Dail told changes to Navan Hospital will see new units replace emergency department

Campaigners are mobilising to get thousands of people out on to the streets of Navan in order to stop HSE plans to replace the Emergency Department with a new Local Injuries Unit that will only open 12 hours a day.

A protest will take place outside the Dail at 12pm on Thursday while a Zoom meeting is being hosted by the Save Navan Hospital campaign at 8pm (see link below) on Thursday night to update the people of Navan and beyond of the situation with a view to mobilising street protests. (A planned meeting for the Newgrange Hotel was cancelled due to Covid restrictions.)

Deputies Johnny Guirke and Darren O'Rourke and Peadar Toibin participated in a Dail debate on the issue last night (Tuesday) where it was confirmed that the changes would see the 24/7 A&E Dept phased out along with critical care.

A statement was read out in the Dail by Minister for Disability Anne Rabbitte, standing in for Health Minister Stephen Donnelly which stated:

"...Changes to services at Navan hospital will be undertaken in a planned and orderly manner, when agreed, on completion of the necessary planning, which is ongoing. Planning envisages the development of a 24/7 acute medical assessment unit (AMAU) at Navan hospital, which is an extension of the current medical assessment unit hours at Navan. It also includes a 12/7 local injuries unit (LIU).

"This will replace the current emergency department and ensure that the hospital continues to cater for unscheduled presentations where appropriate and safe to do so."

According to the HSE's own 'Securing the Future of Smaller Hospitals: A Framework for Development' - published in 2013, where there is an LIU on site there will be an (AMAU) but there will be no critical care facility on site.

The LIU, which is earmarked to operate for just seven public-facing hours a day, will be self-referring for unscheduled emergency care for patients with non-life threatening or limb threatening injuries.

The AMAU, according to the 'Securing the Future of Smaller Hospitals' document will not be self-referring. Patients will only be admitted from the AMAU "under the care of a named consultant, and out-of-hours selected medical patients can be admitted by agreement between the GP and the on-call medical team/consultant."

Effectively a Local Injuries Unit will operate between the hours of 8am-8pm for patients with non life or limb threatening injuries with patients requiring more critical care sent to another hospital's A&E Department.

Deputy Johnny Guirke said the Minister (Anne Rabbitte) stated on the record that ‘’it’s not the case’’ of services getting cut at Navan Hospital, but then read a prepared script for her which stated that ‘’Planning envisages the development of a 24/7 Acute Medical Assessment Unit at Navan, which is an extension of the current AMAU hours at Navan. It also includes a 12/7 Local Injuries Unit. These will replace the current emergency Department and ensure that the hospital continues to cater for unscheduled presentations where appropriate and safe to do so’'"

"This contradictory statement also went on to say ‘’that changes about patient safety and quality on the one hand and ensuring that people have care as close to home as possible on the other’’ is damning to people in and around County Meath.

"It’s for this reason I say that we should take to the streets and take this fight to Leinster House. We will be protesting outside the Dail from 12pm to 2pm this Thursday 30th September and I urge anyone that can come in, that they do so.

"There will also be a ‘’Save Navan Hospital’’ public meeting that evening at the Newgrange hotel at 8:30pm and it's important that there is good attendance.

"Together, we are stronger in numbers so Meath must stand side by side and unite in our fight against downgrading of services at Our Lady’s Hospital in Navan."

FULL TRANSCRIPT OF DAIL PROCEEDINGS ON NAVAN HOSPITAL

DEPUTY DARREN O'ROURKE

I welcome the opportunity to discuss this incredibly important issue. I can say on behalf of the staff of Our Lady's Hospital, Navan, that there is serious concern about the future of critical and emergency care services at the hospital and that concern is matched by the local community and the population of County Meath.

The rumour mill is rife with stories of impending cuts to hours, staff and services in the emergency department and to critical care services. Is this the case?

That is the question we want answered. There is deep concern and it is heightened by the silence of the HSE.

