Shane Cassells (Fianna Fail)
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In the film, "A Few Good Men", there is a famous courtroom scene at the end where Tom Cruise questions Jack Nicholson, who plays the character, Colonel Jessup. He tells him that he ordered Lieutenant Kendrick to make sure that Private Santiago was not to be touched, but then Santiago is transferred off the base. He asked why there were two orders. Jack Nicholson replied that sometimes men take things into their own hands, to which Cruise retorted with the famous line: "No, Sir...[you said] Your men follow orders or people die".Two weeks ago, an order was given after Oireachtas Members from Meath sat in the Department of Health with 18 of the lead figures within the HSE and top clinicians in Ireland. They painted a stark vista of clinical concerns regarding the operation of the emergency department in Navan. We all listened intently. A stark vista was also painted of the emergency department situation in Drogheda, where it is proposed to transfer patients from Navan to sit in a queue for 12 hours waiting to be seen. The leading clinical director in the room claimed he would rather see people in that queue in Drogheda than in Navan. That is hardly a sales pitch for the people of Navan. We heard that clearly, as did the Minister for Health. Consequently, that day he put a hold on the plans by the HSE to reconfigure the emergency department in Navan. Last Sunday, Paul Reid, the CEO of the HSE, adopted the role of Lieutenant Kendrick while on radio and decided he was going to ignore the order and do his own thing.

My question is very straightforward. Who is in control of our health system? I do not want the stuff the Department will have prepared in advance. I want Deputy Feighan, as a Minister of State in the Department of Health, to answer that question. Who is in control of our health system? The senior Minister halted plans. That was not done for parish pump political reasons, as Fionnán Sheahan claimed yesterday in the Irish Independent. Not only could the clinicians not answer our questions about capacity, they also admitted they would be sending patients to an already overcrowded emergency department. They blatantly said that.

The HSE has given the two fingers to the Minister for Health. We have been warned by consultants, and by Paul Reid, that politicians holding out against this could result in the deaths of people in Navan emergency department. That works both ways. Nobody in that room was able to answer the tough questions on what would happen to people from Navan when they got to an overcrowded emergency department in Drogheda, where they would have to wait for 12 or 13 hours to be seen. That is not an adequate health service. It is a stain on the country.

The HSE is proposing to handle people like cattle. It is a goddamn disgrace. It is operating on a wing and a prayer. It wants to build up capacity later and recreate Limerick and Navan. Not on my watch. The claim that people will die works both ways. The HSE cannot threaten me or other politicians. Why can it not do its job to provide the services people need? It is given the budget so it should go and do it. Men follow orders or people die. Lots of lads are playing God here. I look forward to the Minister of State's response.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank Senator Cassells for raising the matter of the plans to reconfigure services at Navan hospital’s emergency department. Navan is one of nine hospitals that were designated as model 2 hospitals under the smaller hospitals framework, which was approved by the Government in 2013. Navan is the last of these nine hospitals to undergo transition to a model 2 hospital. Currently, Navan is a model 3 acute general hospital with a 24-hour emergency department service to which patients may self-present or be brought by ambulance. It also provides a range of inpatient and outpatient general medical, elective surgical and orthopaedic services. Ambulances currently bypass the emergency department for certain conditions that cannot be catered for at Navan. These are STEMI heart attacks, strokes and traumas, as well as paediatrics and obstetrics. Patients who present to the emergency department who require surgery are transferred to Our Lady of Lourdes Hospital in Drogheda. The HSE has advised that the current acute model of care at Navan holds significant risks from a governance and clinical care perspective.

In 2013, the smaller hospitals framework described the evolution of healthcare delivery, including the shift to day surgery and ambulatory care, and the consolidation of complex care in larger volume centres. There is a recognition that there is a link between volume and outcomes. This in no way means we must only provide care in larger hospitals. Less complex care, which is the majority of hospital care, can be and is provided safely in smaller hospitals.Other hospitals in the smaller hospitals framework that have already transitioned to becoming model 2 hospitals provide excellent examples of how these hospitals can be even busier than before.

As the Senator mentioned, elected representatives from the Navan area met the HSE operational and clinical leads on 13 June. At that meeting, the HSE described clearly the patient safety rationale for the proposed change to a model 2 hospital so that critically ill and unstable patients could have the best chance of survival. Let us ensure that these issues of survival and patient safety are at the forefront of discussions on this matter.

There would be a 24-7 medical assessment unit, which would continue to cater for the vast majority of medically unwell patients who currently come into Navan hospital through its emergency department. There has been considerable capital investment in Navan hospital, with the opening of a new second general theatre, a new day ward, an expanded recovery room, a new laboratory, a new rehab unit and a new psychiatric day ward. There are other future development plans. The future vision for Navan hospital is that, with the expansion and development of services, it will be busier.

It is important to note that Navan hospital is not closing or being downsized. However, while recognising the real clinical concerns, the Government is clear that several important issues, including additional capacity in other hospitals impacted and the continued ability of people in the Navan area to access emergency and urgent care, would need to be fully addressed before any proposed transition by the HSE could be considered.

Shane Cassells (Fianna Fail)
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We are told by the HSE that medical safety issues dictate its policies and that clinicians know best. No one questions that, but what we are being asked to accept from an agency whenever it fails people in emergency departments across the country like it did in Limerick is a one-word statement from its PR department telling us, "Sorry". I do not want the HSE's "Sorry". It proved in that room two weeks ago in front of us that it did not have its homework done and that, just as happened in Limerick, it was trying to implement something before having capacity built up. It has admitted this, yet after bulldozing its way onwards, it has the brass neck to threaten politicians that we will have blood on our hands because people will die. That works both ways. Transferring people from Navan to an overcrowded emergency department in Drogheda is not a health policy. It is dangerous.

Frank Feighan (Sligo-Leitrim, Fine Gael)
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I thank the Senator for his contribution. There is a shared concern to ensure that patients in Meath, the north east or any other part of the country can access the services they need. That is a core element of the planning for the reconfiguration at Navan. These concerns must be addressed. More widely, access and quality are core to the Government's unprecedented investment in the health system.

I will bring the Senator's concerns to the Minister, Deputy Stephen Donnelly.