Johnny Guirke (Meath West, Sinn Fein)
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Last Saturday there were chaotic scenes at Our Lady of Lourdes Hospital in Drogheda, which is one of Ireland's busiest hospitals. A total of 11 ambulances were parked outside the emergency department and could not leave because there were no beds or trolleys for the patients inside. At the same time the HSE wants to divert more ambulances from Navan to Drogheda. Some paramedics were left waiting for five hours before their patients had a place at the hospital. It is understood there was extreme overcrowding and every bed and trolley in the hospital was taken up. The ambulance crews treated patients in the ambulances while others were brought inside on the ambulance trolleys. None of the ambulances could leave and respond to other emergency calls until they had their trolleys back. According to a newspaper report:

One furious paramedic said:I have never seen anything like it in my life, absolute total chaos. Eleven ambulances at one stage were lined up outside the A&E at the Lourdes hospital and none of us could go anywhere. There were no beds and no trolleys. The place was full. We minded our patients as best we could in the back of our vehicles until we could get them inside. The whole thing was complete madness.

Why in the name of God are we still talking about diverting people from Navan to Drogheda?

Gerald Nash (Louth, Labour)
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This is an outrageous situation and simply cannot go ahead. I am disappointed the Minister, Deputy Donnelly is not here and that is no disrespect to the Minister of State. This is an issue that has been on his desk for many months. The reality is that he simply does not have a plan for Drogheda. The Minister of State has seen, heard about and read about the letter from the 16 hospital consultants in Drogheda. No additional resources whatsoever are being made available for Our Lady of Lourdes Hospital in Drogheda to accommodate the changes the Minister seems to want to steamroll through next Monday. This is simply unacceptable. Drogheda has had enough problems over recent years. It needs additional resources anyway outside of the fact this decision will be steamrolled on Monday. This needs to be addressed now and it simply cannot go ahead.

Darren O'Rourke (Meath East, Sinn Fein)
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There is a recognised risk associated with a small number of patients attending at Navan hospital. It will probably come as no surprise that the HSE's plan is to make matters worse. In June, 17 consultants at Drogheda wrote to the Minister to state that transferring risk from one hospital's accident and emergency department to another will lead to poorer clinical outcomes for patients. They obviously have no trust in the HSE. They noted the divergence of acute stroke patients from Navan to Drogheda two years ago was done without clinical engagement or adequate resourcing. Despite this warning, six months later it looks like the HSE is intent on pursuing this agenda. It makes absolutely no sense. It will put patients' lives at risk.

Fergus O'Dowd (Louth, Fine Gael)
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Huge resources have been given to the hospital. Since 2015 the number of beds has gone from 357 to 478. A total of €60 million has been spent. It is wrong is to say the hospital is under-resourced. It is not. Nobody is applying for the jobs that are being advertised. This is the difficulty. We need to examine the management in Our Lady of Lourdes Hospital and Our Lady's Hospital Navan. Can a new synergy be found in terms of corporate governance and medical governance to allow patients to be kept in Navan and dealt with by the experts with a higher level of knowledge who are in Our Lady of Lourdes Hospital? This is the way forward. It will keep patients in Navan and make sure they are properly looked after. It would also relieve the pressure on Our Lady of Lourdes Hospital, which is obviously significant this time of the year.

Mary Butler (Waterford, Fianna Fail)
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I thank Deputies Nash, Guirke, O'Rourke and O'Dowd for raising the matter of the ambulance bypass protocols at Navan hospital's emergency department and for providing me with the opportunity to update the House on behalf of the Minister, Deputy Donnelly.

There are a number of ambulance bypass protocols in place throughout the country at this time and they are important to ensure patients receive the right care in the appropriate hospital, depending on their clinical needs. Our Lady's Hospital Navan provides a range of inpatient and outpatient general medical, elective surgical and orthopaedic services, with a 24-hour emergency department service to which patients may self-present or be brought by ambulance. The emergency department at Our Lady's Hospital Navan has an ambulance bypass protocol in place for patients who have suffered a stroke, heart attack or major trauma and also those in need of paediatric and obstetric care.

From the week commencing 12 December the HSE is enhancing this ambulance bypass protocol to include patients who are critically or seriously unwell, or likely to deteriorate. Following the update, this cohort of patients will bypass the emergency department at Our Lady's Hospital Navan and be brought to the closest appropriate hospital for their needs. The decision to convey a patient to, or bypass, the emergency department at Our Lady's Hospital Navan will be made by the attending National Ambulance Service teams. The National Ambulance Service teams will assess patients, treat them as appropriate, and transport them to the nearest appropriate hospital depending on their clinical condition. This change is expected to affect only a small number of patients. However, this small cohort of patients, who are critically and seriously unwell, require appropriate treatment urgently. This update to the current ambulance bypass protocols will ensure that these patients receive the most appropriate care as quickly as possible in the most appropriate hospital.

