New closure threat emerges at Our Lady's

Will continuing health service reforms spell the end for smaller regional hospitals around the country? That is one of the questions that has been preoccupying the minds of local politicians and ordinary people over the last number of years - and one to which a definitive answer cannot yet be given. However, it appears that with health cutbacks reaching new heights, the future for some local hospitals, like Our Lady's in Navan, remains as uncertain as ever. There is now growing concern that some busy hospital emergency departments (EDs) will be forced to close at night from the middle of July onwards due to a chronic shortage of non-consultant hospital doctors (or junior doctors) who are due to take up new contracts in July. In some cases, the HSE has recruited just 40 per cent of junior doctor posts required to operate EDs and acknowledges this as a very challenging national issue. Management has also warned that running the emergency department at Our Lady of Lourdes Hospital in Drogheda - to where the majority of Meath emergency cases now end up - was unsustainable due to the crisis and warned of a drastic reduction in a number of services. In other cases around the country, the HSE has closed emergency departments at Ennis and Nenagh in favour of daytime minor injury units. Every July, a new rota of junior doctors is recruited around the country and this year there are not enough new recruits to go around. There are particular fears for smaller local hospitals like Our Lady's in Navan will get the raw end of the deal when it comes to recruiting new non-consultant hospital doctors. A combination of changes to registration rules, restrictions on foreign doctors coming to Ireland, cuts in pay and overtime coupled with long hours and a central recruitment regime whereby the bigger hospitals tend to get the bulk of the new recruits, all mean some smaller hospitals are at risk of seeing their EDs partially or fully closed. It has been suggested by one local TD that four out of five junior doctor posts at Navan Hospital remain unfilled and five out of 12 at Our Lady of Lourdes Hospital in Drogheda are similarly vacant. However, even EDs of larger hospitals like Drogheda are at risk of having to close during night-time hours as a result of the staff shortages. Fine Gael is saying that, separate to the current controversy about ED closures, it is confident the coming months will see some services being restored in Navan. Speculation is increasing that a report commissioned by the HSE into patient safety concerns at the Navan hospital, due out shortly, will vindicate Our Lady's, its surgeons and staff and will recommend a return to elective surgery. Navan FG TD Damien English has said the Minister for Health is setting up a new special delivery unit which would see more services being provided in public hospitals and less spent on the National Treatment Purchase Fund. He believes the report on surgical services in Navan would show the need for increased services at Our Lady's, adding that closing the regional orthopaedic unit for the north-east - as had been mooted in an internal leaked HSE document last week - would be a big mistake. He insists the restoration of elective surgery at Navan Hospital remains a major priority for the government. However, in spite of these optimistic noises being made about other medical and surgical services in Our Lady's, coupled with the reduction of ambulance cover in Navan - which went ahead earlier this month - and dire warnings about the future of the North-East Doctor on Call (NEDoC) service, the local population still has plenty of reasons to be concerned about the future provision of health services and access to hospital emergency departments. There is now just a single ambulance operating at night from Navan, and the entire county must rely on only two ambulance crews - one in Navan and another in Dunshaughlin - operating the night shift of 7pm to 7am nightly. Now, local emergency departments could end up only opening for 12-hour periods as they try to cope with critical shortages in staffing. It is simply inconceivable that the country's major regional hospitals would not have a 24/7 ED operation and it cannot be allowed to happen. Bad and all as waiting times are at the present time in major emergency departments, at least they are open to receive seriously ill and injured patients. There needs to be urgent intervention by Health Minister Dr James Reilly to sort out this mess before the 11th July deadline when new junior doctors are due to take up new duties. This self-perpetuating chaotic structure needs to change for the better - for everyone, patients and medical professionals.