Na­van hos­pi­tal de­ter­mined to re­tain emer­gency de­part­ment

For­mer HSE chief Tony O’Brien de­scribed the emer­gency de­part­ment as ‘a waste­ful use of pub­lic re­sources’

The Irish Times - - Home News - Paul Cullen Health Cor­re­spon­dent

When the re­cent head of the health ser­vice says he would not want to be treated in your hos­pi­tal, then you should know you have a prob­lem.

Na­van hos­pi­tal’s 24-hour emer­gency de­part­ment is “a waste­ful use of pub­lic re­source” that sees few pa­tients and is costly to staff with ex­pen­sive locums, ac­cord­ing to for­mer Health Ser­vice Ex­ec­u­tive boss Tony O’Brien.

“It’s not an emer­gency de­part­ment I per­son­ally would have a wish to be taken to,” he said in a frank in­ter­view with the Sun­day Busi­ness Post last week­end.

The con­text was O’Brien’s crit­i­cism of politi­cians’ fail­ure to make “hard de­ci­sions” or let the HSE take them to cre­ate a bet­ter-func­tion­ing health ser­vice. Na­van was not his only tar­get – he also ques­tioned the need for so many emer­gency de­part­ments in Dublin and an emer­gency de­part­ment in Port­laoise hos­pi­tal – but it was the most ob­vi­ous.

The sur­vival of Na­van’s emer­gency de­part­ment is ei­ther a mir­a­cle or a mas­ter­ful po­lit­i­cal stroke, de­pend­ing on how you look at it.

Back in 2013, a re­port rec­om­mended the down­grad­ing of nine emer­gency de­part­ments in smaller fa­cil­i­ties to in­jury units. All of th­ese changes have come to pass – with the ex­cep­tion of Na­van.

The Save Na­van Hos­pi­tal Cam­paign, which has or­gan­ised sev­eral mas­sive protest marches over the years, is happy to take the credit. “The fact that Na­van is the only hos­pi­tal re­tain­ing its emer­gency de­part­ment is down to a very suc­cess­ful cam­paign,” says the group’s spokesman, Dr Ruairi Han­ley. He goes on to re­fer to the other, down­graded hospi­tals as “glo­ri­fied nurs­ing homes”.

Na­van’s five-year “tem­po­rary” ar­range­ment is the sub­ject of reg­u­lar ru­mours about the end­ing of the 24/7 emer­gency de­part­ment ser­vice, but so far noth­ing has changed. Sur­gi­cal ser­vices were taken from Na­van al­most a decade ago and trans­ferred to other hospi­tals in the re­gion, but the emer­gency de­part­ment has sur­vived de­spite the con­cerns of se­nior clin­i­cians within the HSE.

Con­nolly Hos­pi­tal in Blan­chard­stown is 29 min­utes away from Na­van, Our Lady of Lour­des Hos­pi­tal in Drogheda is 38 min­utes away and Beau­mont Hos­pi­tal in Dublin is 45 min­utes away, ac­cord­ing to the sat­nav. All have round-the-clock emer­gency de­part­ments.

O’Brien has pointed out that Na­van sees rel­a­tively few pa­tients overnight. Most of the staff are locums, in part be­cause work­ing in such a small hos­pi­tal with­out train­ing op­por­tu­ni­ties is unattrac­tive to doc­tors and in part be­cause of the gen­eral dif­fi­culty re­cruit­ing staff for the health ser­vice.

Un­derused doc­tors

The in­ter­na­tional ev­i­dence is that hospi­tals’ per­for­mance im­proves with through­put of pa­tients – as­sum­ing they are ad­e­quately re­sourced. Quiet hospi­tals make for un­derused doc­tors whose skills be­come blunted.

One medic fa­mil­iar with the hos­pi­tal told The Ir­ish Times he be­lieved pa­tients were at se­ri­ous risk in Na­van. Un­der cur­rent ar­range­ments, pa­tients re­quir­ing surgery are sent to other hospi­tals in the re­gion – the Mater, Beau­mont and Con­nolly in Dublin, Ca­van and Drogheda – on a rota ba­sis.