Following this update to the ambulance bypass protocols, ambulances will continue to bring patients outside of the critically and seriously unwell categories to the emergency department at Our Lady's Hospital Navan. The National Ambulance Service has put an additional 24-7 emergency ambulance and an additional intermediate care vehicle on the ground in Navan to support this change. This updated ambulance bypass protocol at Our Lady's Hospital Navan is important to ensure patients receive the right care, in the right place, at the right time.

I confirm that no decision regarding the HSE's proposal for the transition of the emergency department at Our Lady's Hospital Navan has been agreed by the Minister for Health. This matter remains under consideration. The Minister for Health and the Government are clear that several important issues would need to be fully addressed before any proposed transition by the HSE could be considered.

I have listened intently to what all four Deputies had to say. I was in Navan last week with regard to the new early intervention psychosis unit and the Cara suite which will support people with outpatient mental health needs on a 24-7 basis. I have heard about the 11 ambulances that were queued at the weekend in the other hospital. I have taken on board what Deputy O'Dowd said about management and synergies. I will certainly pass all of his thoughts and reflections to the Minister.

Johnny Guirke (Meath West, Sinn Fein)
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Why are we not looking at the option of investing in Our Lady's Hospital, Navan? There is a review that has been completed, but we have not yet received the results of it. That review never even looked into the option of investing in, protecting and enhancing services that are already in place at Our Lady's Hospital, Navan. Why are we not doing that?

Gerald Nash (Louth, Labour)
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I do not believe that a plan is in place. I have been seeking a meeting with senior representatives for months about the impending changes that the Minister for Health is considering. I have been stonewalled consistently. I do not believe that a plan in place. The Minister of State referred to several important issues that need to be fully addressed before any transition might occur. There was a significant transition signed off on by the Minister that will come into effect on Monday. It is a significant transition that will affect patient care and that will result in the transfer of risk from Navan to Drogheda. If the Minister of State does not want to listen to me, she should please listen to the consultants. It has been said that six extra patients a day will be affected-----

Catherine Connolly (Galway West, Independent)
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I thank the Deputy.

Gerald Nash (Louth, Labour)
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-----but that is laughable. It is not true. The consultants counter that, and they do not agree with the Minister of State in the context of that assessment. They are the people we need to listen to.

Darren O'Rourke (Meath East, Sinn Fein)
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Our Lady Of Lourdes Hospital, Drogheda, does not have the capacity to take any additional patients, regardless how small the number might be. That is a statement of fact, and it has been confirmed by the 17 consultants. The Minister of State indicated that no decision has been made, as though that is a badge of honour. The Minister has had the report since 8 October. There needs to be a plan in place to resource the region and to ensure that there is safe acute and emergency care for people. That involves investing in Our Lady's Hospital, Navan. It is incredibly frustrating that the Government stands in the face of that very clear solution.

Fergus O'Dowd (Louth, Fine Gael)
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I welcome the Minister of State’s comments on the updated ambulance bypass protocols. I do not doubt the credibility or the integrity of that decision, nor do I doubt that it will include patients who are critically or seriously unwell or whose condition is likely to deteriorate. This is not a matter of closing the accident and emergency department in Navan. It is a case of moving seriously ill patients to the appropriate place. I welcome that. I also welcome the Minister of State's comment to the effect that the Minister has not made a final decision on that matter. I further welcome the fact that the Minister is prepared to give consideration to ideas that I and other people have put forward about a new synergy in the management of both hospitals. This can leave both hospitals safe and can ensure that patients will be able to get the best care nearest where they currently reside.

Catherine Connolly (Galway West, Independent)
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The Minister of State to conclude.

Mary Butler (Waterford, Fianna Fail)
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I thank the Deputies for their contributions on this matter. I know how important it is. I also know that the Minister shares a concern to ensure that patients in Navan, County Meath in general, the north east and any other part of the country can access urgent services when they need them. As I mentioned earlier, there is currently an ambulance bypass protocol in place for Our Lady's Hospital, Navan, in respect of paediatric patients, obstetrics patients, major trauma patients, heart attack patients and stroke care patients.

From the week commencing 12 December, the ambulance bypass protocol will be updated to include patients who are critically or seriously unwell or who are likely to deteriorate. This bypass is expected to affect a small cohort of patients who will be brought to the closest appropriate hospital for their needs. This is not a full ambulance bypass. Ambulances will continue to bring patients outside of the critically and seriously unwell categories to the emergency department at Our Lady's Hospital, Navan. This update is important to ensure that patients receive the right care in the right place at the right time.

I reiterate that no decision regarding the HSE’s proposal for the transition of the emergency department at Our Lady's Hospital, Navan, has been agreed by the Minister for Health. This matter remains under consideration.