Tuesday, 19 October 2021

Questions (92, 107)

Johnny Guirke


92. Deputy Johnny Guirke asked the Minister for Health if the emergency department at Our Lady’s Hospital, Navan will be downgraded from 24 hours to 12 hours; and if he will make a statement on the matter. [50826/21]

View answer

Darren O'Rourke


107. Deputy Darren O'Rourke asked the Minister for Health if the emergency department and the intensive care unit in Navan hospital will close; and if he will make a statement on the matter. [50516/21]

View answer

Oral answers (17 contributions) (Question to Health)

I ask the Minister for Health if the emergency department at Our Lady's Hospital in Navan will be downgraded from a 24-hour to a 12-hour service and if he will make a statement on the matter.

I thank the Deputy for his question. Many elected representatives are keenly involved in this issue, including the Ministers of State, Deputies Thomas Byrne and Damien English, and Senators-----

Is the Minister taking this question with No. 107?

He has to finish naming all of the Government Deputies first-----


I thank the Deputy for the question. The point I am making is that this is a serious issue, which is very real for the local community. It is something that has been discussed with me by Oireachtas Members in opposition and obviously, in government as well. I am aware that the HSE initiated a process of planning for changes to the services at Our Lady’s Hospital, Navan. I am also acutely aware that any proposed changes to health services can be a source of great anxiety and worry for communities affected and for the people we all represent and in this case, the people Deputy Guirke represents. I am determined that any consideration of changes to services at Navan must be happen in consultation with the local community in the first instance, through their elected representatives.  I have, therefore, instructed the HSE to pause any such movements and to engage in a comprehensive manner with the elected representatives on behalf of the community.

I would like to set out for the Deputies the context for the proposed changes. In 2013, a smaller hospitals framework was published. It included a list of nine designated model two hospitals, including Our Lady’s Hospital in Navan. Eight of the nine have transitioned and Our Lady's in Navan is last on the list. The HSE has advised that the proposed changes to the services at Navan, in line with the Government decision, are necessary to support safe service delivery on a sustained basis and to address some very real clinical concerns.

The HSE's planning envisages the development of a 24-7 acute medical assessment unit, along with a 12-7 local injuries unit, and an extended role for the hospital in areas such as day and ambulatory surgery. I am advised that this would see the significant majority of current footfall continue, with the hospital in the future providing more care rather than less. Of course, this would have to be supported by the necessary investment.

I want to see the details of all of these proposals and I want those details to be shared with the elected representatives. I also want the proposals to be discussed in detail with the elected representatives. If it is the clinical view, and I am advised that it is, that what is being proposed will save the lives of the people Deputy Guirke represents, then I want us all to hear that from the senior clinical team on the ground. I want them to tell us that. If they believe this is going to save lives, and I am advised that they do believe that, then we need to hear it directly from them. If part of this is dependent on serious investment, then let us make sure we know exactly what level of investment is being proposed and how it is proposed to spend that investment. I will then need to make sure that funding is allocated so that these are not promises about things that could happen in the future but are specific, tangible, funded investments. Ultimately, what we all want is to make sure that if there are to be changes to systems, and healthcare systems go through reconfiguration all of the time, then they must be absolutely and clearly in the interests of the local community, they must be about saving lives as well as improving the quality and accessibility of healthcare. Critically, any such process must be done in consultation with the people affected through their elected representatives.

I hope consultation with elected representatives includes Opposition Deputies.

We did not get the meeting with the Minister that we were supposed to get. It was promised by the Minister of State sitting behind him the last time we raised this issue. While we welcome the temporary reprieve for the accident and emergency department and ICU in Navan hospital that the Minister announced today, we still need more clarity. I understand what the Minister said about being in consultation with the HSE but what is the long-term sustainable plan? The accident and emergency service and ICU capacity is critical to the future of the hospital. To downgrade or close these services would be to rip the heart from the hospital and would endanger patient care. Meath has a population of 210,000 and is the fifth largest county in the State. Neighbouring hospitals, namely, Drogheda and Connolly hospitals, are at full capacity. We need a clear and unequivocal commitment from the Minister to maintain and put the necessary resources into Navan hospital and build on the excellent services provided by it.

