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Dáil Éireann debate -
Tuesday, 21 Jun 2022

Vol. 1023 No. 7

Our Lady's Hospital Navan Emergency Services: Motion [Private Members]

I move:

That Dáil Éireann:

notes:

— the announcement on 13th June by senior members of the Health Service Executive (HSE) that the final stages of downgrading the 24-hour Emergency Department (ED) at Our Lady's Hospital, Navan (OLHN) would commence on 30th June, 2022;

— that HSE officials have acknowledged that Our Lady of Lourdes Hospital in Drogheda will see an increase in emergency patients and a projected increase of 2,100 ambulance transfers per year from Navan;

— that, in May 2022, the average wait time for EDs across the State was 11.2 hours, significantly above the Sláintecare target of four hours;

— that figures from May 2022 show that the average waiting time for admission to EDs at Connolly Hospital, Blanchardstown and Our Lady of Lourdes Hospital, Drogheda are 11.9 and 8.9 hours respectively, with 48 per cent of patients at Connolly Hospital and 31 per cent at Our Lady of Lourdes Hospital waiting over 12 hours;

— that the last census shows that Meath is one of the fastest growing counties in Ireland with a population of over 195,000;

— the consistently high waiting times and ongoing overcrowding in EDs across the State and, only in the past two weeks, that the Mater University Hospital ED in Dublin was forced to advise members of the public to stay away;

— that EDs closed under the small hospitals framework, such as Ennis and Nenagh, were closed without the corresponding increase in capacity at University Hospital Limerick, which is one of the most chronically overcrowded hospitals in the State, and that senior management have publicly called for an elective hospital to be built in the area; and

— a press statement released by the Irish Nurses and Midwives Organisation (INMO) on the same day as the announcement by the HSE in respect of OLHN, stating that the body was left with no option but to consult with members in EDs across the State on potential industrial action due to the consistent overcrowding and lack of action by the Government, as there were 457 patients on hospital trollies that day;

further notes:

— the contradictory statement from the Minister for Health on the 14th June 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 this Government", despite the fact that the briefing event on 13th June to local Oireachtas members and media was arranged at the request of the Minister for Health, which is symbolic of the chaos and confusion at the heart of the current Government; and

— the Minister for Health's complete failure to address the chronic under capacity in primary, community and acute care services in the region, which puts people's health in danger; and

calls on the Minister for Health to:

— immediately clarify his position, and that of the Government, in relation to the future of the ED in OLHN;

— put forward proposals to protect and enhance emergency and critical services at OLHN and the wider Eastern Health region;

— immediately put forward plans to address overcrowding in EDs across the State, including investment in community and primary care, out of hours general practitioner care and realignment of care to reduce pressure on existing hospital EDs, including the emergency services at OLHN; and

— immediately engage with members of the INMO, convene the Emergency Department Taskforce as requested three times by the INMO, and commit to the implementation of the Emergency Department Agreement which was agreed between the HSE and the INMO.

I thank the Ceann Comhairle for the opportunity to bring forward this important motion on behalf of the people of Meath. I would like to thank my colleagues for their support, particularly Deputy Cullinane, our party spokesperson on health, and Deputy McDonald, our party leader. This motion calls on the Minister for Health and the Government to state clearly their position on the future of the emergency department at Our Lady's Hospital, Navan. It also calls on the Minister to put forward proposals to protect and enhance emergency and critical care services at Navan hospital.

Last week, the HSE announced the final stages of downgrading the emergency department at Navan hospital, to commence on 30 June. This is the wrong decision. Emergency departments across the State are suffering from ongoing and chronic overcrowding. In May, the average wait time for admission to emergency departments across the State stood at 11 hours, which is almost three times the Sláintecare target of four hours. It is clear that the hospitals closest to Navan do not have additional capacity. At Our Lady of Lourdes Hospital, Drogheda, in May, 31% of patients waited over 12 hours in the emergency department for admission, while in Connolly Hospital, the figure was 48%. This is the reality in hospitals across the State. Now is not the time to reduce emergency care capacity in our hospitals and to even consider such a move in the current climate is baffling. Just this week Mr. Sean Egan, director of healthcare regulation and the lead HIQA inspector, pointed to the risks associated with such a move. He was speaking in the context of Limerick University Hospital, which is one of the most overcrowded hospitals in the State. Mr. Egan rightly pointed out that the closure of smaller emergency departments in the region has contributed to that situation. Why would we want to repeat the same mistakes again?

I pay tribute to the people of Meath who have fought tooth and nail to protect their emergency department for more than a decade. They have done so tirelessly and will continue to do so, if necessary. They have done so because they see the shambles caused by bad Government policy and they refuse to allow the same to happen to their community. We stand with them. The manner in which this was announced was a further insult to those people and a clear display of the chaos that lies at the heart of this Government. The day after the HSE made the announcement, it was directly contradicted by the Minister. The North East Doctor on Call service and healthcare unions have said that they were not consulted on the proposal. The Government Deputies in Meath have stood in silence or paid lip service to the issue. The people of Meath deserve better. They deserve more than mixed messages from the Government and the HSE. They deserve better than having to constantly take to the streets to battle to protect their health services, which they have been doing for over a decade now. They deserve accessible and high quality health services and clarity from this Government. They deserve to know, once and for all, where the Minister and his Government stands on the future of Navan hospital. Is the Minister committed to protecting and enhancing emergency and critical care services at Navan hospital? I hope that the Minister and his Government will give that commitment to the people of Meath tonight.

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.

I welcome the opportunity to speak on the motion. The HSE's plan is very clear, and it was spelled out in black and white, but it is just a plan. This is surprising because it has had 13 years to prepare it: nine years if one starts the clock from the small hospital framework. We are still none the wiser as to the Government's plan, and this includes the Minister's amendment here tonight. Frankly, this is disgraceful.

We are aware the HSE has a plan and Deputy Cullinane outlined some of the detail of that. It states it has legitimate concerns for safety but in my firm opinion the HSE's so-called solution will make matters worse. The concern is that in the region of 2,000 patients would present to Our Lady's Hospital, Navan, who the HSE believes should go directly to Drogheda.

The medical assessment unit that is proposed to deal with up to 90% of the patients currently presenting to Navan will not work. I want this on the record of the Dáil. It will not work because it is GP referral only. Our GPs are already overworked and overbooked during the day, and it is even worse at night. What will happen? If a person is ill at home, he or she will go to the door that will accept them. It will not be five a day or 2,000 a year. Up to 20,000 people per year would present at Our Lady of Lourdes Hospital in Drogheda. They may not be appropriate presentations, but they will be there and there is deep concern about this. We are hearing this spelled out in detail from clinicians on the front line. There is deep concern that those people who are currently presenting to Navan will all, or in very significant numbers, present to Drogheda and lead to worse outcomes and worse safety rather than better. I wish to spell this out clearly. We have heard from GPs and, while there are differences of opinion in the medical world, I believe that in practical terms this is exactly what will happen. I encourage the Minister to listen to that.

The suggestion that there is no alternative to this proposal is simply not the case. At the meeting last night, we heard from one clinician who said that the only alternative to this proposal was to quadruple capacity at Our Lady's Hospital in Navan and to turn it from a 107-bed hospital to a 400-bed hospital. The idea that no hospital could exist if it was not a 400-bed hospital is just outrageous. Within the medical profession, there is a belief that to bring Our Lady's Hospital, Navan, up to a model three hospital rather than downgrading it, it needs an extra emergency department consultant; two extra consultant surgeons; and two extra consultant anaesthetists. That is the proposal there and I believe the Minister should take it on board.

It is completely unacceptable that we have a clear proposal from the HSE that is scrambling. Anybody who attended that meeting last Monday in good faith could not be convinced that the HSE has a coherent plan to deliver a safe service for the people of County Meath. The ambition for increased capacity in the acute services was the subject of ongoing discussions. There was no clear plan for increased capacity in community or general practice. In fact, we heard that everybody has problems in terms of general practice.

I have had enough of Ministers in my county and at a senior level acting as observers and commentators. I heard it on LMFM and read it in the Meath Chronicle that they are leaning one way and leaning towards closure, or they are leaning the other way and leaning towards keeping it open. It is simply unacceptable. We see the same here with the Minister's amendment. In effect, with the Government's amendment, the sword or the axe will continue to hang over Our Lady's Hospital in Navan. It is simply unacceptable. The Minister outlined that several important issues would have to be fully addressed. What does the Minister mean? What are the proposals and what is the plan for the hospital in Navan? I want to lay it fully on the agenda that the proposal from Sinn Féin is to retain the service and enhance the services at Our Lady's Hospital in Navan. That is the solution for it. There is no other credible alternative.

I commend my colleague, Deputy Johnny Guirke, on bringing this motion forward. It is not an exaggeration to say that I have literally lost count of the number of constituents who come into my offices telling me the health and hospital services are stumbling from crisis to catastrophe. As the two-tier system has become very much entrenched in healthcare, we now have that very clear delineation between private and public. Coupled with this, we have the undervaluing of hospitals' accident and emergency departments, such as that in Our Lady's Hospital in Navan, which are failing people when they are most in need of urgent care. For years, people throughout the State have had to march, lobby, campaign, write letters and take to social media in an effort to save their services in their hospitals and in their accident and emergency departments. This is all against the perceived dismantling of healthcare services.

