Shane Cassells (Fianna Fail)
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Colm O'Rourke, one of the legendary figures of Gaelic games, was recently appointed manager of the Meath senior football team. It is a role he has long coveted and his appointment has enthused Meath fans with the hope of a return to glory. I invite the Minister of State to imagine that, as Colm sets off on this journey, the GAA told him he can be Meath manager and have the title and the prestige but it is not going to allow him to have any footballers whatsoever. It might let him have a few farm animals - a few donkeys or goats to put in the full-forward line - but that is it, and he should go off and win the All-Ireland. I ask the Minister of State to hold that thought.

Across the road from the school of which Colm is principal is Navan hospital, which, as of this morning, still has an operational emergency department. However, following a letter from the HSE on Monday, there is a plan - irony of ironies, this involves a former Meath football colleague of Colm's, Gerry McEntee - under which the HSE has directed that the ambulance service will now bypass Navan hospital in the case of all patients bar, in the words of its report, elderly persons who fall off a chair and have no respiratory problems. A bit like the job of the manager of the Meath football team, the hospital can have its emergency department and the neon light flashing above the door to signal that it is open but it cannot have any patients.

I am a patient man but my patience with those who purport to run the health service in the name of the people of Meath is over. We discussed this issue in the Chamber in June. In the intervening six months, those running the health service have done nothing to build capacity at Drogheda hospital to facilitate their marvellous plan. They simply leak documents and minutes of meetings and spin lines about how people will die if they do not get their way. They are bullies. What will happen if they get their way? Where will the people of Navan and the rest of County Meath go? Are they going to implement a plan like the one put in place at Dublin Airport during summer and put up tents at Drogheda hospital so that people from Navan can be triaged out in the car park? That is where we are heading. Drogheda hospital does not have the capacity required. I have spoken to the people at the hospital. They do not have the capacity.

The HSE has pulled this trick once before, when it closed the emergency department at Dundalk hospital. It took it three years to get things right in Drogheda afterwards, with the influx of people from Dundalk and the surrounding area down to Drogheda. The HSE implements a plan with no resources or backup, and who suffers? It is the ordinary people, the people in whose name the HSE purports to run a health service. My patience with the HSE has gone. It does not represent the best interests of ordinary people.It represents the best interests of consultants and medical practitioners. The stroke unit it has closed this week hurts people; it does not help people. I want to hear from the Department of Health, which is the boss of the HSE, in case it has forgotten that with its leaked memos, how it proposes to actually implement this marvellous plan.

Mary Seery Kearney (Fine Gael)
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Before I call on the Minister of State, I welcome the students from Rockbrook Park School and Deputy Francis Noel Duffy to the Seanad. They get to see it at its finest this morning as the Minister of State responds to the Senator's impassioned pleas on this matter.

Malcolm Noonan (Carlow-Kilkenny, Green Party)
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They certainly picked a good time to come in. It is great to see such a good contribution in the Seanad Chamber. The students are very welcome and I thank Deputy Duffy for bringing them here.

I am taking this question on behalf of the Minister for Health. It might have been preferable to use a hurling analogy, being a Kilkenny man, but it is okay; I will accept the football parlance. I thank Senator Cassells for raising the matter of the ambulance bypass protocols at Navan hospital's emergency department and welcome the opportunity to update the House. There are a number of ambulance bypass protocols in place around 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 in 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 HSE has advised that the current acute model of care at Our Lady's Hospital holds significant risks from a governance and clinical care perspective. The emergency department at Our Lady's Hospital currently has an ambulance bypass protocol in place for patients who have suffered a stroke, heart attack or major trauma, as well as those in need of paediatric and obstetric care. From 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 enhancement, this cohort of patients will bypass the emergency department at Our Lady's Hospital 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 enhancement of the current ambulance bypass protocol will ensure these patients receive the most appropriate care as quickly as possible in the most appropriate hospital. Following the enhancement of the ambulance bypass protocol, 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 to the current ambulance bypass protocol.

I would like to reiterate that no decision regarding the HSE's proposal for the transition of the emergency department at Navan has been agreed. While recognising the very 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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The Minister of State said "regarding the HSE's proposal for the transition of the emergency department at Navan has been agreed." Yesterday, the HSE issued a letter saying it has this done. I have it here. It is being shared by the HSE itself. I do not trust it when it is issuing statements counter to what Ministers and Departments are saying. There is no trust between elected Members and the HSE, and more important, between it and the people, because of the manner in which is does its business. The Minister of State said the change is expected to affect only a small number of patients. Some 2,000 people a year go through those doors. As a result of these bypass protocols, 90% of them will not be going to Navan. How can the HSE send 2,000 people to an emergency department that is already at capacity? Where will they go? The HSE does not have the answer. They will be in tents out in the carpark. The Minister of State says this is an enhancement. How is it an enhancement if an elderly relative of mine is on a trolley in a carpark in Drogheda? It is a disgrace and a stain on this State and its health service to hold up this and say it is an adequate health service for the people of Meath and Navan. If the HSE thinks it can carry this off, it has another think coming.

Mary Seery Kearney (Fine Gael)
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Thank you, Senator.

Shane Cassells (Fianna Fail)
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Political responsibility will be called for. I will be calling on the Minister for Health to make sure he stops this fallacy.

Malcolm Noonan (Carlow-Kilkenny, Green Party)
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There is a shared concern to ensure patients in Navan, Meath and the north east, or any part of the country, can access the services they need. As mentioned earlier, there is currently an ambulance bypass protocol in place for Our Lady's Hospital Navan for paediatric, obstetric, major trauma, heart attack and stroke care patients. These patients bypass the emergency department at Our Lady's Hospital and are brought to the closest appropriate hospital for their needs. This ambulance bypass protocol is being enhanced to include patients who are critically or seriously ill or likely to deteriorate. This will ensure the cohort of patients who require appropriate treatment urgently will be brought to the closest appropriate hospital for their needs as quickly as possible. 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 enhanced ambulance bypass protocol is important to ensure patients receive the right care in the right place and at the right time. I was not aware, and I am not sure the Minister is, of the letter the Senator is referring to but I will certainly bring it to his attention.

Shane Cassells (Fianna Fail)
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Unfortunately, there were retractions this morning-----

Mary Seery Kearney (Fine Gael)
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Thank you, Senator.

Shane Cassells (Fianna Fail)
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-----but that was done after the event.

Mary Seery Kearney (Fine Gael)
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The Senator has had his time.

Shane Cassells (Fianna Fail)
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I was just answering the Minister of State's questions, with respect.

Mary Seery Kearney (Fine Gael)
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You should have respect for everyone else's time as well.

Shane Cassells (Fianna Fail)
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He needed to hear the answer.