What I am hearing from the Minister is that he is not happy with the way these changes are being implemented. He said it is not acceptable for the changes to happen in the manner reported but ultimately what I am hearing is that the destination is the same. The accident and emergency department and ICU in Navan are going to close. It is only a matter of when. We might have the opportunity now, on the back of the Minister's intervention, to do a bit of talking about it but we will stand before clinical leaders and they will tell us why these changes need to happen. It is fundamentally the wrong basis for the conversation because at the root of this is a chronic under-investment in our acute hospital system, ICUs, accident and emergency departments and elsewhere. It is very real. There are solutions to address real clinical concerns that do not involve the closure of the accident and emergency department and ICU.

I understand that this is a very serious issue for the local communities. My own community was involved in exactly this small hospital framework with regard to the hospital in Loughlinstown. Changes were made. I backed those changes from the Opposition and I will tell the Deputies why I did so. I and the other four elected representatives from the constituency met the senior clinical team and I asked them if it was their unanimous view that this would save lives. We were all told that this would save lives and the real story, in fact, was how many lives not doing this earlier had cost. That is what I heard as an Opposition Deputy. Based on that, I said that if the experts and doctors were telling us this was going to save lives then it was something I would back. Ultimately, that was the right call and it has saved a lot of lives but the process was not done properly because people like the Deputies and I were left to explain it to the public. The clinicians were nowhere to be found.

We do not want to be back here every couple of months, which is what will happen if there is not a long-term solution. The people we are talking to are telling us that what is needed is for the Minister for Health to overturn the HSE decision to close Navan accident and emergency department and the ICU once and for all, and not pause it. We need the Minister to remove from the HSE policy documents that Navan accident and emergency and the ICU will be closed or downgraded in the future and we need the necessary investments in Navan hospital that are so badly needed in order to have a fully functioning hospital. That is what we are hearing. That is what the people on the ground are telling us is needed for Navan hospital.

Ten years ago, Deputies Naughten and Feighan were in the same place having the same conversation about Roscommon hospital. Two weeks ago the Leas-Cheann Comhairle, Deputy Connolly, had a Topical Issue debate with the Minister of State, Deputy Feighan, about the failures at the accident and emergency department in Galway. That is what the people in Navan and County Meath are faced with now. I worked in Our Lady of Lourdes Hospital. I have council colleagues who work in Connolly Hospital. They were on the picket line last week because they do not have sufficient staffing there. They are in a dangerous, precarious position. The suggestion is that it would be safer to close the capacity we have in Navan and move it to those already overstretched facilities. We have seen this in Roscommon, Dundalk, Mallow and Ennis. It is not going to be repeated in Navan.

Deputy Cullinane wants to come in briefly.

I was in Navan today with my two colleagues. I met a number of different groups as I wanted to see and hear for myself at first hand what was happening in Navan. In the spirit of the offer the Minister made to work with Oireachtas Members from both the Government and Opposition in the constituency, as the main Opposition health spokesperson I want to work with him on this as well. If it is about saving lives and quality of care, then we can all work together to make sure we get the best outcome for the people of Navan. The difficulty the people of Navan have when they hear about the ICU and the emergency department closing is where they will go. If it is Drogheda, there are capacity problems there and if it is Connolly Hospital there are capacity problems there as well. The Minister might have seen nurses from the Irish Nurses and Midwives Organisation protesting outside that hospital last week because of capacity issues in ICU. That is the fear and concern people have. I want to work with the Minister to resolve this issue for the benefit of the people in Navan.

I again thank the Deputies. I am listening to them and to my Government colleagues very carefully. The debate we are having right now is an important one. I would expect nothing less. I want this debate to happen with the HSE management and the senior clinicians in the room because they need to answer these questions, not just from the Opposition but from the elected representatives of the community. I have been through this process in Wicklow and while ultimately Loughlinstown became a great success story, it was not done properly and the community was left misinformed and scared. Without prejudice to any outcomes to this situation, I want all of us to meet and we can do that more than once. Let us meet the HSE and the senior clinical teams and let us have exactly this conversation with them.