In June 2022 my neighbouring constituents in County Meath are campaigning to save their accident and emergency department in Navan, and not for the first time. The Minister need not think that some of them are going to come across to Mullingar. In January 2021, there were 75.5 whole-time equivalent vacancies. As of June 2022, that figure has skyrocketed to 125.42 whole-time equivalent vacancies in Mullingar hospital. The patients could use the waiting lists as wallpaper. Waiting times in accident and emergency departments are through the roof and staff are at the end of their tether.

That is before we even get to disability intervention therapy services or respite care, which has carers and loved ones so distressed and disillusioned they are literally in tears. Has this become so commonplace that the Minister and Members of Government are utterly unaffected by the sight of distressed citizens taking to the streets with placards in an attempt to save the hospital services on which they rely? There is no doubt that successive Governments have done a merry dance, which this Government seems to be perfecting. The people of Navan deserve so much more than this, as does every person with an urgent medical need in this country.

I fully support this motion because I come from a county that has seen first-hand the negative impact of cuts on local services. The Minister knows this because in 2013, he supported the closure of our local accident and emergency department in St. Colmcille's Hospital in Loughlinstown. At that time, while in opposition, the Minister fully supported the downgrading and closure of that emergency department. He said that the reconfiguration would save lives in Wicklow and improve the quality of emergency care for the people of Wicklow. Over 21,000 people who used the accident and emergency department in Loughlinstown were thrown into an already overwhelmed St. Vincent's University Hospital, which simply could not and cannot deal with that increased demand.

As we stand here, there are 42 people lying on hospital trolleys in St. Vincent's. Last week, an aunt of mine was one of those people. She is a cancer patient. She has ovarian cancer, liver cancer and lung cancer. She collapsed on the street of Wicklow last week. She was rushed into St. Vincent's, bypassing a hospital that the Minister supported the closure of, and was left lying on a trolley in St. Vincent's for four days and three nights. She went through suffering, pain and indignity. That is my aunt but I am conscious there are many other people in similar situations. They are not looking for preferential treatment. I am not raising my aunt's case looking for preferential treatment. They are looking for dignity and respect. They are looking for a bed.

What the Minister is trying to do, supported by his Government colleagues and the HSE, is replicate the disaster visited on the people of Wicklow for the people of Meath. I will not stand idly by, like the Minister did in 2013, when he supported the closure of our local accident and emergency department. He is culpable for the failure of the local medical services in Wicklow and for the suffering people like my auntie and thousands of others have had to endure because of his failures. We cannot stand idly by and allow the Minister's failures be visited on the people of Meath. He must stand up to support the local services. He must support this motion. He failed Wicklow. He cannot be allowed fail other counties.

I move amendment No. 1:

To delete all words after "Dáil Éireann" and substitute the following:

"notes that:

— the Health Service Executive (HSE) and clinicians in Our Lady's Hospital, Navan have clinical concerns about the safety of the Emergency Department (ED) in the hospital;

— the North East Doctor on Call service has expressed concern regarding reports that the acute Medical Assessment Unit will only be accessible by means of a general practitioner (GP) referral, as they believe this will create further pressures on already overloaded daytime and out of hours GPs;

— there are also clear concerns of clinicians at other hospitals that would be impacted by the suggested changes at a time when all health services are under such pressure; and

— no Government decision has been taken regarding the HSE's proposal for the transition of the ED of Our Lady's Hospital, Navan; and

agrees that several important issues, including additional capacity in other hospitals impacted, EDs, as well as 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."

I thank Deputies for raising this important issue. There are aspects of the Sinn Féin motion I agree with and I also agree with elements of the contributions made this evening. However, what is most noticeable about the Sinn Féin motion is not what it says, but what it does not say. The vast majority of doctors and nurses working in Navan hospital are warning us, including the Deputies as their directly elected representatives, that the current situation is not safe for some patients. They are telling us that over 2,000 people a year arrive at the emergency department who could be at serious risk because the specialist care they need is not available. They told Deputy Brady the same thing about the hospital in Loughlinstown. I was in the room when the senior clinicians told us all, including Deputy Brady, that people in Wicklow could die-----

People in Wicklow did die, because you swallowed that.

In spite of that, Deputy Brady played politics and populism. Clearly, the truth hurts. That is what he did.

You cannot see the truth, Minister.

(Interruptions).

Please, let the Minister speak. Nobody interrupted the Deputy when he was speaking.

Deputy Brady was told the position he was taking was putting people at risk but he stuck with it and he perpetuates those falsehoods years later. It is an insult to the brilliant men and women who are working in Loughlinstown hospital. If he was to bother taking any time to talk to them about what the best successes in healthcare have been recently for the people he and I represent, they would point to Loughlinstown hospital.

Sinn Féin and other Opposition Deputies have a choice. They can play politics and ignore the warnings from doctors and nurses, as Deputy Brady did and continues to do, or they can have an honest conversation about finding the best outcome for people in the north east with regard to emergency and urgent care. To that end, I have tabled an amendment stating that the HSE and clinicians in the hospital have clinical concerns about the safety of the emergency department but also that the north east Doctor on Call service has expressed concern regarding reports about the acute medical assessment unit. There are also clear concerns from clinicians in other hospitals, including Our Lady of Lourdes in Drogheda, that their patients and services would be impacted under the current proposal. Critically, no Government decision has been taken regarding the HSE's proposal for the transition of the emergency department at Our Lady's Hospital in Navan. The motion goes on to say that "several important issues, including additional capacity in other hospitals impacted, EDs, as well as 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."

Navan is an acute general hospital with 62 medical beds. It does not provide paediatric or obstetric care. It does not provide an acute surgical service. Ambulances bypass the emergency department for several conditions that cannot be catered for at the hospital. As part of the reconfiguration the HSE is looking to implement, it is proposing investment in more patient care in Navan. However, for any proposal to be considered, we would need to be satisfied on several levels. I am not satisfied and neither are the Government or Members of the Oireachtas. I acknowledge that. Legitimate questions have been raised by Members of the Oireachtas regarding issues including access to the medical assessment unit, the capacity of the National Ambulance Service, local access to GPs, emergency and other resources in Drogheda and other hospitals, the use of injury units and more. All these issues have to be addressed and they have not been addressed to my satisfaction, to the satisfaction of the Government or, I dare say, of this House. We are all agreed on that. I have met with senior clinicians in Our Lady of Lourdes Hospital in Drogheda and they told me they do not currently have the resources required to cater for the additional patients who would have to go through their emergency department. For all of these reasons, I have instructed the HSE not to proceed at this time with any proposed reconfiguration at Navan. We need to allow for meaningful discussion and engagement with elected Members on all sides of the House and other stakeholders, including the community and clinicians. We need to assess all of that in the round and then decide where we are going. I want to be very clear on this. For the reasons I have raised and Members of the Government have raised, and indeed for reasons raised this evening, the Government position is absolutely clear. I have instructed the HSE not to proceed with what it had intended to do on 30 June.

I too welcome the opportunity to discuss this issue. At the outset, I stress that we all want what is best for the people of Meath and the surrounding counties. That includes our family members and friends. We want to ensure everybody gets the best possible healthcare, that we have appropriate access to that healthcare in appropriate timeframes and that we are seen in the best possible places by the best possible people. That needs to be said clearly. That is what we all want. There have been understandable concerns about the proposed changes to Navan hospital. These changes started with the publication of the small hospitals framework. We all agree not every hospital can be a large hospital and have expertise in every field.

Equally, no document should be thought of as concrete, and as times change and as populations expand, we always need to be open to the fact other options are possible.

That framework was followed closely by the closure of the acute surgical unit and then the movement of the stroke unit, both of which decisions have resulted in, understandably, a clear concern about patient safety. A total of 1,700 of 2,000 patients were referred to equipment where the resources were simply not there. I do not doubt, and I am sure none of us does for a moment, the genuine clinical concern. I do not in any way contradict it; how could any of us given it is clear medical evidence? In the same vein, however, as the Minister outlined, I do not think any of us doubts the concerns raised by clinicians and medical experts in other departments and other hospitals, namely, that relating to the possible transfer risk if we were to close the Navan hospital accident and emergency room to avert that possible risk. The fear is that we would be simply transferring one kind of risk to another hospital, whereby there would be an increase in the number of patients attending an emergency department in Drogheda that is overstretched and overloaded.

While I acknowledge the wonderful staff who work in each hospital, it is important to stress there are different opinions and it is important all opinions, views and clinical expertise be taken into consideration. It is only fair and right that all of us in this Chamber, where we have a role when it comes to health in funding and capacity and where we have to answer questions about the decisions we take, should ask questions, get clarity and be able to tell the people we represent that they will get the best possible healthcare. In recent days, weeks and years, I have raised, along with others, questions relating to, for example, patient numbers and types. Since 2019, there have been about 22,000 presentations to the Navan hospital accident and emergency department, 2,000 or so of which comprise critical patients who have been mentioned, while one third relate to GP referrals. Where should the remaining 10,000 or so patients go and how will they know whom to go to? We need clear answers for all these questions.

How will the medical assessment unit work? There was a welcome letter from some GPs today stating they had been engaged with in regard to our hospital in Navan and that they support it. There is another letter, however, from North East Doctor on Call, which is part of the same group, stating it has not been engaged with and that its doctors do not support it. We need clear answers as to how this will work.

On capacity, our neighbouring hospitals are under severe strain. We have been told by clinicians in Drogheda that the capacity is not there and that we would be simply transferring a risk, and that additional capacity will be built into the system, yet a capital plan announced only a few weeks ago did not include resources or additional capacity for Drogheda in this context.