As public representatives, we have raised questions, as have others. We have been deliberately ignored or those questions have been avoided.

Will the Minister of State provide assurances that critical and emergency services at Navan hospital will not be cut?

DEPUTY JOHNNY GUIRKE

There were rumours in August that patients who had presented to the accident and emergency unit at Our Lady's Hospital, Navan, were sent to Drogheda.

When I heard this, I called management at Navan hospital but I did not get a call back. I sent an email to the general manager of the hospital on 26 August and again last Friday, 24 September, but received no replies.

What are we supposed to think? More important, what about the people we represent if the hospital will not answer calls or emails on such serious issues? Is there a basis for our fears and those of the people of Meath that the future of accident and emergency and ICU services in Our Lady's Hospital, Navan, are in danger of being closed or downgraded?

Is it true the HSE leadership has been hell-bent on downgrading Navan hospital for years? If this is true, it will seriously affect healthcare in the north-east region. Meath has a population of 210,000, the fifth largest in the State.

We know the hospital in Drogheda is already under pressure, so are we to expect people from Meath to travel to Drogheda or Dublin this winter to lie on a hospital trolley? That is what will happen if emergency department or ICU services are downgraded in Navan hospital.

DEPUTY PEADAR TOIBIN

For ten years, the Government's stated policy has been to close the accident and emergency department in Navan hospital.

The hospital was put on the list in the small hospital framework document. It was to be moved to a level 2 hospital. It was on the HIQA hit list of ten hospitals that were to have accident and emergency departments removed.

Navan hospital is the only one of those ten hospitals whose accident and emergency remains open. In March 2020, the HSE went public to say it would close the accident and emergency department at the end of March overnight.

The only reason it did not do so was that cases of Covid started to arise in the country. It postponed the closure until April and then completely dropped the plan because Covid was swamping the country. In the past fortnight, four medical professionals have told me the HSE has made a formal decision to close the accident and emergency overnight. We know from a parliamentary question I submitted that the Minister has admitted a programme of redesign is under way in the Ireland East Hospital Group.

That redesign includes provision for a 24-7 acute medical assessment unit in Navan, in other words, a replacement for the accident and emergency department.

WATCH THE DEBATE HERE FROM (Slide to 38.30)

DEPUTY ANNE RABBITTE - Minister for Disability, standing in for Minister for Health Stephen Donnelly

Before coming to the House, I took advice in the Department. I spoke to the Minister, Deputy Stephen Donnelly, and my colleagues, the Ministers of State, Deputies English and Thomas Byrne, to gain a good understanding of what this issue was about. Deputy O'Rourke asked me a straight question and I am giving him a straight answer. No, it is not the case.c

I have a script that has been prepared by the Department, which I will read. It is important but it is also important to preface it with the answer I have just given.

Our Lady's Hospital, Navan, is part of Ireland East Hospital Group. In 2013, Navan hospital was included in the list of designated Model 2 hospitals under the smaller hospitals framework. The framework was approved by the then Government in 2013.

The Ireland East Hospital Group has been engaged in a programme of work to plan for future service configuration at Navan hospital in line with the Government decision. This aims to further integrate and enhance the role of Navan hospital within the hospital group. Every hospital in the group has a key role. Smaller hospitals such as Navan hospital are well placed to manage routine, urgent or planned care locally, while more complex cases are managed in larger hospitals.

Changes to services at Navan hospital will be undertaken in a planned and orderly manner, when agreed, on completion of the necessary planning, which is ongoing. Planning envisages the development of a 24-7 acute medical assessment unit at Navan hospital, which is an extension of the current medical assessment unit hours at Navan. It also includes a 12-7 local injuries unit. This will replace the current emergency department and ensure that the hospital continues to cater for unscheduled presentations where appropriate and safe to do so.

I understand that it is likely that the medical assessment unit and local injuries unit services will cater for around 80% of the unscheduled presentations to Navan hospital currently. The ambulance bypass of Navan hospital is already in place for patients who have acute coronary symptoms and for major trauma, including fractured femur. The planning envisages an extended role for the hospital in areas such as delivery of day and ambulatory surgical activity to support the overall delivery of access to care targets for the group, and strengthened links with the Mater Hospital in terms of clinical governance and patient safety.

