LAST UPDATE | 14 Jun 2022

THE GOVERNMENT HAS not sanctioned the closing of the emergency department in Navan, according to Tánaiste Leo Varadkar. 

His comments come as Health Minister Stephen Donnelly issued a statement saying that “no decision” has been taken on the replacement of emergency department in Navan with ‘medical assessment unit’.

The HSE outlined plans yesterday for a 24-hour Medical Assessment Unit to replace the emergency department in Our Lady’s Hospital Navan.

The HSE insisted that the new MAU will still be able to see around 80% of the current number of patients who present to ED every day.

However, it has been confirmed that the planned MAU will be GP referral 24 hours a day, 7 days a week, while the proposed injury unit will be walk-in. 

Donnelly said that the transition has yet to be signed off on by the Government.

The Journal asked Varadkar today if the Department of Health and HSE are at odds with one another over the hospital. 

Varadkar said there “are a lot of questions to be asked” about whether it is “wise” to close the ED in Navan. 

“I worked in Navan hospital for a time, it provided a lot of good care to a lot of people particularly those with pneumonia, with minor injuries, UTIs, it provided very good care,” he said. 

“I fully appreciate it is not a major specialist centre for people with major trauma who have a heart attack or a stroke, it is better that they are taken elsewhere, and that is generally done by the ambulance service.

“But I think if there are to be any changes to services at Navan, we would need a lot of assurances around the ability of the ambulance service,” he said. 

Assurances would also need to be given regarding whether Drogheda or Connolly Hospital can take the additional patient load, he added. 

The health minister, as well as ministers that sit at the Cabinet table from Meath, Justice Minister Helen McEntee and Minister of State Damien English, “are not satisfied with the HSE’s responses to those very straightforward and reasonable questions”, said Varadkar.  

In his statement today, the health minister said “several important issues” must be addressed before any transition can take place, including ensuring people in the Navan area can still access urgent care. 

He said while he accepts the concerns of clinicians in Navan over safety issues for operating a “small emergency Department”, he has also listened to clinicians at other hospitals who fear overcrowding if the transition occurs soon.

He said: “No decision regarding the HSE’s proposal for the transition of the Emergency Department at Our Lady’s Hospital Navan (OLHN) has been agreed by this government.”

The minister noted that the HSE has clinical concerns about the safety of the Emergency Department at Navan and said the HSE met with local representatives to to outline those concerns. 

“I have heard clearly the concerns of clinicians in Navan as to the ongoing safety concerns of operating a small Emergency Department,” he added. 

“I have also heard the concerns of clinicians at other hospitals that would be impacted at a time when all health services are under such pressure.

“Several important issues, including additional capacity in other hospitals impacted, 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 takes place.”

To address extra patients expected in the emergency department in Our Lady of Lourdes Hospital Drogheda, the HSE says an additional emergency ambulance, as well as an additional advanced paramedic, will be put in place. 

The replacement of the emergency department with a MAU is the final step in the transition of the hospital to a “model 2” hospital, which does not provide emergency or unscheduled procedures.

Navan is the last hospital to complete such a transition, and the HSE have said that the change will make the hospital safer, allow it to provide a higher quality of care and increased activity.

The MAU will treat patients who are deemed stable and not likely to deteriorate or require resuscitation.

A Local Injury Unit will be opened alongside the MAU, which will treat minor injuries during the day.

The hospital’s ICU will close, and will be replaced by a new system of acute care.

There is also no emergency surgery in the hospital.

Additionally, Navan’s ICU is the smallest in the country, and there is national and international research showing a correlation between low numbers of critically ill patients and “poor outcomes”.

Chief Clinical Officer of the HSE, Colm Henry, told RTÉ’s Morning Ireland programme that the transition plan is not a downgrading for Navan hospital.

Speaking before the minister’s intervention, Henry said: “There is no downgrading. To be very clear about this, what’s happening here is - as we planned with other hospitals that we successfully implemented what are called model two hospitals, it expanded their services.

“They continued to see acutely ill medical patients through the medical assessment unit.”

He added that there will continue to be active, busy local injury units.

“What we’re looking at here is a small proportion of patients who come to emergency departments,” he said. 

“And for a small proportion of patients their needs are best served by bringing them to the right place first time. This is the latest in a series of steps that have already taken place at Navan Hospital where patients with heart attack or stroke bypass the hospital.”

Speaking in the Seanad this afternoon, Fianna Fáil Meath Senator Shane Cassells said after a meeting yesterday with the HSE, Meath representatives were handed out a document stating that the phasing out of the emergency department would begin on 30 June.

“The last time I checked, the HSE did not run this country. The Cabinet, the Government, is responsible for the running of the country. The HSE was reminded of that fact very forcefully by the Minister for Health last night and again this morning. He reminded it who runs the health service.

“Ultimately, responsibility rests with the Minister for Health. These people who think they are a law unto themselves and can bypass Cabinet and elected Members got a reminder today,” he said.

“The HSE should remember that, if it wants to have an honest and frank discussion with the political leaders of the country, it must start by showing respect for those leaders and not with what was attempted yesterday,” said the senator

With additional reporting by Christina Finn