Many questions still need to be answered and we as public representatives deserve answers to them. I am very grateful to the Minister, Deputy Donnelly, who has committed to looking at all these questions and ensuring they will be answered. I refer not just to capacity in Navan hospital and access to services in the proposed medical assessment unit but also to the National Ambulance Service and the capacity in the surrounding hospitals.

I am sharing time with Deputies Daly, Cronin and Buckley.

As the Minister for Health will be aware, this motion calls on the Government to retain and enhance emergency services in Navan hospital. We are also asking that the Government, once and for all, end overcrowding in emergency hospitals. Only major investment in our health service will finally change this situation. The way this has been handled is atrocious. It is becoming a feature of Deputy Donnelly’s tenure as Minister and of how the Government does business. There has been confusion and mixed messages from the HSE and the Government, and we need the latter to outline exactly what its plans are for the Navan hospital accident and emergency department and its plans for the emergency services in Meath and Louth generally. He said he has instructed the HSE to pause, but for how long? It is the Government’s policy to close the emergency department in Navan hospital, as outlined in its small hospitals policy. Which is the Minister saying? Is he saying the intention is not to close it, or that the Government is going to pause doing so while the public outcry remains and then give the HSE the nod to move swiftly on with implementing its policy?

Our Lady of Lourdes Hospital, Drogheda, is the largest hospital in the area and, under the Government’s hare-brained plan to close the Navan hospital accident and emergency department, it stands to reason the number coming to it will increase very significantly, as clinicians have told the Minister. This influx of additional patients is going to put unbearable pressure on the hospital and the plan cannot go ahead for that reason. North East Doctor on Call has indicated that the proposal to make the acute medical assessment unit in Navan hospital accessible only by means of a GP referral will place significant additional pressures on GP services. That was not thought out either. It will compound the matter. The doctor-on-call service recently had to reconfigure its out-of-hour services, which it has stated is because of acute doctor shortages and the underfunding of services, and it has told Navan hospital that it will not be put in a position whereby it will have to manage acute and serious presentations.

Will the Minister give clarity? Either it is his Government’s policy to close the emergency department in Navan hospital or he is going to tell the HSE to halt it completely and go back to the drawing board. Which is it?

I welcome the opportunity to speak to the motion and thank my colleagues from County Meath for enabling it. The downgrading of services is well known to people in Munster. I encourage people from the Meath area to look at what happened in Ennis and Nenagh, where there was a downgrading of services, staff shortages, the closure of units and the promise of a centre of excellence in Limerick. Last week, a HSE report outlined serious problems in Limerick hospital relating to patient flow, inpatients, dignity and privacy for patients and staffing levels, yet the two hospitals in counties Clare and Tipperary were downgraded and services put in there.

I heard the Minister quoted on the radio yesterday, although I am not sure whether it was accurate, as saying there was a fear due to the current climate that operations will be postponed due to Covid, but that is already happening in University Hospital Kerry. For the past seven weeks, elective surgeries have been suffering because of a lack of staff and early closing hours, and the number of day procedures has reduced. Moreover, trolley numbers have increased by ten times on the figure in 2012, and by 40% year-on-year to last December.

Over the weekend, I spoke to a former neighbour of mine in Rock Street, Tralee, who has ulcerated feet. He is suffering because he cannot see a podiatrist, given there is no podiatrist in all of Kerry. He has to travel to Cork twice a month to see someone there, spending €100. On occasion, he has been on the way at 5 a.m. or 6 a.m. and has got a text message to tell him he will have to return. He relies on the community services and his GP. Part of his toe fell off on Thursday night and he spent 12 hours waiting for an ambulance before he was seen, after which he was sent back to the same services as before.

There is a fear in Kerry that services will be downgraded. I urge my colleagues up the country to ensure that will not happen in Navan.

I am pleased to speak to this motion because regional hospitals are vital in our communities, yet what the Government is talking about doing in Navan hospital amounts to taking a sledgehammer to a supporting role. I commend Deputies Guirke and O’Rourke on highlighting the downgrading of Meath regional hospital because centralising expertise is worthy and all very well. Nevertheless, doing so implies the rest of the health service around it is working well, but in the Navan area and, indeed, throughout the health service, it is not.

A total of 1.3 million people are awaiting healthcare and the two neighbouring hospitals, Connolly Hospital and Drogheda hospital, are at breaking point. The local GPs are on their knees and there are just too many patients. We all have a lot of constituents coming to us saying they cannot get a GP, so a GP referral just will not work. The GPs who are there are just exhausted, overworked and undervalued. They are exasperated by dealing with a hospital system that is perpetually in crisis. Who in the name of God looked at this healthcare disaster and thought we should close the emergency department and critical beds in Navan hospital when the surrounding hospitals are simply out the door?

Who in the Minister’s Department agreed that this would be good idea? It certainly was not the people who live in my neighbouring county of Meath. I am sure it was not the local healthcare providers in Connolly Hospital or Drogheda either. It seems that the Department of Health does not have a notion of what is going on. It is like the Department of Housing, Local Government and Heritage or the effects of the increase in the cost of living, because the Government making the decisions is so far removed from the people who must feel their effects. We see what is happening in Meath from the perspective of our hospital in Naas and we want to make sure that Naas is okay. I have spoken to the Minister about trying to get the maternity section back in Naas. We want that and we have wonderful staff in Naas General Hospital. The Minister knows I am campaigning to get the Coombe antenatal clinic reopened there and they are talking about not doing it. Local care is progressive and especially with climate change coming upon us, local care should be our aim.

I listened to the response of both Ministers earlier. I commend my Meath colleagues on bringing this motion forward tonight. The downgrading of any services and centralising emergency departments only cause a funnel and it is like gridlock, which I heard some of the earlier speakers say.

In May, the Minister visited Cork where the average waiting time at Cork University Hospital, CUH, is 28.8 hours. At the Mercy University Hospital in Cork, it is 26.8 hours. It was said earlier that anybody over the age of 75 must wait an average of 14 hours for admission to a bed from the emergency department. I live a long way from Navan but I see the same thing happening again. I see something similar in County Tipperary where they are downgrading as well and no doubt we will be here in a couple of weeks discussing that. Even from listening to the Minister earlier, I understand where he is coming from. The problem is that we should be retaining and enhancing services, however.

From listening to the debate coming tonight from the Government's side of the House, it seems to be going away from what the Sláintecare report recommended, which was that everything be community-led and that prevention is better than cure and people should be able to access services. The issue around GPs was mentioned a while ago. If this is going to be the situation in Navan, I would hate to get a heart attack and have to look for a GP referral. It is not possible. I think we really have to go back here. There has to be a massive upgrading because I suspect this is across the board. I see it in my own town and we spoke about it many times. Again, they are downgrading respite services and mental health services and trying to push them all into a central area. The resistance is frightening because it makes things almost impossible to access. I have seen it in many reports and I read pieces today. It is about access to services and we are taking away the vital services. I heard the Minister say that some of the services are not being provided. That is what the speakers on this side of the House said - invest in it and enhance it. We cannot funnel everybody in one area. It is going to end up in gridlock and what happens when we have a funnel like that is that everything piles up and gets dumped and nothing will work. I ask the Minister to please support the motion from this side of the House.

I am pleased to speak for the Labour Party on this very important motion. I am more than familiar with Our Lady's Hospital, Navan. Outside of Our Lady of Lourdes Hospital, Drogheda, it is the medical facility with which I am probably most familiar . That will be the case for any resident of the Drogheda, south Louth and east Meath areas. It is a valued and very valuable piece of health infrastructure in our region in the counties of Meath and Louth. I say counties Meath and Louth deliberately because I represent Louth and a very significant part of the east of County Meath.

I also say this because no Louth-based Deputies were invited to the briefing with the HSE on 13 June. That was wrong; we needed to be. I will tell the Minister exactly why and I think he knows why. If the Minister proceeds with the plan to finally close the emergency department in Navan, and I acknowledge that he put on the record this evening his intention to pause that - for how long we do not know - then he knows he will be dealing with a whole host of new problems. The Minister articulated that in his response this evening. That problem is even more overcrowding in emergency departments and on the floors of Our Lady of Lourdes Hospital, Drogheda. This plan has been badly organised, badly planned, badly thought through and incredibly poorly executed. I say this because neither the Minister, the HSE nor the RCSI Hospitals Group over the past week could tell me precisely how many new beds and what additional capacity would go into Our Lady of Lourdes Hospital, in the event of this move going ahead, to deal with the additional demand that would inevitably arise were the emergency department in Navan to close.

We got some sense of this from a reply to a parliamentary question the Minister issued to me this evening in which references were made to ten additional beds. Anybody who is familiar with Meath and Louth will tell the Minister that ten additional beds, even in the context of the current demand, notwithstanding the Minister's ultimate plan for Navan, simply would not cut it. We know today that 521 patients were awaiting admission to a hospital bed across the country and 441 were in emergency departments. Those are the figures from across the country. I know too there are pressures today, as there are every day, in Our Lady of Lourdes Hospital, Drogheda.

I am very familiar with one case because it was raised with me today. Hardly a day and certainly a week does not go by, notwithstanding the very hard and dedicated work of the staff at Our Lady of Lourdes Hospital, without me being informed of a difficult situation in which an often elderly, frail and vulnerable person might find himself or herself. As I said, that is notwithstanding the commitment and dedication of staff to resolving all the problems that present themselves at emergency departments. I will give the Minister one case that illustrates the wider point. A family were in touch me today about their dad, who is a very elderly man with dementia and an acute respiratory problem. He was in the emergency department in Drogheda waiting for a room since 8 a.m. this morning. He is now in a multi-bed situation in one room. His family got in touch to tell me the circumstances he is in and the way he is being accommodated at the moment given the pressures on the hospital are not appropriate for him. I think the Minister would accept that himself. The man's daughter signed off her first email to me this morning by saying, "and they are talking about sending patients from Navan to this hospital". That is what she said I think she speaks for all of us - she speaks for me. She is right to be concerned and the clinicians and staff in the hospital are right to be concerned. The Minister expressed that himself in his remarks this evening. He confirmed that the clinicians in Our Lady of Lourdes Hospital, whom he has met, are concerned about the consequences of the closure of the Navan emergency department on an already stretched hospital.

