I’m a Meath woman, and in Meath you don’t go up against the McEntees. They’re fearless and proud. So what happens when the McEntees go up against each other? I was gobsmacked to see Justice Minister Helen McEntee opposing the HSE’s plan to close the ICU and A&E in Navan Hospital and move critical cases to Our Lady of Lourdes in Drogheda.
Her uncle, Gerry, the famous footballer from Meath’s glory days, is the chief executive of Navan Hospital and insists the reform should go ahead. He says patients’ lives are at risk in the small Navan department.
Taking sides in a family tiff is usually unwise, but in this case I have no hesitation. I’ve always admired Helen’s poise, but I’m with Gerry on this one.
I had noted the justice minister dithering over the National Maternity Hospital a month ago. It was the first misstep I’d seen her take. Going ahead with the maternity hospital was the right thing to do.
When the Cabinet finally stuck together, the hysteria bubble was burst and the row dissolved overnight. The indecision, not the decision, fuelled the controversy.
That’s the lesson the Government keeps forgetting. Governments must govern. When you make a decision that’s correct in substance, ignore the objectors and move on.
What drives voters completely mad is a government afraid to fix things.
In particular, Fine Gael voters expect Fine Gael to be responsible. The reason the party’s popularity has declined is not because of unpopular decisions, but the failure to make them. Policy is made up on the hoof in response to the latest Twitter-inspired panic attack.
So, when I got an email from the Department of Health at 10.43am on Tuesday with a statement from Fianna Fáil minister Stephen Donnelly insisting the HSE decision on Navan A&E – announced the day before and flagged for 10 years – was not going ahead, I rolled my eyes and thought: “Here we go.” Another row when panic-stricken politics gets in the way of good policy.
Let’s look at the medicine and the politics of Navan A&E.
First, the medicine. Whatever happened to “following the science”? Here’s some science: when you’re sick – really sick – you don’t need the nearest doctor, you need the best doctor.
The best doctors are the most experienced doctors who deal in volume. Do you want the doctor who sees 10 patients a week or 10 patients a year with your specific cardiac condition?
ICU is a particularly demanding field requiring specialised nursing and medical care. If you’re at death’s door, you need highly skilled staff, 24 hours a day. It’s wildly expensive. It’s neither good medicine nor economic sense to provide this in every mid-sized town in Ireland.
For every sound medical and financial reason it should be centralised and smaller hospitals reserved for minor injuries and other specialised units.
Moving the hard cases to Drogheda means really sick patients get better treatment and not-so-sick patients get faster treatment back in Navan. Everyone is better off.
There are concerns about capacity in Drogheda, but if they close Navan ICU and A&E they can move the specialist staff too.
Recruitment is easier when re- sources are focused in specific locations. Good doctors don’t want to work in small units. That’s why recruitment is such a challenge in regional hospitals. This is an easily defensible logical position.
Now let’s look at the politics. We have a template for this: Roscommon Hospital, where an emotive row on exactly the same grounds went on for years after it was proposed to move critical cases to Galway. It went ahead, and far from being “down-graded”, more procedures than ever were done in Roscommon. For example, a new €5.5m endoscopy unit was opened in 2016.
However, the row got so out of hand that Denis Naughten resigned from Fine Gael in 2011.
Meanwhile, Frank Feighan stood by the decision and was bullied and vilified. He lost his seat in 2016. It was a terrible time for him, but he got that seat back in 2020 and is now Minister of State for Public Health, Well-being and the National Drugs Strategy.
Feighan was the better man who did the right thing and has been vindicated. Naughten was wrong. Fine Gael would do much better in the polls if it stuck to the spirit of Feighan, not Naughten.
Damien English, the Meath West Fine Gael TD based in Navan, is obviously worried about his seat and has expressed his concerns about the closure of the A&E, but Fine Gael TDs need to get together and plan this one out.
Do they accept professional health advice? Does the party care about its legacy, reputation and brand? Is there any senior figure guiding Fine Gael strategy who understands why people vote Fine Gael in the first place? Does anyone in party HQ even think about this stuff?
When the minister for health sends out an email on a Tuesday morning undermining a long-flagged and soundly developed policy decision, it looks to most people like a government reacting to headlines, not governing with good authority.
The health service must be reformed. That needs brave decisions. Fear is why reform is so slow, and it’s this paralysis that drives people into the arms of populists. Doing the right thing is never wrong. Make good decisions, defend them fiercely and crack on.
A McEntee should understand that. So should everyone in Fine Gael.