Catherine Murphy (Kildare North, Social Democrats) | Oireachtas source

I have been following this story for the past week and during the debate tonight and I am struggling to figure out exactly who is in charge. Is it the management that is running the hospital or what input does the Government have? The Taoiseach made his position quite clear earlier today regarding UHL. He said the HSE is directly responsible for the running and the management of hospitals and that the Government will not interfere in that. I am struggling to find out why Navan is different. The HSE announced early last week that the emergency department in Our Lady's Hospital, Navan, would be closed to critically ill patients from next September. Within minutes, senior Government Ministers were stating the opposite, that it had not been sanctioned by the Government and that it would not be closed. We are in the unfortunate situation where the clinical director in Navan hospital, Mr. Gerry McEntee, had to go on the defence in the media against the words of the Tánaiste, the Minister for Justice and the Minister for Health.

The closure of Navan emergency department was decided by a Fine Gael Government and Fine Gael Minister for Health in 2013 in the framework document on securing the future of smaller hospitals. That document provided for nine smaller hospitals changing from model 3 to model 2, with the closure of their emergency departments as a consequence of the shift. When every party in this House came together in agreement on Sláintecare, it was not only a commitment to universal healthcare free at the point of use but also a commitment to an evidence-based healthcare system, to end the tradition of using healthcare as a political football where resources were often distributed in accordance with the constituencies of Ministers of the day, rather than where the need was most acute.

The situation in which Navan emergency department has found itself is bleak, to say the least. The clinical director could not have been clearer in his assessment, stating that the emergency department is a risk to the lives of critically ill patients and that they are not afforded the best chance of survival. When family members or an ambulance service bring critically ill patients to Navan they do so in the belief that the emergency department will deliver life-saving care when that care is needed. Why would they not so believe? The absolute least we should expect from an emergency department is that it would have the skills and resources to do the best it can to save someone's life. We expect the same standard of care in every emergency department in the State, whether it is in Beaumont Hospital or Navan. However, that is not the reality for the people of Meath. Emergency department nursing staff, physicians, surgeons, anaesthetists, junior doctors and every HSE official connected to the hospital have all raised the concern that the emergency department in Our Lady's Hospital is unsafe. We cannot ignore the voices of the medical professionals who are working day and night to care for the people of Meath and who are making it clear that they do not believe they can continue to provide emergency care to critically ill patients.

Local hospitals are incredibly vital components of our communities. Of course, they provide employment but, more importantly, they provide a sense of security. Living within a short distance of an emergency department is comforting, especially for older people or those with additional healthcare needs or, indeed, people who want to ensure they can visit so they can have some oversight of a family member. It is absolutely understandable that local communities want to retain the hospitals and are anxious about the potential impact on their access to emergency care when a closure is imminent. The logic behind the closure of small emergency departments is well supported by evidence. Small emergency departments are just not viable, not in terms of cost but in terms of patient safety. The critical mass is not there to ensure staff are trained properly. I believe there are only 64 beds in Navan hospital. Approximately 300 beds are generally needed for a critical mass that would allow for specialisation.

The emergency department in Navan is already bypassed by ambulances carrying heart attack and stroke victims because it is known by medical professionals that it is safer to bring them to Drogheda. However, family members who are transporting a loved one who has suffered a stroke will go straight to Navan. It is unacceptable that these patients would receive a lower level of care just because their families do not know about the internal way the health service is run in that hospital. Cover in the emergency department is not provided by consultants but by agency registrars who are not specialists in emergency medicine. The hospital is not accredited for junior doctors so it cannot attract the staff it needs. As the smallest intensive care unit, ICU, in the country, the staff who are there do not get the necessary experience to be properly trained on the job in the way that staff would be or are in busier hospitals.

The writing has been on the wall for the emergency department in Navan since 2009, with official commitments given in 2013. That is nine years the Government and the HSE had to plan for an orderly transfer of critical care from Navan to Our Lady of Lourdes Hospital, if that is what the plan was. Why have we once again wasted time, with years of kicking the can down the road and delaying important decisions until we get to a point of crisis?

We do not appear to do planning in this country. We just wait until the crisis happens and then try to work back from it. This could and should have been an orderly transition. The necessary resources should have been in place in Drogheda well in advance of the transfer. An increase in ambulance cover should have been provided. Fundamentally, the local community should have been informed every step of the way. Their care and concern should have been addressed. There should have been constant communication with the local community, assuring them that their access to emergency healthcare would in fact be improved, not worsened. None of that has happened. This is an exercise in the failure of planning and preparation. It is a pattern that is well evident at this point. The plan for transitioning smaller hospitals from model 3 to model 2 has always been very clear. The larger hospitals would receive more resources and training to become centres of excellence, with larger catchment areas and more specialisation.

A census of the population has just been taken. We talk about that as a basis for planning services. We even roll out advertisements about that. In 2016, County Meath had a population just short of 200,000 and the census will reveal that has increased significantly. County Louth is a growing area, as is Fingal, which is adjacent to it. We talk about using demographics and the census statistics to design services, but it is very difficult to see what kind of thought has gone into this entire catchment. While the new model 2 hospitals will become busier than ever, providing a range of care, from minor injury units, step-down rehabilitative care, scanning centres, laboratories, etc., the latter has been largely successful, the former not so much. The HSE tends to give a lot of promises in relation to the resourcing of emergency departments and the standards that will be achieved but it often does not follow through on that. People do not believe the HSE. That is part of the problem. Is it any wonder people are opposing the closure of the emergency department, inadequate as it is, when the HSE's track record is so poor? We only need to look at the impact of the closure of Loughlinstown hospital on St. Vincent's, or the impact of the closure of the emergency departments in Ennis and Nenagh hospitals on University Hospital Limerick, UHL, which was mentioned earlier in the debate. As we know, UHL was subject to a damning HIQA report last week. The problems with overcrowding in Limerick can be tracked back to the closure of the two emergency departments in Ennis and Nenagh.

County Meath has one of the fastest growing populations in the country but it is very difficult to see how that has even been factored in. The average wait time in Our Lady of Lourdes Hospital, Drogheda is already reported to be 14 hours but the HSE is predicting very low numbers of patients transferring from Navan to Drogheda. That waiting time is already too high and the population in the larger catchment area is only going to grow. It is essential that the problems faced by UHL are not replicated in Drogheda. Medical staff in Drogheda are already quite concerned about their capacity to take patients. Again, we have heard that already this evening. The concerns of the medical professions in Navan also need to be at the centre of this debate. They know the situation on the ground. I am sorry, I have gone over time.

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