This is not the first time that Our Lady of Lourdes Hospital has been in the firing line and has had to accommodate additional numbers of patients as a consequence of a closure of an emergency department in our community. I want to take the Minister back to the late 2000s and the initial reconfiguration programme, with which we will all be familiar, under a former Fianna Fáil-led Government. That Government made the decision to close the emergency department in Louth County Hospital, Dundalk. Let us look for a minute at how that went for Our Lady of Lourdes Hospital, Drogheda. As a resident of the area, then as a councillor for the area and later as a Deputy, I remember the chaos at a time when investment in our public services was stretched because of the collapse of the economy. In 2010, the year before the full impact of the closure of the accident and emergency department in the Louth County Hospital became apparent, the Irish Nurses and Midwives Organisation, INMO, annualised trolley watch figures from Drogheda suggested that 3,484 people were on trolleys in the emergency department at one point or another in that year. In 2011, after the closure of Dundalk, 7,449 citizens had been counted on trolleys at one point or other across that year; a more than doubling of the figures before the emergency department in Louth County Hospital was closed.

There is a direct and very severe causal relationship between the closure of emergency departments in the region and the impact on stretched resources at Our Lady of Lourdes Hospital. Now it appears, notwithstanding what the Minister said tonight about the pausing of his approach to the Navan ED, that he is still preparing the axe to fall. The sword of Damocles is still hanging over the emergency department in Our Lady of Lourdes Hospital because it appears that the HSE and the Department of Health are preparing to do the same thing again. They are incapable of adequately preparing and of learning the lessons of recent history in the north east.

Our Lady of Lourdes Hospital, as Deputy O'Rourke and others know, has historically been the poor relation in terms of centres of excellence in this country when it comes to investment. It is the de facto regional hospital but it never received the appropriate resources to bring it to the next level. It is the regional trauma centre. We are very proud of our hospital and of the great work that the dedicated and committed staff do there. We all rely on them and their expertise and dedication. One thing that the system never reflects in the hospital's budgets is the fact that it is also the hospital and ED of choice for many people in the Fingal area of north County Dublin, often because of pressures in Beaumont Hospital and other hospitals on the northside of Dublin. It is also a fact that many cases that one would ordinarily expect to be dealt with in the emergency department of Daisy Hill Hospital, Newry, for example, make their way to Our Lady of Lourdes Hospital, Drogheda. Even without the extra resources that would be needed as a consequence of the inevitable decision that the Minister will ultimately take regarding Navan ED, the case for significant investment in Our Lady of Lourdes Hospital should be clear.

The Minister should also be mindful of what I will say next. We now have a perfect storm of circumstances arising that could lead to a real potential catastrophe in the provision of healthcare in the area. It is a letter that all local Deputies received from North East Doctor on Call, NEDOC, the doctor on call service, last Thursday night. It is an absolutely explosive letter that acknowledged that because of GP burnout, the burdens on GPs in the area who are involved in the NEDOC co-operative and, importantly, because of underinvestment from the HSE, it plans to reconfigure its services and reduce the hours of operation from early August. We potentially have a situation where the ED in Navan closes, there is huge pressure on Drogheda and there is an imminent threat hanging over the NEDOC service as well.

This is being handled in a cack-handed way. I am glad the Minister is reflecting on how he will proceed on this, although I cannot help but think he is only reflecting because of the political fallout from a decision that seems to me to be inevitable and on which the Minister and the Government have made up their minds in any case. The Minister has to be clear on what the timeline is. Our Lady of Lourdes Hospital staff and the people of the region need reassurance that the service is not going to suffer when the Minister inevitably makes the decision to close the door of the emergency department in Navan, which will have huge implications for the provision of healthcare in our area.

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.

I thank Sinn Féin for bringing forward this motion, which I support. I pay tribute to the people in Navan and the region for mobilising and coming out in their thousands to defend and seek to ensure the future of their hospital. They are absolutely right to do so. I understand there is another protest planned for 9 July. It is only through those people-power mobilisations that the hospital and emergency department in Navan will be defended. I would prepare those people by saying that they will hear all sorts of positive soothing noises, in particular from Government Deputies in the area telling them not to worry; that it will be okay and so on, but the people who have been mobilising and campaigning for so long know that what is being attempted here is really death by a thousand cuts. If the Government and the HSE are not checked or stopped by a movement which says "No" and that it needs to continue to have a full, proper emergency department in Navan, then that process will continue. It is only people power that will be able to stop it. When campaigners who attend protests and meetings wonder if it will be okay and that there is a medical basis to the logic of centralisation, which is always the argument they try to make, I would just tell them to look at the experience of the mid-west region. On a daily basis, the same arguments were made then in terms of the closure of regional hospitals. It was said that it makes sense and that we had to centralise hospitals, but the resources were not put in place in Limerick and the result is that there is massive overcrowding on a daily basis. The disaster of this process of centralisation, which in reality becomes an excuse for cutbacks and downgrading, is just witnessed on a daily basis in Limerick and in the mid-west region. That is why this plan must be stopped.

One of the good points made in the motion is about the extraordinary waiting times for emergency departments at Connolly Hospital in Blanchardstown and Our Lady of Lourdes Hospital, Drogheda. What struck me when looking at them is that we are talking about nine, 11 and 12 hours across the State as an average. In Tallaght Hospital at the moment, the average wait time for someone going to the accident and emergency department is 18 hours. It is scandalous. The figures across the country are scandalous. That is just the average. People are left waiting significantly longer than that. The wait time in the accident and emergency departments in Tallaght, Drogheda and Connolly Hospital, Blanchardstown is an emergency, but it is no accident. The waiting times are the result of decades of neglect of the health service by successive Governments underfunding hospitals, running the staff ragged, not providing the investment into hospitals to expand capacity and not bringing private hospitals into public ownership, but instead continuing with the logic of a two-tier health service - almost a three-tier health service. That only works if there is a problem with the public tier, whether that is the first, second or third tier. The private tier will not make any money if the public health service provides the sort of service that people need. Instead of downgrading hospitals, we need investment to improve hospitals across the board, to hire more staff, support the staff that we have, and to build a top-quality Irish national health service that we can be proud of.

I want to take the opportunity to raise some other health-related points with the Minister in terms of the current situation regarding Covid. One point I want to make is that there are now 200 health workers who have been long-term sick with Covid, who now face having the sick leave scheme they are on being closed down at the end of this month. The Minister is saying it is not happening. I hope that is definitely the case. They are workers who helped to keep the health service running during the crisis. Many of them caught the virus through their work and are now suffering debilitating long-term Covid. What has been reported is that the Government was planning to pull the rug out from them, scrapping the paid leave scheme, and failing to engage with SIPTU. If the Minister is saying that is not going to happen, that is very welcome news. In this debate, the focus should be on Navan, but it is important for the Minister to make a statement about what is happening in terms of the Covid situation. The INMO's members are the people on the front lines. They are ringing the alarm bells in terms of the levels of hospitalisation. More than 600 people are in hospital and the rate of increase in hospitalisation is more than 16% week on week. In comments from the Minister or the Government in the media generally we hear a lot of talk of living with Covid, but if that is to mean anything, the Government must do some things to enable us to live with Covid. We cannot just continue as normal and say we are living with Covid, because then the results will be tens, then hundreds then thousands of unnecessary deaths, both through Covid and through the impact on the health service generally.

We need to see a plan and action on living with Covid. I will quickly say a few things. We need to get back to a situation where people are wearing masks inside, on public transport, in crowded spaces and so on. The best way for the Government to signal that, and for it to happen, is to send out quality FFP2 or N95 masks, the kind of masks we get for free in Leinster House, to people in their homes, to have them available at public transport locations, such as bus stations, train stations, etc., and just try to renormalise the idea we need to go back for a period to wearing masks, where people possibly can do so. There should be big public health advertisements around it and so on. Let us invest in this; it makes sense to do it.

I was disappointed to see the free antigen tests for relatives of those who have Covid have now been removed. We should encourage as much testing as possible throughout the population in order that people find out when they have Covid as quickly as possible. Antigen tests should be made free to all.

I will make a final point on ventilation. It is now more than six months since we passed the Bill giving workers the right to clean air through ventilation and filtration, including in schools. On that day, 1 December, the Minister of State, Deputy English, said not to worry, the Government was not just plámásing us and was very eager to have this implemented, that it might make sense to do it through regulation, to which the Government was very open, and that he would give us a call-----

Deputies received a letter telling them it has been done.

It has not been done.

We are implementing the changes Deputies suggested.

The Government is implementing the changes we suggested.

Most of them. Deputies got a communication regarding the Health and Safety Authority.

We got a letter. It did not state it was being done.

Was this a few months ago?

It was only about two weeks ago.

We have not got that. It has not appeared on my desk.

Okay. I will keep talking because if I say something, the Minister of State says it has been done. Can we please nationalise the private hospitals? Has the Government decided to do that? No. I will check and, if these things are being implemented, that will obviously be excellent news because we need to put these measures in place. I will find this letter. I was absent due to Covid for the past couple of weeks so it is possible it came in. I will look for it. I will leave it there. I wish the people of Navan and the surrounding areas very well in their struggle to keep their hospital.

