Delays in closing Navan Hospital’s emergency department due to political opposition are putting the lives of critically ill patients at risk, the hospital’s clinical director has warned.
“At present the critically ill in County Meath are not being given the best opportunity of survival,” Mr McEntee told the Sunday Independent.
“For different reasons the politicians are voicing objections to it and if the process is delayed the risks of a critical incident becoming a fatality are present all the time and are ongoing.”
Mr McEntee’s intervention, his strongest to date, comes amid ongoing rancour over the plan to downgrade Navan Hospital, which has caused a political headache for Health Minister Stephen Donnelly and the Government.
While the HSE insists it is pressing ahead with the reconfiguration plans on the basis of patient safety, Mr Donnelly, who does ultimately favour the downgrade of Navan’s ED, has asked it pause the plan for the time being and develop “a more comprehensive proposal” to address concerns that more patients will end up in Drogheda than the HSE claims.
Amid strong local opposition in Navan the Sunday Independent can also reveal that six emergency medicine consultants at Our Lady of Lourdes Hospital have claimed their A&E department will have to cope with up to 45 additional patients every day if the plan goes ahead.
In a letter sent to Mr Donnelly last Friday, the consultants said the additional workload “cannot be safely managed” without a significant increase in resources. The six consultants said the “public message” is the closure of Navan’s emergency department will result in only four to five extra patients a day being diverted to Drogheda.
However, the consultants said their analysis, based on the HSE’s own internal figures, is very different. They calculated the average daily attendances at Navan emergency department from figures on the hospital’s internal iPIMS system.
“An additional workload of 35 to 45 patients a day equates to an increase of activity of at least 25pc in adults presenting,” the letter said.
They said the majority of the additional patients who will attend Drogheda from Navan will require “significant clinical input”. The six consultants said they accepted there was a clinical risk associated with Navan emergency department.
They warned of the mortality associated with overcrowding and prolonged waits in emergency departments. They said the proposed reconfiguration of services has to potential to result in risk “merely being transferred from one hospital to another without resolving that risk”.
The consultants warned of the mortality associated with overcrowding and prolonged waits in emergency departments.
There has been a “serious underestimation of the workload involved and a failure to provide the necessary supports to Our Lady of Lourdes hospital to allow the transition be managed safely”, the letter stated. The consultants have called for more resources to manage the transition safely.
The intervention is the second in a week from consultants at Our Lady of Lourdes Hospital. Seventeen specialists at the hospital separately wrote to the minister last week, also warning of a risk to patient safety if the critically ill patients were transferred to Drogheda from Navan without the former being properly resourced.
This newspaper has also seen a nine-page HSE memo outlining the rationale for changing Navan’s ED to a 24-hour medical assessment unit with support from a local injuries unit.
The memo, which was given to local politicians at a meeting on June 13 and said the final stages of implementation would begin last Thursday, stated the HSE can no longer stand over the safety of the Co Meath facility.
“The ED no longer meets ‘best in class’ clinical standards and clinicians and other medical staff have gone on record to express their concerns about the safety of the unit,” it stated.
“It would be a dereliction of duty for us to ignore this at the risk of patient safety.
“Empirical evidence exists in several published reports over the last 14 years commissioned by the Department of Health and the HSE clearly highlighting acute services at OLHN [Our Lady’s Hospital Navan] are unsafe.”
Navan is already by-passed by all trauma ambulances, for heart attacks and for suspected strokes, while there have been no acute surgery or acute surgical admissions allowed in Navan for more than a decade.
The memo argues the hospital in Drogheda has increased its beds by 100, added three surgical units and expanded its emergency department and that additional budgets will transfer from Navan Hospital to allow Drogheda deal with the estimated five to six extra patients per day.
However, this HSE plan is being opposed by politicians including Justice Minister McEntee — who is also Fine Gael TD for Meath East — as they said it had “caused further concern as it did not address serious questions around capacity”.
Mr Donnelly’s spokesperson said that while the health minister acknowledged the expert clinical view that Navan cannot provide the full range of emergency department services into the future he has also heard “the very real concerns of senior clinicians working at other hospitals which would be impacted at a time when all health services are under intense pressure”.
The spokesperson said: “These concerns need to be comprehensively addressed. The minister has asked the HSE to pause the final reconfiguration and to develop a more comprehensive proposal for consideration.”
But the HSE said it has planned for and is already putting in place the extra resources required to transition Navan to what’s known as a Model Two hospital. “This change is supported by HSE national clinical leadership, clinicians at Our Lady’s Hospital in Navan, and Meath Faculty of GPs,” the HSE said.
“The HSE understands the concerns of the local community and public representatives. Those concerns have been reflected by the Minister for Health, who also understands the important patient safety risks behind the changes that are needed. We are working to address those concerns.”
Aontú TD Peadar Tóibin, who chairs the Save Navan Hospital campaign group, said: “The minister needs to either introduce or reaffirm his authority on the HSE, whichever word is more appropriate, there is an authority deficit here. Public servants are telling the minister what to do.”
But in an interview with this newspaper last Friday, Navan Hospital’s clinical director Mr McEntee, said: “A delay is likely to compromise the health and safety of the critically ill patients coming into Navan.
“Any delay for whatever reason whether it’s coming up with another proposal or for whatever reason means that these critically ill patients continue to not be provided with the best opportunity of survival.”
He claimed that as a consequence of reconfiguration there would be 10 to 12 extra patients a day attending Our Lady of Lourdes Hospital in Drogheda or almost 4,000 per year and not the 10,000 or 25,000 extra claimed by some politicians.
“Those statements are incorrect and of those 10 to 12, based on our data, four to five will require admission and of those four to five, one to two of those patients are already admitted under the surgical service in Drogheda as we speak.
“So we’re then left with three to four medical patients requiring admission per day and not the grossly inflated figures that some of the politicians are claiming.”
He declined to be drawn on the opposition of his own niece, Ms McEntee, to the current HSE plan other than to say: “The Justice Minister is a TD who represents the constituents of east Meath. I am a clinical director in Our Lady’s Hospital Navan and my job is to represent the health and safety of the patients who come in and that they are given the best opportunity of survival. That is my sole concern.”