Am­bu­lance jour­neys

This means crit­i­cally ill pa­tients are be­ing need­lessly sub­jected to am­bu­lance jour­neys, the doc­tor says. “In ad­di­tion, if the pa­tient has to come back due to com­pli­ca­tions, and the same hos­pi­tal is not on call that night, they may end up in a third hos­pi­tal. There’s no proper post-op­er­a­tive care.”

The sit­u­a­tion is fur­ther com­pli­cated by the bu­reau­cratic mess that sees Na­van sit­u­ated in the Ire­land East hos­pi­tal group headed by the Mater, whereas the other four hospi­tals are in the RCSI hos­pi­tal group headed by Beau­mont.

Han­ley, a GP in Co Louth, is dis­mis­sive of clin­i­cal crit­i­cisms of the ser­vice in Na­van. “I’m tired of lis­ten­ing to south Dublin med­i­cal ivory tow­ers say­ing the ser­vice does not make sense. It’s easy to say that in Dublin when you have seven emer­gency de­part­ments on your doorstep.

“Yes, ma­jor cen­tres do bet­ter trauma work, but they don’t do bet­ter in look­ing af­ter old ladies with pneu­mo­nia, and that’s the kind of ser­vice Na­van pro­vides.”

Clos­ing the hos­pi­tal’s emer­gency de­part­ment will only re­sult in more pa­tients be­ing sent to an al­ready-over­crowded Our Lady of Lour­des Hos­pi­tal in

‘ ‘ I’m tired of lis­ten­ing to south Dublin med­i­cal ivory tow­ers say­ing the ser­vice does not make sense. It’s easy to say that in Dublin when you have seven emer­gency de­part­ments on your doorstep

Drogheda, the group points out. An es­ti­mated 300 pa­tients a year die as a re­sult of trol­ley over­crowd­ing, Han­ley says.

The Ire­land East group says it is work­ing with man­age­ment at Na­van in co-op­er­a­tion with other hospi­tals in the group to plan the fu­ture as a model-2 hos­pi­tal “in line with Gov­ern­ment pol­icy”.

A model-2 hos­pi­tal can pro­vide day surgery, se­lected acute medicine, a lo­cal in­juries ser­vices, di­ag­nos­tic ser­vices, pal­lia­tive care and re­ha­bil­i­ta­tion medicine, a spokes­woman says. Na­van is cur­rently a model-3 hos­pi­tal with 89 in­pa­tient beds.

Lo­cal TD Peadar Tóibín, who chairs the Save Na­van Hos­pi­tal Cam­paign, says Tony O’Brien’s re­marks came as a shock lo­cally. “It was bad for staff morale to have a for­mer di­rec­tor gen­eral of the HSE speak like this and it wasn’t good for pa­tient con­fi­dence ei­ther.”


“His job in the HSE was to en­sure ser­vices were staffed prop­erly so it’s not good enough for him to com­plain about hospi­tals strug­gling with a med­i­cal man­power is­sue he could have dealt with.”

Co Meath has one of the fastest-grow­ing pop­u­la­tions in the State, he points out. “We’re con­fi­dent peo­ple will take to the streets again if there is any threat to their hos­pi­tal.”

The pro­vi­sion of fund­ing for 29 new beds in Drogheda in Oc­to­ber’s bud­get has fu­elled fears in Na­van that the emer­gency de­part­ment in the town is un­der re­newed threat.

Health bosses are also said to be bend­ing the ear of lo­cal GPs, who are seen as hav­ing a crit­i­cal role in in­flu­enc­ing pub­lic opin­ion and the im­ple­men­ta­tion of any changes.

De­spite th­ese con­cerns, and O’Brien’s com­ments, change would seem un­likely. With an elec­tion due, the three Min­is­ters in Co Meath can ill-af­ford the hos­pi­tal be­com­ing a po­lit­i­cal hot po­tato.

“When they build a new re­gional hos­pi­tal in Co Meath, I’ll be the first to call for the clo­sure of Na­van,” says Han­ley, “But not un­til then.”


Dr Ruairi Han­ley es­ti­mates that 300 pa­tients a year die as a re­sult of trol­ley over­crowd­ing.

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