HSE closure of Navan A&E department a mirror of Limerick hospital disaster

Eoin Ryan

Representatives say the closure of Navan hospital’s A&E unit “is absolutely identical” to the closure of Nenagh and Ennis’ emergency departments.

The HSE announced they will close Navan’s emergency unit and replace it with a Medical Assessment Unit (MAU) where 80% of patients will be treated.

In 2013, a report recommended the downgrading of nine EDs in smaller facilities around the country to injury units. Navan is the one hospital for which this recommendation has still to be implemented.

The briefing was told Navan hospital’s ED currently does not meet safe clinical standards for certain presentations, and the revision of its status has been sought by clinicians in both Navan and Drogheda for some years.

The new MAU being proposed in Navan can only be accessed after receiving a GP referral letter for its use.

Cllr. Gillian Toole said that some doctors are already telling patients to go to the emergency department, such is the long wait time to get an appointment with a GP. It is believed people would therefore be unable to access the MAU and they would go directly to an already overcrowded Drogheda hospital.

TD Darren O’ Rourke said 84 beds were to be delivered, 3 additional operating theatres and a new build for the ED.

“My deep concern is that these resources will not materialise,” Darren O’Rourke said on these additions. 

The HSE said the hospital currently does not treat major heart attacks, suspected strokes, major trauma, any issues requiring maternity or paediatric care. Patients arriving at Navan requiring critical care therefore often experience potentially catastrophic delays in accessing the treatment they require.

Clinically unstable patients will no longer be brought to the Medical assessment Unit to be put in place in Navan hospital.

The HSE announced the closure of Emergency Departments in Ennis and Nenagh for similar reasons back in 2009 for similar reasons. The emergency departments were closed due to safety issues arising from the emergency department and a lack of equipment needed for certain procedures.

HSE representatives at the time said the current Nenagh and Ennis A&E units are unsafe and denied fears brought up by GPs that the reconfiguration was due to cutbacks.

Clinical director of the Mid Western Hospitals Reconfiguration Project Team, consultant surgeon Paul Burke said. “The objective of the changes is to provide high-quality and safe services closer to the patient’s home where possible, while at the same time ensuring that those who require complex care can get access to it as quickly and as safely as possible.”

HSE staff wanted the patient to “receive the right care in the right place at the right time”.

The HSE agreed to open an extra 15 beds in UHL (UH Limerick) following the closures in response to concerns brought forward by SIPTU and the Irish Nurses Organisation. 

Minor injuries units were made available in both towns, open from 8am-8pm with injuries outside of these times treated at Limerick hospital.

It has been 13 years since this decision UHL is now the most overcrowded hospital in a country where overcapacity is already a major issue.

Chronic overcrowding and significant nurse and bed shortages left the hospital coping with twice its capacity according to a Health and Information Quality Authority (HIQA) report. 

An unannounced inspection took place on 15th March this year found there was a significant lack of beds and staff which contributed to the overcrowding.

Inspectors found that one patient had been waiting on a trolley for more than 116 hours.

Minister for health Stephen Donnelly said senior clinicians at Our Lady of Lourdes Hospital in Drogheda told him they do not currently have the resources required to cater for the additional patients who would have to go through their Emergency Department.

There was a 17 percent shortfall in the agreed number of nurses on the roster which was found to be a regular problem.

Of the 139 people attending hospital at that time, 43 percent were awaiting a bed. One person was left in a wheelchair for 14 hours while waiting for a trolley. Another arrived at the hospital in an ambulance and waited more than three hours for a trolley.

HIQA was “not assured” that Limerick hospital had measures in place to manage the overcrowding sufficiently and the patient safety risks posed by the overcrowding.

The briefing heard Navan hospital currently does not treat major heart attacks, suspected strokes, major trauma, nor does it deal with those requiring maternity or paediatric care. The HSE said patients arriving at Navan requiring critical care therefore often experience potentially catastrophic delays in accessing the treatment they require.

Minister for Justice Helen McEntee said in the Dail that medical staff have made their concerns for patient safety very clear, but worries expressed from workers at Drogheda hospital can not be ignored. She said The HSE has not been clear about the additional capacity and resources Drogheda Hospital will get should the ED close.

Sinn Fein have brought forward a motion in the Dail to prevent the closure of Navan Hospital A&E. Stephen Donnelly said the Government will oppose the motion, but he said he agreed with some aspects of the Sinn Féin motion.

One in four Irish people are on a hospital waiting list, according to figures gathered by Sinn Fein, with over 100,000 children on waiting lists.

Darren O’Rourke says that Our Lady’s hospital’s emergency department should be “protected and enhanced” instead of replaced.

“I do not believe there is any sound evidence-base for this claim. In fact, the opposite,” Darren O’Rourke TD said.  I believe the closure of Navan ED and urgent care services will push patients into already overcrowded hospitals and result in worse outcomes,” O’Rourke continued.

According to HSE data, the average wait time in A&Es in the first quarter of the year was almost 13 hours.

Drogheda is no different as Our Lady of Lourdes Hospital has an average wait time of 10.6 hours. Just one in three patients were administered to hospital within 6 hours of arrival.

Damian O’ Donoghue of the Nenagh Needs its A&E group told Meath South East News “At the time we were promised that a centre of excellence would be available in Limerick and we were told it was a good idea to close the regional A+E’s. The people of Ennis were made the same promises. It turned out to be a disaster. 

“There was no centre of excellence then and there certainly is no centre of excellence now.

Residents from North Tipperary are among those waiting long periods of time in Limerick hospital waiting for treatment. O’Donoghue said the conditions are a danger to patients and staff alike.”

Angela Coll from the Friends of Ennis Hospital Group said that the situations in Limerick and Navan are “absolutely identical.” Coll said the current situation in UHL “is actually dangerous,” for a number of reasons including fire safety.

“The lack of privacy and dignity for patients at end of life has been well documented, 

but also when corridors are crowded there is no space for nurses to carry out normal procedures like blood pressure checks, never mind trying to squeeze through the trolleys with a defibrillator or a medical trolley,” she said.

She also said that some patients are deciding to get treatment in other hospitals or “not seeking treatment at all in some cases of elderly people who are scared they will end up alone potentially dying on trolleys in a corridor.”

The Nenagh Needs Its A&E group have been campaigning for the revival of the emergency department in Nenagh, but have not garnered local support from TDs as of yet.

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