Questions around access and capacity raised at Dail debate on future of Navan ED
The Minister of Health has said that he has instructed the HSE not to proceed with any proposed reconfiguration of the Emergency Department at Navan Hospital, for now.
Minister Stephen Donnelly said neither he nor his government colleagues were happy regarding issues including access to the proposed medical assessment unit (MAU), the capacity of the National Ambulance Service, local access to GPs, emergency and other resources in Drogheda and other hospitals.
Local Oireachtas members had been told at a meeting with the Minister on 13th June the ED was to close on 30th Junewith the aim of replacing it with a Medical Assessment Unit that was referral only. That decision was quickly paused by the Minister leaving local TDs demanding clarity on the issue.
"We need to allow for meaningful discussion and engagement with elected Members on all sides of the House and other stakeholders, including the community and clinicians. We need to assess all of that in the round and then decide where we are going."
The Minister was responding to a motion tabled by Sinn Fein's Johnny Guirke calling on the Government to state clearly their position on the future of the Emergency Department at Our Lady's Hospital, Navan. It also calls on the Minister to put forward proposals to protect and enhance emergency and critical care services at Navan hospital.
"Emergency departments across the State are suffering from ongoing and chronic overcrowding. In May, the average wait time for admission to emergency departments across the State stood at 11 hours, which is almost three times the Sláintecare target of four hours. It is clear that the hospitals closest to Navan do not have additional capacity.
"At Our Lady of Lourdes Hospital, Drogheda, in May, 31% of patients waited over 12 hours in the emergency department for admission, while in Connolly Hospital, the figure was 48%. This is the reality in hospitals across the State. Now is not the time to reduce emergency care capacity in our hospitals and to even consider such a move in the current climate is baffling."
Deputy Guirke paid tribute to the people of Meath for "fighting tooth and nail" to protect their hospital services.
"They have done so because they see the shambles caused by bad Government policy and they refuse to allow the same to happen to their community. We stand with them.
"The manner in which this was announced was a further insult to those people and a clear display of the chaos that lies at the heart of this Government. The day after the HSE made the announcement, it was directly contradicted by the Minister.
"The people of Meath deserve better. They deserve more than mixed messages from the Government and the HSE. They deserve better than having to constantly take to the streets to battle to protect their health services, which they have been doing for over a decade now. They deserve accessible and high quality health services and clarity from this Government.
Meat East TD Darren O'Rourke said the medical assessment unit (MAU) that is proposed to deal with up to 90% of the patients currently presenting to Navan will not work.
"It will not work because it is GP referral only. Our GPs are already overworked and overbooked during the day, and it is even worse at night. What will happen? If a person is ill at home, he or she will go to the door that will accept them. It will not be five a day or 2,000 a year. Up to 20,000 people per year would present at Our Lady of Lourdes Hospital in Drogheda.
"They may not be appropriate presentations, but they will be there and there is deep concern about this. We are hearing this spelled out in detail from clinicians on the front line. There is deep concern that those people who are currently presenting to Navan will all, or in very significant numbers, present to Drogheda and lead to worse outcomes and worse safety rather than better. I wish to spell this out clearly.
"We have heard from GPs and, while there are differences of opinion in the medical world, I believe that in practical terms this is exactly what will happen. I encourage the Minister to listen to that.
"I want to lay it fully on the agenda that the proposal from Sinn Féin is to retain the service and enhance the services at Our Lady's Hospital in Navan. That is the solution for it. There is no other credible alternative."
Justice Minister and Meath East TD Helen McEntee said she wanted what was best for the people of Meath and the surrounding counties.
"We want to ensure everybody gets the best possible healthcare, that we have appropriate access to that healthcare in appropriate timeframes and that we are seen in the best possible places by the best possible people."
Minister McEntee said there were still many questions to be answered concerning capacity in Navan and surrounding hospital as well as access to services in the proposed medical assessment unit.
"On capacity, our neighbouring hospitals are under severe strain. We have been told by clinicians in Drogheda that the capacity is not there and that we would be simply transferring a risk, and that additional capacity will be built into the system, yet a capital plan announced only a few weeks ago did not include resources or additional capacity for Drogheda in this context."
Responding, Minister Donnelly said no Government decision has been taken regarding the HSE's proposal for the transition of the emergency department at Our Lady's Hospital in Navan.
"It does not provide paediatric or obstetric care. It does not provide an acute surgical service. Ambulances bypass the emergency department for several conditions that cannot be catered for at the hospital.
"As part of the reconfiguration the HSE is looking to implement, it is proposing investment in more patient care in Navan. However, for any proposal to be considered, we would need to be satisfied on several levels. I am not satisfied and neither are the Government or Members of the Oireachtas. I acknowledge that.
"Legitimate questions have been raised by Members of the Oireachtas regarding issues including access to the medical assessment unit, the capacity of the National Ambulance Service, local access to GPs, emergency and other resources in Drogheda and other hospitals, the use of injury units and more."
The Minister said all of these issues have to be addressed and they have not been addressed "to my satisfaction".
"I have met with senior clinicians in Our Lady of Lourdes Hospital in Drogheda and they told me they do not currently have the resources required to cater for the additional patients who would have to go through their emergency department. For all of these reasons, I have instructed the HSE not to proceed at this time with any proposed reconfiguration at Navan.
"We need to allow for meaningful discussion and engagement with elected Members on all sides of the House and other stakeholders, including the community and clinicians. We need to assess all of that in the round and then decide where we are going. I want to be very clear on this.
"For the reasons I have raised and Members of the Government have raised, and indeed for reasons raised this evening, the Government position is absolutely clear. I have instructed the HSE not to proceed with what it had intended to do on 30th June."