin’s B&B
It can be difficult to make a fair and neutral determination about issues like the possible loss of Navan’s 24-hour emergency department because they’re so inherently emotive. Nobody wants to lose a service on their doorstep, particularly when more and more people consider Navan their doorstep.
It should be recognised that there are some areas in which reconfiguration like the one proposed seems to have worked. The closure of the emergency department in Roscommon in 2011 was hugely politically contentious, but the upgrading of other local services, and the specialisation of labour in other nearby hospitals like Portiuncula, mean people having strokes or heart attacks largely have better outcomes than a decade ago.
That said, other parts of the country have not had the same positive experience. When similar closures happened in Ennis and Nenagh, the new expanded emergency department in Limerick was supposed to take up the slack. That ED is now the worst in the country for overcrowding; the ED expanded but the rest of the hospital did not. It’s like a funnel where the mouth is too big for the container.
Yet around the country there are stories of people who genuinely do better in bypassing their local hospital. One practitioner told me of a relative who woke overnight having a heart attack, but drove past their regional hospital on the road to Dublin where a surgeon inserted a stent less than two hours after the first chest pain. The same service wasn’t available in the local hospital; bypassing it probably saved his life. But others tell me of trying to triage a patient in the back of an ambulance, as it drove past a former ED which could naturally have done the same job better.
The overall lesson is that the positive experiences of one area aren’t always reflected elsewhere. Meath may be lucky to have two other acute hospitals on its north and south borders, but reconfiguring services only makes sense if those two hospitals can pick up the slack. A look at the HSE’s trolley stats last night (Monday) showed nobody on a trolley in Navan ED all day, while Connolly had ten yesterday afternoon and Drogheda had seven last night. Any additional heart attack patients going there will of course be prioritised, but that means someone else getting pushed down the queue.
It might well be the case that Ireland simply cannot sustain the number of emergency departments it has. But is there no sense of imagination, or ambition, where a modest number of additional staff might be able to maintain the service as it currently is? Where even one additional registrar, or a couple of extra consultants, could help to sustain a facility which has served people so well for so long?
Ultimately it seems to come down to the gimlet eye of a HR manager: if you were designing a brand-new hospital system from scratch, maybe you wouldn’t put an emergency department in Navan. But we’re not designing one from scratch, and it’s difficult to feel anything other than disheartened at Meath’s further slide into becoming Dublin’s B&B.