I move amendment No. 1 to amendment No. 1:

To delete all words from "notes that" down to and including "could be considered" and substitute the following:

"calls for:

— the Government to end plans to close the ED in Our Lady's Hospital, Navan;

— the Government to remove the policy within Securing the Future of Smaller Hospitals: A Framework for Development to downgrade Our Lady's Hospital, Navan from a level 3 hospital to a level 2 hospital; and

— the necessary investment to be made by the HSE to restore acute surgical services in Our Lady's Hospital, Navan in order to provide a safe service to the 200,000 people living in Co. Meath"

There is a palpable sense of anger in County Meath at present regarding the Government and HSE plan to shut down Navan accident and emergency department. That department is without doubt the most important piece of health infrastructure we have. For us, it is a life-and-death issue. I attended the discussion on the future of Navan's accident and emergency department in the Department of Health last Monday. I was shocked, and the Minister must have had a sense of shock as well, because in all the presentations we received from the HSE on that day, no reference was made to overcrowding. The context of the crisis engulfing the accident and emergency system in this country was never mentioned. It is incomprehensible that the Government would consider closing our accident and emergency department at a time of record waiting times.

The HSE figures show that people are waiting up to 12 hours in Drogheda's accident and emergency department. At Connolly Hospital Blanchardstown just before Christmas, the staff had to come out on a picket due to the overcrowding conditions they were enduring in their accident and emergency department. The Mater Hospital, Dublin, and the Regional Hospital Mullingar have asked patients not to arrive in their accident and emergency departments due to overcrowding. Last week, 546 people were on trolleys throughout the State and that is in the middle of summer. At the meeting last Monday - I was amazed by the sentence - I heard the HSE state that people keep turning up at accident and emergency departments. Orthopaedic treatment and elective surgery in the hospital at Navan were suspended during the winter months because of the pressure on its accident and emergency. It is unbelievable the Government is seeking to close an emergency department that was overcrowded just a few months ago.

I have no faith in the HSE. I am told to have faith but it is impossible to do so. These are the people who closed the emergency departments in Ennis and Nenagh hospitals. These are the people who made the decisions that are precipitating the crisis in UHL at present. Under their stewardship, and this is very important, adverse incidents have jumped from 79,000 in 2017 to 105,000 just last year. That is an increase of 32% in the number of people who have suffered due to mistakes in clinical care. Extreme incidents, which include death and permanent incapacity, rose from 375 people in 2017 to 579 people just last year. The main cause, and this is crucial, is the fact the staff the Minister manages and is in charge of are under such extraordinary pressure.

Information I have received through a parliamentary question to the Minister has shown that if Navan accident and emergency is closed, it would push thousands of patients from a hospital group, Ireland East Hospital Group, with a lower level of adverse incidents into the RCSI Hospital Group, which has the highest level of adverse incidents in the country. I asked HIQA whether it has ever carried out an investigation into this; it said "No". I have asked HIQA if it has ever carried out an investigation into the effects of the closure of an accident and emergency department on patient outcomes. It has said "No". This is because we do not do investigations in this country into decisions made by senior HSE staff or Ministers that have enormous repercussions on the lives of people in this country.

The HSE is proposing a replacement for Navan, namely, a GP referral medical assessment unit, MAU. It states it will be a 24-hour service. How in the name of God can it be when GP offices close at 6 p.m. and when North-East Doctor on Call stated it would not accept patients who would normally have been dealt with by Our Lady's Hospital in Navan? The idea that it will be 24 hours is absolute nonsense. I will direct this key point to the Minister of State because he knows it as well as anybody else; it is nearly impossible as a person new to the county to get a GP. People are going to Dublin and elsewhere to get GPs. If someone wants an appointment with a GP, it could take up a fortnight to obtain one. Does anybody in their right mind think that a person suffering an emergency, or an accident or ill health, will ring his or her GP and wait for a fortnight to get a referral to an MAU? It will not happen. People will circumvent the MAU and go straight to Our Lady of Lourdes Hospital, Drogheda.

I draw the Minister's attention a report published by the HSE a number of years ago. The report in question is available on Lenus and states that the new regional hospital should go to Navan because of the burgeoning population there. The HSE spent millions on that report and it is now pegging it into the bin. In late 2010, the Minister of State, Deputy English, and five other Fine Gael representatives stood outside the hospital in Navan and promised that a new regional hospital would be built in five years. It is nowhere to be seen. Mr. Thomas Lynch promised in front of 10,000 people at a march in Navan that he and Fianna Fáil would protect the accident and emergency department. He is now making arguments in public for the closure of that department. I will mention the Sinn Féin Private Members' motion. It is not strong enough. It studiously avoids calling on the Government not to close Navan accident and emergency.

I am proud to have been chair of the hospital campaign for the past ten years. We will not give up. We will fight for the retention. We will bring thousands of people onto the streets on 9 July. If the emergency department closes, it will cost significantly in human terms but it will also cost in political terms. There is no Fianna Fáil or Fine Gael Deputy in Roscommon. That should be remembered when Deputies vote.

On Monday, 28 June 2010, around-the-clock emergency services ended at Louth County Hospital in Dundalk. The emergency department closed and was replaced by a minor injuries unit. At the time, that meant patients in the north- and mid-Louth area who got chest pains or abdominal pains, or were involved in road accidents, had pregnancy-related conditions and more, would have to pass Louth County Hospital in Dundalk to get treatment in Our Lady of Lourdes Hospital in Drogheda. From that day on, the minor injuries unit opened from 9 a.m. to 8 p.m. seven days a week for patients who presented with non-emergency conditions, and people with strokes and other rehabilitation needs could use the 35 remaining beds, which were known as step-down beds. In February 2010, the HSE stated that Louth County Hospital was changing but not closing, but the opening of a new emergency department and medical assessment unit at Our Lady of Lourdes Hospital paved the way for the closure of the 24-hour accident and emergency department in Louth County Hospital and the transfer of acute medical services to Drogheda.

The same situation is now happening in Our Lady's Hospital in Navan. On Monday, 13 June, it was reported that the emergency department in Our Lady's Hospital in Navan is to be closed and replaced by a medical assessment unit. Emergency patients were informed they should go to other hospitals and that 80% of the people who go to the emergency department in Navan would continue to be treated in that hospital.

It was also stated that the hospital did not meet safe clinical standards for some patients. These are mixed messages.

On Tuesday, 14 June, the Minister stated that no decision regarding the HSE's proposal for the transition of the emergency department at Our Lady's Hospital, Navan, had been granted by the Government. He also stated that the HSE had clinical concerns about safety and that the 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 took place. On the same day, the Tánaiste stated that the Government had not sanctioned the closure of the emergency department at Navan. It is no wonder that people in Navan and its surrounding areas are confused. These are mixed messages. What is happening is similar to the situation at Louth County Hospital, with tens of thousands of people marching and people talking about all of the lives that have been saved at the hospital and its excellent staff.

At the moment, all roads seem to be heading towards Our Lady of Lourdes Hospital in Drogheda. I must pay tribute to its staff for turning the hospital around. In recent years, it used to be at the top of the list of overcrowded hospitals in the country. Now, it is one of the best performing and busiest hospitals in the country. It has 14-hour waiting lists and patients there receive a high standard of care, but I fear that, given the extra catchment area and the current resources and staffing, the position could get worse. I am concerned by the population covered and the level of investment. The Government promises plenty of money but none of it seems to land. The situation in Navan should not be used for political point scoring.

I have always said that your health is your wealth. Please, let us all work together and stop sending different signals. Let us consider the patient and what is best for everyone. The communication lines have been dreadful. Both the HSE and the Government are sending the wrong signals. The HSE says that it has concerns about the safety of the emergency department at Navan. This is a bad signal to send at a time when all health services are under pressure and concerns about additional capacity at other hospitals and the ability of people in the Navan area to access emergency and urgent care have not been addressed.

This situation has been ongoing for years. The Minister has let the people of Meath and surrounding areas down. He promised for years to meet them, but when he met them, he gave them bad news. I personally believe that he did not have the balls to do that on day one. Please, sit down with the relevant people, sort the situation out and look after people's health.

Next is the Rural Independent Group, with five Deputies sharing time.

I compliment the Deputies who proposed this motion. We have seen what happened in Monaghan, Ennis and Nenagh. Ministers act as if they are bystanders at a wake. All they are missing is the snuff. They might make the caointe cáin. The Minister of State, Deputy Butler, allowed a wonderful hospital in Carrick-on-Suir to be closed in the middle of Covid - it was used for Covid - and denied the people of her own area, but she will have to deal with them at the ballot box. I do not know what to say to the Minister. I always said that the previous Minister, Deputy Harris, would go down in history as the worst Minister for Health ever, but Deputy Stephen Donnelly is surpassing him by the hour. He is inept.

The HSE is out of control. Former taoisigh, Mr. Bertie Ahern and Mr. Brian Cowen, told me that they were going to disband the HSE. No one in the Government has the gumption to do it. The HSE is out of control. The Government might as well be rubbing Vaseline to you know where on a sow. The HSE does not care about or respect the Government. It does not respect the patients or elected representatives. Community nurses, who do a fabulous job in my area, are being moved around for the second time in three years out of fear that they might get to know the people or start feeling empathy towards them. It is blackguarding of good, honest workers. Then there are the people in the layers of bureaucracy who are missing in action, MIA. We can see what is happening in Limerick. When Nenagh, St. John's and Ennis hospitals are closed, all of the people will be pushed into Limerick. It will be catastrophic.

