HSE 'hasty' in surgery removal from Navan

THE decision by the Health Service Executive (HSE) to end laparoscopic (keyhole) surgery at Our Lady's Hospital, Navan has been challenged by 47 medical practitioners in the county who say that the move was "hasty" and "inappropriate" and have called on it to provide evidence to back up its claim that there were concerns about the consistency of meeting necessary standards in this type of surgery. The GPs said that they had a number of complaints to make about the decision and called on the HSE to respond urgently to them. Dubbing the HSE decision "hasty", the GPs said that unless there were well founded clinical concerns - such as evidence of poor practice or outcome that were not seen at other hospitals - it would appear "inappropriate" to end the surgical service without first consulting the GPs who use the hospital. "A failure to engage with the medical network before such a radical decision is of grave concern to us," the GPs said. The HSE replied yesterday (Tuesday) that it was available if requested to meet with GPs in the region to address their concerns. It was now advising GPs of the waiting time for laparascopic surgery at other hospitals in the Dublin North East region and to which patients might be referred. It said the decision to cease laparascopic surgery was based on an ongoing clinical review at the hospital "which identified a number of concerns regarding the consistency of meeting the necessary standards regarding laparascopic surgery". They also expressed concern that a leading surgeon in the north east, Finbarr Lennon, had not justified the HSE decision to end larascopy at Navan. "This colleague is the senior surgeon in the region, a keen advocate of appropriately resourced hospital services transformation and someone whose opinion we must value at least as highly as that of the experts unnamed in your statement". "The advice of Mr Lennon and other surgeons is that Our Lady's Hospital, Navan is an appropriate setting for the sort of surgery which you have now curtailed. His opinion, and therefore ours, is that the Capita report of last year makes it clear that Our Lady's is a safe setting for minor and intermediate level surgery and more especially for emergency appendicectomy and hernioraphy. We find it unlikely that your recent audit should have concluded otherwise if it was properly conducted". The GPs said that they found it unlikely that the HSE's recent audit should have concluded otherwise if it was properly conducted. "It seems to us that this policy will entail a far deeper loss of service than that suggested by your press statement of 10th August. While the number of cases per week may be as few as three, this represents the tip of the iceberg, with far more patients likely to require assessment for possible acute or elective surgery. These patients will also be adversely affected by your decision". The doctors accused the HSE of failing to take account of the adverse effect on other acute services of a surgical downgrade at Navan. "We understand that the loss of surgical capacity may preclude the safety of accepting acute medical cases at the hospital. In our opinion the Drogheda site [Our Lady of Lourdes] is not capable of accommodating the increase in surgical referrals which you have now engendered and would be wholly unable to cope with a redirection of acute medicine, should that occur". The GPs, who addressed their letter to Margaret Swords, Group Hospital Manager, Our Lady's Hospital, Navan and the Lourdes Hospital, and Dr D O Brannagain, Clinical Director (Medicine), HSE Louth Meath, said that the HSE's method of effecting the change "appears to call into question the competence of the surgical consultants in Navan. They referred to the recent "summary suspension" of a named surgeon at Navan, a decision which was subsequently reversed, and said they found it difficult to accept that all three surgeons could now be further undermined". They call on the HSE to provide evidence that the quality of surgical care at Navan has deteriorated since the Capita report. "We expect that you will have statistics for surgical outcome for the Navan site and comparative date from other hospitals. Unless these can be produced, we must suspect that the motive for this decision reflects a desire to downgrade the hospital at Navan." Meath East Fine Gael TD Shane McEntee said that the removal of laparoscopy services was yet another sign that "the whole health system is breaking down". He said that he knew of people who were on hospital waiting lists for 18 months. "One man who was in terrible pain came to see me and I learned that he was 63rd or 64th on the waiting list. "In the last few weeks I have been inundated with people who can't get appointments or health services. As far as I can see, Navan hospital is being turned into a nursing home and that's it". The Deputy called for an investigation into the medical services offered to a person whom he said was seriously injured during the 'Celebrity Bainisteoir' football event in Nobber at the weekend. On the removal of laparoscopy from Our Lady's Hospital Navan, he called on the HSE to offer justification for the decision. "The population in Meath is exploding yet we are having this drip-drip erosion of hospital services for the people here. "The HSE seems intent on pushing people into Drogheda which we know cannot cope with them. And there is the fact that a lot of people don't want to go to the Drogheda hospital. Fine Gael Cllr Suzanne Jamal said that the surgeon who performed laparoscopy at Navan hospital was very experienced at his job and would become deskilled if he was not allowed to continue this type of surgery. "This was a very hasty decision and one which leads people to believe that services at Our Lady's are being reduced, reduced and further reduced. I am not one to jump on the bandwagon to criticise the HSE but this decision completely lacked thought. The patients should come first in all of this". She said that if the HSE had concerns about medical safety surrounding this procedure, these concerns should have been raised and dealt with. In this case, however, the HSE had simply decided to put a blanket ban on laparoscopy. "I'm not falling for that one," the councillor said.