These changes will require some investment and this will take time. Capital works are under way this year to bring a second theatre into operation at Navan hospital. I understand Our Lady's Hospital, Navan, has relatively recently opened a new laboratory and a new rehabilitation facility with 20 beds. That is a considerable investment. Clearly, it is essential that we resource other receiving hospitals before we make any change to the services at Navan hospital. This core part of the planning is under way and will take considerable time.

It is important to emphasise that changes will be about patient safety and quality, on one hand, and ensuring that people have care as close to home as possible, on the other. The HSE has stated clearly there is a patient safety rationale for the change and we must be mindful of that.

The vision for the hospital in the future is that it will be a core element in the delivery of integrated care for patients in line with the Sláintecare vision - providing the right care in the right place at the right time, building up capacity and supporting delivery of integrated and ambulatory care as close to home as possible.

For the Deputies opposite who did not receive a response from the HSE, I will contact directly whoever is in charge of this area seeking a detailed response as to why the good Deputies are not being communicated with as public representatives on the ground.

DEPUTY O'ROURKE

I thank the Minister of State for her forthright response, which is appreciated. However, I cannot understand how she can say there is no change in policy and then read that script. As far as I can see, the writing is on the wall. I have read enough from the HSE and enough health service policy down the years to know that. I have seen this before in the cases of Roscommon, Monaghan, Dundalk and Ennis hospitals. This is what it looks like. This is the language that is used to refer to change that is coming, including reference to a 24-7 acute medical assessment unit.

I do not believe, based on the written record here from the Department, that the concerns of the community will be allayed.

In fact, I believe that what was spelled out in the reply reflects the concerns that have been raised about the services that will be provided. I am very concerned and I think the community will be similarly concerned.

DEPUTY GUIRKE

I would like to get a commitment in writing that these services will not be downgraded during the lifetime of this Government. It would be good if the people of County Meath could get that because I think it would allay an awful lot of the fears they have. Those are genuine fears. You never see so many people come together than when it is to do with a hospital.

Another reason we are here is the HSE. It will not give any information, and not just to me. When radio stations, including our local station, LMFM, do not get information from the HSE, that creates fear.

I heard the Minister of State, Deputy English, on the radio this morning. He stated that there will be no downgrading of services. Navan hospital needs an expansion of its services, not a downgrade. If there is any downgrading of the accident and emergency service and the ICU in Navan, we will be left with no option but to take to the streets again. We will not let the HSE take our accident and emergency department.

DEPUTY TOIBIN

The response the Minister of State provided does not mention the words "accident and emergency" at all. I cannot find those words in the entire script that was written for her by the Department.

The hospital in Navan is the most important piece of infrastructure we have in County Meath. Nothing surpasses it. There are thousands of people walking around the county today who would not be alive only for the hospital's existence. Roscommon was mentioned. A Fine Gael Minister of State said that Roscommon University Hospital's accident and emergency department would remain open and then went into government and voted to close it. We know that the Government already tried to close the hospital accident and emergency in Navan in March 2020. That is in the plans. I am just astonished that in the whole of the Minister of State's response the accident and emergency department is not mentioned whatsoever.

What we need is a commitment to the accident and emergency department, that is, that the Department changes and amends the language in the small hospitals framework document and takes the threat away. As long as that threat is there, the people in the HSE will be tasked to close the accident and emergency department overnight. That is their job. If they are to fulfil the policy direction of the Government, they are tasked to close the accident and emergency department. Will the Department commit to taking that threat out of the small hospitals framework document?

Zoom Meeting to discuss closure threat to Navan Hospital A&E (Thurs 8pm)

https://us02web.zoom.us/j/89531387361pwd=WDhLZWVuTnNWbTNDRVJ2R3IzdDNldz09