I spoke to Mr. Jonathan Irwin today - a campaigner for sick children, today is his 81st birthday and I wish him well - to see what was happening with the children's hospital. Tá sé imithe. It cannot be seen above ground. It will cost more than €2 billion now, but those opposite will rub their hands in glee and get their pensions, and to hell with the people. I remind them that, under the Constitution, they are elected to represent the people, not conglomerates.

My colleagues in the Rural Independent Group and I demand that the Government retain accident and emergency services at Our Lady's Hospital, Navan fully. We also demand that the Minister for Health immediately remove any reference to the closure of these services from the small hospitals framework.

I know exactly how the people of Navan feel. Just last year, I had to drag the Government through the gutter to keep services at Bantry General Hospital open to the public. A crisis that was flagged well in advance arose when the hospital had no anaesthetist cover. The people of Bandon, Clonakilty, Dunmanway, Skibbereen, Mizen Head, Sheep's Head, Beara Peninsula and parts of west Kerry were left in a scandalous way. I have no doubt that if not for people power last year, the hospital would have been downgraded. Bantry General Hospital is one of the best hospitals of its type in the country and I thank our staff for making it the best. Without them, we would have nothing. It is sad to think that, if we do not keep our eye on the ball, cuts will be made. Consider the endoscopy unit at Bantry hospital. There were promises after promises. If we had a block laid for every promise, the unit would have been built ten times over. I promise the people of Bantry that I will keep the Government accountable until the work on the endoscopy unit begins.

I urge the politicians as well as the public who are served by Navan hospital to fight tooth and nail. If they accept the closure or downgrading of services, which many people did in west Cork until I launched the Save Bantry Hospital campaign, they will be closed or downgraded. Consider the fight that we put up for funding for Clonakilty Community Hospital to bring it up to HIQA standards. That is a right that the people of Clonakilty and the great hospital staff serving them should have, but I needed to drag and kick successive Governments into providing funding to get it across the line. Hospitals can be the gold standard. We have that in Schull community hospital, for which we fought and fundraised. Credit is due to the former Minister, Dr. James Reilly, who delivered the funds to give us a state-of-the-art hospital after others and I met him many years ago. The hospital is getting glowing reports from HIQA. I thank the hospital's management and staff for their professionalism down the years and for working with the public on making it the leading community hospital in the country.

I wish the Minister of State, Deputy Butler, would listen to me. She was in Bantry last week but turned her back on the ordinary people by not even inviting me. Now she is talking while I am trying to discuss this urgent matter.

I welcome this motion on Navan hospital, but I am devastated and heartbroken for the people of Limerick, Clare, Tipperary and north Kerry. The manner in which they and staff have been treated by the management of UHL is shocking. Last Friday's HIQA report on UHL confirmed everything that we in the Rural Independent Group had highlighted in the Dáil about overcrowding on trolleys in corridors, but the management structure is where the failure lies. Why did HIQA take so long to come on board? The Minister carried out a surprise visit to the hospital, yet he found nothing wrong. HIQA responds to incidents that are reported by line managers, doctors and other professionals, but serious incidents at UHL were not reported in the national incident management system, NIMS. Why was this the case? This is where the problem lies. Incidents there were not reported by the line managers. That is why HIQA took so long to figure out what was wrong there. Under UHL's management structure, people were silenced and had to sign non-disclosure agreements to cover up the incidents. That is why HIQA was not involved for so long. Now, I need the Minister's help to ensure that the management of UHL steps down immediately and an investigation is put in place. Given that the management put so many people in harm's way, cases should be taken against its members through the courts if they are deemed negligent for what they have done to the people of Limerick, Clare, Tipperary and north Kerry.

I support this sound motion from Sinn Féin. Speaking on behalf of the Rural Independent Group, we demand the full retention by the Government of accident and emergency services at Our Lady's Hospital, Navan. I am grateful to Sinn Féin for again giving us an opportunity to debate the important issue of health.

It is annoying for the Opposition that the Minister is doing everything in the world except listening. Last week, he did nothing to endear himself to anyone, including his colleagues, when he did not keep to the practice. All members of the Government seem to be doing it now, with Ministers going around the country and believing it is okay to march into a county without informing their colleagues, with whom they are supposed to be working in conjunction. Even though the Minister is in government, he is supposed to be listening to and working with the people in opposition. If what is happening is nothing else, it is the height of bad manners. The Minister is not the only one doing it. He and other Ministers are going around and not informing representatives who are working on behalf of the people in their constituencies. All it would involve would be a simple email. In Jackie Healy-Rae's time when he was in the Dáil, God be good to him, a Minister would not go anywhere without notifying everyone about what he or she was doing because that was the proper thing to do.

Enough about that.

I want to highlight what is happening in County Kerry. Over the past ten days, I have been monitoring what has been happening in the accident and emergency department in University Hospital Kerry closely. Up until a couple of hours ago, I was speaking to people in management there to find out what is happening. They are at crisis and breaking point. They are doing everything they can to deal with the amount of people who are going in there. Their kindness, work ethic and ability to do their jobs is second to none but they need more management and resources and they are not getting it. Animals can get better and quicker treatment than people can now, and that is a fact.

I also thank Deputy Guirke and Sinn Féin for giving us this opportunity to talk about our regional hospitals. I concur with everyone else here in asking that Our Lady's Hospital, Navan, and its accident and emergency department be kept open because it is most important. As Deputy Michael Healy-Rae stated, our accident and emergency department at University Hospital Kerry in Tralee is clogged up day after day. We have highlighted this here so many times, and the same thing is still happening. Even today we are hearing that there are 21 people on trolleys and last Thursday and Friday 17 people were on trolleys. That is not good enough. No mention is made of the number of people who are waiting on chairs. When they run out of trolleys, people are put on chairs and they are not counted at all for some reason or another but they are human beings. When they get sick they go to hospital and they need attention, which they are not getting. I am glad to take the calls I get on this at 10 p.m. or 11 p.m. from an 89-year-old or a 91-year-old woman or man on a trolley and their families are so concerned. They often say that maybe they should not have taken them into the hospital at all because at least they would be in bed at home. That is not good enough.

We have to increase capacity and the number of workers. I compliment the workers in University Hospital Kerry and in our community hospitals throughout the county, like Kenmare Community Hospital, Killarney Community Hospital and Bantry General Hospital, where we also go. I compliment the workers on the service we get from them when they are under so much pressure. The Government has to wake up. We need to increase capacity at University Hospital Kerry. We are waiting for consultants and we cannot get nurses. Why is it that we cannot recruit consultants, nurses or staff in University Hospital Kerry and yet Cork University Hospital and the bigger hospitals have no problem in doing so? Is it the way the HSE is not offering them enough? Then we heard this morning that HSE officials or consultants are getting €700,000 per year. There is no man or woman in this country or in any part of the world worth that kind of money. The Government has to wake up. That would comfortably employ 12 people but to give it to one person is ridiculous.

I am wide awake, and we are over time.

I thank Sinn Féin for tabling this motion. I partially heard the Minister's response to it. What I heard was slightly surprising in that, on the one hand, the Minister accused Sinn Féin of playing politics and not going with the clinical advice and, on the other hand, it appeared that he overruled the clinical advice and said they were not going ahead as previously planned.

UHL and what can go wrong have been brought up on a number of occasions. The clinical advice at the time was that we needed to consolidate the provision of emergency medicine at UHL, and that is what was done. On 15 March, there was a surprise visit by HIQA to the hospital. That was not the first surprise visit; there was one back in 2014 since that consolidation of emergency services was done and a damning report was provided by HIQA back then. Rather a lot has happened since. A new accident and emergency department has been built, kitted out and staffed. There was a surprise visit to the department on 15 March last. Notwithstanding that, not a lot has changed. It was a damning report. I see the Minister nodding in agreement. I have not heard the Minister comment on it yet but I expect that I will hear him do so. More than the Minister commenting on it, I expect to see something happen at UHL because it is inadequate. I cannot go into the matter any further.

I have accompanied elderly and vulnerable relatives to the hospital and, like many people across Clare, you pray and hope they will not have an accident and be brought there or end their days in there. The HIQA report stated that the hospital failed to provide dignity to patients. Everybody wants dignity as a patient but that is especially true for an elderly person in their last moments. They want dignity, and it is not being provided there. I had an elderly relative who had a fall in a healthcare setting and an ambulance was being brought. I begged them not to bring an ambulance and I had to sign forms so that they would not be brought to UHL. Instead, I bundled that person, who had lost their mobility, into a car and brought them to another healthcare setting and, thankfully, they received the care they needed. If they had been brought to UHL, they would have sat in a wheelchair or on a trolley in overcrowded conditions, with the attendant risk that they would get an infection - and this was pre Covid - because hospitals are places where, inevitably, despite the best efforts of everybody, people are sick. If you are there waiting for a long period, you have an increased likelihood of at least encountering an infection there. That is not something that would worry me terribly on my behalf because I hope I am reasonably healthy but when you have an elderly person whose immune system is inevitably compromised by the conditions that beset them it is a different environment and it is not safe.

