David Cullinane (Waterford, Sinn Fein) | Oireachtas source

I commend my colleague, Deputy Guirke, on tabling this motion and giving us an opportunity to debate this issue, which is really important. There was a meeting last week of Oireachtas Members, HSE officials, clinicians and others who work in the hospital group and very frank and important exchanges took place at that meeting. As the Minister knows, a document was circulated by the HSE which made the executive's intentions explicitly clear. It included dates and made it very clear that the ICU and high-dependence unit beds would close and that the emergency department as we know it would close and be replaced with a medical assessment unit. As we know, in a level 2 hospital, such a unit is at a much lower level and can be aligned to a local injury unit as opposed to an acute medical assessment unit or an acute medical unit aligned to a level 3 or level 4 hospital. This is a downgrading of the hospital from level 3 to level 2; we cannot call it anything other than that. This is closing the emergency department as we know it and the Minister cannot say anything other than that if this plan goes ahead.

Clinicians should have their say. It is really important that everyone in this Chamber listens to what clinicians and those who work in the emergency department have to say. It is also important that we listen to what medical experts outside of the hospital, including GPs, have to say. We must listen to everybody who has an opinion. We also have to listen to patients, to the people of Navan and Meath and arguably, to the people of Louth who will be affected by this closure if it goes ahead. We must also listen to hospital management in Connolly Hospital Blanchardstown, the Mater hospital and Our Lady of Lourdes Hospital, Drogheda. I have engaged with many of those individuals already. I am in listening mode and believe it is important that we listen but we must also learn from past mistakes. We must understand that what is happening in Navan, or what is being proposed, has happened elsewhere. In some hospitals, the Minister might argue, it has worked but in other hospitals it has not. What the people of Navan, Meath and Louth will look closely at is what happened in Limerick. Emergency departments were closed in Ennis, Nenagh and in St. John's Hospital in Limerick. People were told at the time that this would result in better access to emergency department care and specialist trauma care in the mid-west region and that centralising all of the emergency care services into one emergency department would deliver better outcomes and faster access to emergency care.

Any objective analysis of what has happened in University Hospital Limerick - the Minister does not have to take my word for it, as a HIQA report was published last week - shows how chaotic, difficult, challenging, understaffed and under-resourced the accident and emergency department in that hospital is. That accident and emergency department is now a single point of failure for that entire region. If that emergency department is full, there is nowhere else for people to go. The Minister, Deputy Donnelly, will be aware that the average wait time in the accident and emergency department in University Hospital Limerick is almost 15 hours, which is well above the already very high average wait time of 11 hours across the other acute hospitals in the State. That is the difficulty and the challenge we have.

I put it to the Minister that we need to be very careful as we look at what is happening across all of the emergency departments and the unacceptably high wait times that people are experiencing. As my colleague said, the Sláintecare targets stated that nobody should be waiting for any longer than four hours. That is not happening. In some hospitals in Cork and in Limerick, patients over the age of 75 have, on average, been waiting more than 20 hours in an accident and emergency department, some of them on hospital trolleys. The Minister may have heard the harrowing story of a lady who spoke to RTÉ recently about how her husband had died on a hospital trolley and about the lack of the dignity and the lack of respect that was shown to him and is shown to many other people. It is completely unacceptable. I do not believe that we should proceed with closing the emergency department at Our Lady's Hospital, Navan, at this time. There are too many unanswered questions.

In my closing remarks, I must address the broader issues in our emergency department services. We need a plan to reduce those wait times. I do not know what the HSE's plan is to achieve the Sláintecare target of four hours. When I speak to people in hospital management they tell me that in some hospitals, not all, they need more inpatient beds so they can admit patients more quickly. We know this. They also tell me that they need more community beds. Even when they try to put a discharge plan in place for many patients, they cannot get access to recovery beds or rehabilitation beds because we cannot get home help workers to provide the intensive homecare packages to the extent that we want. Millions of home help hours are not being used because we cannot get the staff, so people cannot get transferred back into their homes.

We also have problems with access to GP care and out-of-hours GP care. Our colleagues from Meath will tell the Minister that this is a real difficulty. One of the challenges, and one of the things people are being asked to do, is that the medical assessment unit would be GP referral only, and that the consultant in the medical assessment unit with the GP would have to agree to admit a patient. That is not going to be realistic. All of these challenges and unanswered questions create a reasonable fear and a reasonable suspicion that this is not the best way forward.

I ask that the Minister supports the motion. I will listen to what he says this evening and what his view is. We are aware of what the HSE's view is. It has put it in black and white. We now need to see what the Minister is going to do.

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