This is being visited upon the people of Navan now. I do now know whether the accident and emergency department in Our Lady's Hospital, Navan, is perfect. It probably is not and I know the clinical director has recommended that the move take place. For God's sake, let that move not take place until there is adequate and sufficient capacity in Our Lady of Lourdes Hospital in Drogheda. I heard Deputies who represent Navan say that, and I have heard Deputies who represent Drogheda, including Deputy Nash, say that. That is exactly what happened in Limerick. I will not recite the HIQA report. I know the Minister has read it. The report refers to: "Circumstances such as the hospital being the only Model 4 hospital in the Midwest region, combined with the hospital experiencing unprecedented numbers of presentations of COVID-19 and non COVID-19 cases to the emergency department." One of the factors, which is repeated throughout the HIQA report, is the fact that it is the only model 4 hospital in the region.

I appreciate that it is clinically recommended that accident and emergency department consultants, doctors and nurses have to see a large number of patients to keep their skills up and it is not considered best practice to have small accident and emergency departments where there are small numbers going through. I appreciate all of that but the alternative we have put in place in Ireland, of which UHL is an example, is not best practice either because it was found that the consistent overcrowding there poses a risk to patients. It is not that the staff in there are reckless or that they are not doing the best they can; it is simply that the overcrowding poses a risk. While there is a risk for patients from being in a small emergency department like in Our Lady's Hospital, Navan, or in Ennis General Hospital, when it was there, there is equally a risk when the alternative is massive overcrowding.

What is going to be done about UHL? I asked the Taoiseach if he was going to take responsibility for remedying this into his Department and if not, what would be done to ensure the situation in Limerick would be remedied. I know he is not here to defend himself but the Minister for Health is here as is the Minister of State, Deputy Butler, so either of them can defend him. His response was highly disingenuous.

He said the HSE is responsible for the delivery and operation of health services and that the capacity is not there for any Department, including the Taoiseach's Department, to begin to run hospitals. I was not for a moment suggesting the Taoiseach go in and manage UHL, or that either of the Ministers present or anybody in the Department of Health do so. I was requesting that a commitment be given to provide the resources required to bring the capacity up to what is needed because that HIQA report talked about the lack of capacity in UHL throughout. I was also requesting that management be put in place that can manage the existing capacity because that was the other part of the report. The part of the report which is as worrying to me is the damning indictment of the current management in UHL. It does not give me any pleasure to say it is an indictment, but it is. To hear the clinical director coming out talking nonsense on the airwaves is an insult to people whose family members are in there and to people who contact me and every Teachta Dála in the mid-west region to complain about what is going on there. It is an insult to HIQA and to people's common sense. They are excuses one would say were pathetic from a politician, much less from a clinical director of a model 4 hospital. I am sorry but they are inadequate and if they had a shred of honour they would fall on their swords after a report like this. It is not good enough. If, as a clinical director, one cannot stand over the standard of healthcare being provided in one's hospital, surely one has a duty to highlight that publicly and walk away if it is not addressed, but neither is happening at the moment. There seems to be collusion between management in UHL, the HSE and the Government whereby they pass the buck, blame one another and say "It's not my problem that the Government did not give me capacity", "It's not my problem that UHL management aren't doing a bit better" and so on. Ultimately, it is my problem and that of my constituents.

I am one of 160 people who can vote for a Government here. The buck has to stop somewhere. If it does not stop with the Department of Health and is not its problem, then it becomes the Minister's problem because he is democratically accountable to 159 others and we are democratically accountable for the provision of Government services in our areas. I do not want to personalise it because the Minister did not create the problem in UHL. Maybe he could manage it. After all, he has management experience, but he has another job, which is to be Minister for Health. It is his responsibility and that of the Government to put management systems in place, make sure existing capacity is properly utilised. Subject to the availability of national resources generally, and it seems that UHL is under-resourced compared with comparable hospitals around the country and healthcare generally is under-resourced in the mid-west compared with other regions, it is the Minister's responsibility to put resources in place for a decent standard of healthcare.

I will vote with the Opposition on this. There is a slim likelihood I will ever end up in hospital in Navan or Drogheda but I do not want to see anybody witness the chaos I have witnessed or to be afraid that their relatives will be brought to hospital. It is unnecessary given the resources at our disposal in this State.

I am glad to have a chance to say a few words in relation to Navan hospital, which we are all proud of and lucky to have in Navan. As a Navan person who attended the hospital many times in my years growing up, I have no doubt that we are lucky to have it and it has saved thousands of lives. The people in it are excellent and provide a top-class service in many areas. However, we have to have an honest debate about our hospital. People ask if we are concerned. Of course I am concerned for Navan hospital. I want the best services in Meath, in Navan and for the people I represent, and to be honest with them. I commend the motion because it asks for the best health service. It has not gone overly political in terms of emotion. Some speeches around it might be different but the ask is the same as what Senator Cassells, the Minister, Deputy McEntee, the Minister of State, Deputy Byrne, and I want. We want the best health service for the people we represent, both in government and opposition. I have always held that view, in government and opposition, and will not change it.

We have to tease through what is the best for Navan and the people we represent in Meath. They want the best service, including my family who have gone there for years at all ages looking for service. The staff that work there provide a top-class service. The debate has to be based on medical evidence. It is not about politics or marches. We must listen to both sides because there is medical opinion on both sides. Let us have that honest debate and honest conversation. I thank the Minister, Deputy Stephen Donnelly, for stepping in on more than one occasion to pause these proposals and say "No. Let's tease this out. Let's work this out first of all. Let's see is it genuinely the right proposal or is it not." As a Teachta Dála and Minister of State for the area, I have many questions I want to be answered and teased out. I want assurances on capacity and everything else. We will tease them out.

I also recognise there are medical suggestions here and people telling us differently. I listened to Gerry McEntee. Most of the Teachtaí Dála here last week listened to him. Most people believed him and were concerned. We will all differ on what the solutions are. I will differ with Gerry McEntee on some of that and row with him, but I do not doubt his medical opinion and his concerns for people going there. We have to work out the best way to address those concerns.

The hospital is not closing and will not close. It is a top asset. It is a national and local asset and we are proud of it. I would never let it close. There is a proposal on the table which would change the accident and emergency department if it is let happen. Three previous Ministers and the current Minister have said over the last ten years, my term in government, that it cannot happen until we work this out to see if it is the right thing to do and if the capacity is there. Previous Governments have said the capacity is not elsewhere so it cannot change.

How did it take ten years to ask that question?

On numerous occasions we have said "No" to the HSE. These proposals are not new. They have changed but over many years we have always said "No" and that the place is not ready for it yet. That conversation is still going on. There is extra capacity in Drogheda. We have to ask ourselves if that is enough. I am not convinced it is enough to deal with the patients who might not be able to go to Navan accident and emergency department. Let us work that out.

There are a couple of things I want to see clarified. First, is there capacity, as in beds, staff, doctors, nurses? Are they elsewhere to take the 2,000 to 3,000 patients that Gerry McEntee, as the lead clinician, and many others are concerned about in Navan?

If there is overcrowding-----

Second, can we address the risk concerns in Navan by investing in Navan? Let us fully tease out and analyse that. We are all naturally biased. As a Navan Teachta Dála, I want Navan hospital to be the best. Can we address the concerns or can we not? If we cannot, is the capacity elsewhere to take our patients or are we only transferring the risk from one place to another? It is likewise if there are to be changes and we are convinced that is the right thing to do. I look at the GPs today who wrote to us. GPs who in the past said "No" are now saying it is the right thing to do.

These are GPs I have listened to for a long number of years, as has Deputy Tóibín.

I spoke to him yesterday and he said invest in it to save it.

Sorry, Chair, can I finish my contribution here? There are GPs saying it is right and GPs saying it is wrong. Let us tease this through. We want to make the right decision. Most of us in here want to do the right thing for health, not for politics. Is the capacity elsewhere? Is the ambulance service in place to accommodate this? Will it ever be in place? Have we got guarantees as to what the ambulance cover will be? Are the extra ambulances and personnel, including paramedics, in place and ready? We need guarantees about the future of other services in Navan hospital, orthopaedic service and so on. Is there investment guaranteed to do that? We have to have guarantees we will not be like Limerick, Roscommon, Mallow or any place that had to wait to get services. We know what happened with Dundalk and Drogheda. That cannot happen again. It is about timing. Behind all that, we have to work out if this is right. Let us have the medical conversation and listen to those who look after our patients, not the politicians but the doctors, both those who are for and against. Then we will be able to make a proper informed decision.

I acknowledge the input of all Deputies to this debate. I know there is a shared concern to ensure patients in Meath, the north east or any part of the country can access the services they need. That is a core element of the planning for any potential reconfiguration at Navan. More widely, access and quality are core to the Government's unprecedented investment in the health system.

Patient safety is at the heart of the changes proposed for Navan. The main goal of the proposed reconfiguration plan is to change the service delivery model in Navan to one that delivers safe, appropriate, patient-focused and cost-effective care.

The proposed plans put emphasis on safer services, timely access to appropriate care and improving patient experiences of care through the development of integrated care with general practitioners and community health partners. The hospital will see a greater integration of services with a level 4 hospital within the current Ireland East Hospital Group. All of this will make the hospital in Navan safer, busier and more efficient in delivering more appropriate care to patients in line with Sláintecare, whose vision is the right care at the right time in the right place.

However, as the Minister, Deputy Donnelly, alluded to, these changes can be the cause of great concern. That is particularly true at a time when our hospital system is under intense pressure. In view of that pressure, it is important we recognise the extraordinary dedication and professionalism of our healthcare workers, who continue to deliver fantastic care to their patients. It is also important to set out the crucial work under way in the HSE to address the challenges we currently face. However, at the outset, I want to acknowledge the distress overcrowded emergency departments can cause to patients, their families and front-line staff working in very challenging conditions in hospitals. Emergency departments are extremely busy. Too many patients are waiting on trolleys. The Minister has been very clear this is not acceptable. I assure the House this is an absolute priority for the Minister, the Department of Health and the HSE.

We have seen a welcome reduction in the number of Covid-positive patients in hospital but, since the end of May, the numbers have been rising again and the ongoing requirement to provide separate Covid-19 and non-Covid-19 pathways continues to put pressure on the capacity and operation of emergency departments across the health system. In this context, the Minister has requested the HSE to develop comprehensive plans to include short-term and long-term measures to be taken nationally and in each emergency department and community healthcare organisation to ensure sustainable improvements in emergency department performance. The Minister and the Department of Health are working closely with the HSE on developing these plans, which will be published in due course.

With regard to concerns about the impacts of changes at Navan and in other hospitals, and in Our Lady of Lourdes Hospital in particular, it is important to recall there has been very significant capital investment in hospitals in the north east totalling almost €100 million. Of this, approximately €62 million has been invested in Our Lady of Lourdes Hospital. In addition to the construction, fit-out and equipping of a new suite of five theatres, the capital funding provided has allowed for an expansion of the emergency department at that hospital. This includes reconfiguration of the existing emergency department, an equipping of the surgical ward, the construction of a new ward block and the purchase and installation of a second CT scanner. Eighty-four beds have opened and a further ten general medical beds are being put in place along with two additional ICU beds being transferred from Navan.

Notwithstanding all of that, the Minister has made it very clear that, for any proposal to be considered, he would need to be satisfied on several levels. He would need to be satisfied in respect of the legitimate questions raised by Oireachtas Members on issues, including access to medical assessment units, the capacity of the National Ambulance Service, local access to GPs, emergency and other resources available in Drogheda, the use of injury units and more. The Minister, Deputy Donnelly, has met with senior clinicians from Our Lady of Lourdes Hospital, Drogheda, who have informed him they do not currently have the resources adequately to take on the several thousand extra patients who would visit the emergency department if this reconfiguration were to go ahead. For all of these reasons, the Minister has instructed the HSE to pause the proposed reconfiguration at Navan to allow for meaningful consultation.

A large proportion of the people who live in the part of my constituency that is in north Meath, including in Drumcondra and Kilmainhamwood, and in parts of east Cavan avail of the services of Navan hospital but, unfortunately, successive governments have been attempting to shut down the service in Navan for years under the small hospitals framework. This has resulted in a lack of investment in emergency and critical services in the hospital despite the significant increase in the population of Meath during this time. This should sound familiar to many on the Government benches because it is exactly the same scenario that occurred with the downgrading of services in Monaghan Hospital in 2009 after years of community opposition and when Fianna Fáil and the Green Party were in power. Fine Gael has been in power since 2011 and there has certainly been no rollback or reversal in the policy of downgrading local hospitals. The downgrading of Monaghan Hospital had an obvious detrimental effect on the people living in Monaghan but it also had an extremely negative indirect spillover effect on hospital services in Cavan and Drogheda, both of which had to deal with a massive increase in patient numbers without the proportional investment needed to ensure safe continuity of services.

One of the arguments made in a Government report at the time of the downgrading of Monaghan Hospital was that local hospitals were not generating enough emergency work to justify a full team of consultants on the doorstep. It instead recommended a new regional hospital to be located in the southern part of the north east. Ironically, the location for this was to be Navan. Some 13 years later, there has still been no new regional hospital built in Navan or anywhere else to service the north east, the services in Monaghan have been downgraded and it is now proposed to downgrade services in Navan. This cannot be allowed to take place again. It would be devastating for the people of Meath and would also, once again, have major repercussions for services in Cavan and Drogheda. What is needed instead of the continued downgrading of local hospitals is investment in our public health services. The people of Meath have been battling for more than a decade to save their hospital services. It is time for the Government to commit to protecting and enhancing emergency and critical services at Navan hospital and in the wider north-eastern region.

The disjointed approach towards the accident and emergency unit in Navan hospital sums up the misdirected approach the Department and the HSE takes towards the provision of emergency care. The Government has been attempting to shut down the service in Nenagh for years under the small hospitals framework. The Minister of State, Deputy English, asked us to listen to doctors and experts. The Government has had 11 years and nothing has moved. It needs to start listening. People in my constituency, especially those who avail of health services provided by University Hospital Limerick's emergency department, know only too well what the consequences of this can be. A fateful thing happened in 2009 when the 24-hour emergency department in Nenagh Hospital was ended with promises of a centre of excellence in Limerick. What do we have today under the Minister's watch? We have chaos. He talks about us playing politics with this matter but we are not. We are telling the truth about what is actually happening out there. I disagree with one thing Deputy McNamara said. The buck does stop with the Minister as far as I am concerned.

The emergency department in Limerick serves an area from Laragh to Lahinch and, according to HIQA, it was the second busiest emergency department in 2021, although it had the second lowest bed stock among model 4 hospitals. In April, patients over the age of 75 had an average wait time before admission at the accident and emergency department of just over 22 hours. Adults are regularly left queueing outside and HIQA has said the emergency department is not compliant with patient safety and dignity standards or with workforce capacity standards. I will also point out that the latest HIQA report on University Hospital Limerick notes a number of times that there is no model 3 hospital in the University Limerick Hospitals Group. The report states this contrasts with the structure of other hospital groups in Ireland. We need more than this and Nenagh has an important role to play. I would like to hear the Minister's thoughts on this.

Ultimately, what we need is a major step change in healthcare. Sinn Féin has accessible proposals as to how to achieve this. We have a plan, in contrast to the chaos shown by the HSE and the Minister. We do not need to see the hospitals close to Navan buckle under the strain the Department and the HSE are brewing up. Let University Hospital Limerick serve as a lesson. We hope the Minister learns that lesson. I commend Deputy Guirke on bringing this motion.

It needs to be said that the people of Meath are 100% correct to fight for their hospital services and their elected representatives are absolutely correct to bring this matter to the floor of the Dáil. I commend Deputies Guirke and O'Rourke on doing so. I encourage the people of Meath and their representatives to keep fighting and to be extremely wary of promises of better services to come at some point in the future because, as someone from County Monaghan, I have to say we have heard all this before. We know what happens to commitments given by Fianna Fáil Ministers for Health. Look at this headline from 2002 which reads "Minister assures future of Monaghan Hospital". Who was that Minister? It was none other than the then Minister for Health and Children, Deputy Micheál Martin. The article says he gave a categorical assurance in Monaghan the previous Tuesday that the future of the general hospital was secure. We are not even allowed to call it a general hospital any more. It is quite right for people to be sceptical because that Minister, Deputy Micheál Martin, and all who came after him continued to oversee the downgrading of services in our hospitals, always with the promise that better services were to come. We are still waiting because those better services did not come. The Minister can ask anybody.

I have spoken to people who have driven past the gates of Monaghan General Hospital to go into the maelstrom of emergency departments at Cavan and Drogheda, sometimes ending up there for hours. Staff in those hospitals are overstressed and overburdened. The Minister should not dare to say that the removal of services from Monaghan hospital or any other place led to better services elsewhere because there is no evidence of that.

The sop was that Monaghan was given a minor injuries unit, which is actually a very good service, but it only operates five days a week from 9 a.m. to 5 p.m. which is by far the shortest opening hours of any minor injuries unit in the State. If those services were expanded, it would actually ease the pressure on GP services, which are extremely stressed, and also on accident and emergency services. When I asked the Minister, Deputy Stephen Donnelly, to ensure the expansion of these hours, his response to me was that it is an operational matter and that there are no plans to extend the opening hours of the minor injuries unit at Monaghan hospital. Then last week I looked at my local newspaper, which reported a Fianna Fáil Senator having been informed that the Minister is willing to engage on extending opening hours at the minor injuries unit. Which is it? Is it an operational matter or is this Fianna Fáil once again playing politics? We will know soon enough because we will know when the vote on this motion takes place.

Any representative from County Meath and the surrounding area who votes for the Government amendment knowing the experience in Monaghan and elsewhere, is knowingly voting for the removal of services at their local hospital and knowingly voting for increased pressures at the emergency department in Drogheda. Any representative from Cavan or Monaghan who votes for the Government amendment is simply showing they have learned nothing from the experiences of the people of our county. Shame on them if they do so.

It is very disappointing that the Government will not support our motion because by pausing it, all we are doing is kicking the can down the road. Instead of protecting and enhancing emergency and critical care services in Navan, uncertainty will hang over the people of Meath for months. The Minister could have put this to bed tonight by saying that he would protect and enhance services at Navan hospital. The Minister of State, Deputy English, said the motion we brought to the floor of the House tonight was a fair one. I hope he will vote for it tomorrow night.

We all know there are safety concerns and those safety concerns need a response. What is proposed will make it worse. The Minister has said that Sinn Féin others are playing politics. That is entirely disingenuous and false. We are standing by our communities and standing by patients. We want the best outcome for everyone. We need a plan to protect and enhance emergency services. Closing services is not a plan; it is the easy option.

The Minister said no decision has been made and that all concerns need to be fully addressed. What is the benchmark to be met to address those concerns? What is the plan? Quite simply, we do not seem to have one. I encourage everyone to come out on 9 July and support the protest in Navan because we need at all costs to keep the emergency department and the critical care services in Navan open.

Is amendment No. 1 to amendment No. 1 agreed to?

Amendment No. 1 to amendment No. 1 put.

Deputies

Vótáil.

In accordance with Standing Order 80(2), the vote is deferred until the weekly division time tomorrow evening.

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