NEWS FOCUS:'THE REGIONAL hospital was always an aspiration just like draining the Shannon or the Bertie Bowl. It was a good aspiration but just that.", writes ELAINE KEOGH
These are the words of Dr Seamus Clarke, GP in the northeast region reacting to the HSE confirmation that the delivery date for the planned new €650 million regional hospital could be as late as 2020.
The news now leaves doctors, nurses and patients alike wondering where the HSE Programme of Transformation, of which the hospital was an integral part, stands and how the remaining acute hospitals in the region will cope in the interim.
In 1993, the then North Eastern Health Board, which accepted a regional hospital could be generations away, decided to provide some services in each of its acute hospitals in Louth, Meath, Cavan and Monaghan.
When it later bought Our Lady of Lourdes hospital in Drogheda, it was obvious it would play a key role.
“Ultimately we needed a new hospital for the region, but it was down the road and, in the meantime, we had to look after the people; we were in a rapidly growing part of the country,” said former NEHB member Cllr Brian Fitzgerald.
The board made two groups from the hospitals, each covering two counties, and consultants were obliged to carry out clinics in two hospitals, eg in the Louth hospital in Dundalk or Our Lady’s in Navan as well as in the Lourdes. Not all services were in all hospitals, but the five dealt with medical and surgical patients and had an emergency department and consultants.
By the time the HSE was created, the NEHB had approval for plans to upgrade three of the hospitals from the Department of Health.
“Immediately the health boards were abolished, that progress was dropped and no capital programme was implemented. Plans for a new female medical ward and a new AE in Navan were scrapped. It was all done in the context of this promised new hospital, so nobody made too much noise. But it was a major con job,” Cllr Fitzgerald said.
The hospital is one of three crucial parts in an action plan to reconfigure services in the northeast region prepared for the HSE by consultants, Teamwork Management Ltd.
It was published in June 2006 and found that the system then in place was “exposing patients to increased risks”. Teamwork concluded that this configuration “was not serving the community well, was unsustainable and had to change”.
It began a programme of change called “Transformation”, which involved moving acute and complex services from five acute hospitals to two – Our Lady of Lourdes and Cavan General – and then the two were to be replaced by the new regional hospital. It would leave Dundalk, Navan and Monaghan as local hospitals with minor injury units and other outpatient services. Earlier this month, the HSE briefed staff on the next step in that process which will involve transferring all but minor injuries from Dundalk and Navan to Drogheda, as well as providing more beds and the new AE in Drogheda. There was much ado about where the regional hospital should be built and more consultants were employed to make that decision.
To the dismay of Louth-based politicians, Navan won that race, and everyone said it was just sour grapes when the Justice Minister, and Dundalk native, Dermot Ahern said there wasn’t “a red cent” to build it.
“He was right,” said Joe Reilly (SF), the current Mayor of Navan where three parcels of land have been set aside as possible sites for the hospital in the new draft Navan development plan.
“The HSE got the Teamwork report and now they have gone and torn it up; the logic doesn’t add up,” he said.
There is little doubt the politicians will have a new fight over where the hospital will end up whenever there is money for it, but for the moment the question is whether the HSE will continue to implement the rest of the Teamwork “Transformation” recommendations.
The third piece of the Teamwork jigsaw was the provision of more community or primary care services.
“There had to be extra services on the ground, but the next thing is the public health nurse has her mileage cut. If you say you are going to resource community care, you don’t turn round and cut the legs off it,” according to Dr Clarke, who is based in Monaghan. “I don’t think this hospital will happen, full stop. It was an aspiration just like draining the Shannon or the Bertie Bowl. But it will not be in our lifetime.”
He and other GPs are well aware of the pressures on both Cavan General and the Lourdes.
“Drogheda is always in the top five of the trolley count [admitted patients waiting for beds] and Cavan regularly hits the top 10. Neither building is fit for its purpose and the HSE is driving forward with Teamwork,” he said.
According to the Irish Hospital Consultants’ Association, the HSE is not doing enough to provide the infrastructure in Cavan and Drogheda hospitals.
Its assistant general secretary, Donal Duffy, said in the context of providing a world-class health service with the necessary infrastructure and staffing, “we accept the recommendations of the Teamwork Report as being a viable solution for the four northeastern counties”.
Until the hospital is built, he said it was incumbent on the HSE to ensure there were “sufficient and appropriate resources in place in the existing hospitals to meet the needs of the region. You will note that we had very serious concerns with the overcrowding in Our Lady of Lourdes Hospital, Drogheda, earlier this year.
“The northeast has traditionally been one of the poorer funded regions for health services. The association awaits evidence of a balancing of resources in the northeast compared to other regions,” added Mr Duffy.
If things continue as the HSE has indicated, “The INO cannot co-operate with that,” according to its regional spokesman, Tony Fitzpatrick. “If the regional hospital is not being built, then they need to stop downgrading the remaining four hospitals and instead build back-up services there,” he said
“The INO cannot co-operate [with downgrading] when there is no sign of the hospital coming down the track. Drogheda and Cavan cannot cope already. It is illogical to downgrade now,” he said.
He said his members thought the HSE was living “in a parallel reality and are detached from the pressures our staff have to deal with. It’s all smoke and mirrors with them. They need to start delivering on their promises to restore confidence.”
There are rumours that a Public Private Partnership (PPP) will emerge to build the hospital in Navan, but given the current economic climate, this too could be wishful thinking.
The HSE said in July that the first acute services were moved from Monaghan to Cavan, and there were now no acute medical or emergency services in Monaghan. It said no acute services had been moved to the Lourdes hospital yet and the pressure on the hospital was due to the growing population.
There have been protocols introduced which pre-date Teamwork, that have seen all children under 14 years treated at Drogheda and Cavan, elective orthopedics are performed in Navan but orthopedic trauma must go to Drogheda. Similarly, joint departments of surgery across the hospital groups were also introduced before Teamwork. The removal of maternity care from Dundalk and Monaghan took place in 2002.
The HSE said the new consultant-led Medical Assessment Unit (MAU) in Cavan, which is part of Transformation, had “priority access to diagnostics, leading to earlier diagnosis and treatment, with an average turn around time per patient of three-and-a-half hours; previous to the opening of the MAU such patients were treated in the busy emergency department with an average turn around of seven to eight hours”.
According to the INO, it also means patients admitted through the unit need beds just like the patients admitted through AE, yet the number of beds remains the same.
The HSE said it had appointed an additional 10 staff to community care in Cavan/ Monaghan and has €4 million funding for community care projects, such as home care and pre-hospital thrombolysis.
“The three non-acute or local hospitals will focus on providing the care most commonly required by patients in a local setting, as part of a focus on providing community-based health services and, increasingly, care closer to the patient’s home,” a spokeswoman said.
As for the hospital, “there has been a lot of recent comment about the new regional hospital. This hospital is obviously part of the HSE’s long-term plan for the region. However, over the next few years, as we await the development of the regional hospital, the HSE will be advancing a number of key improvements in the region to upgrade the health services of the north-east,” she added.
Two things are very clear about the state of the health service in the northeast. Firstly, the shared concern of nurses, GPs and consultants on the delay in providing the badly needed new hospital and, secondly, the conviction of the HSE to proceed with the next steps in the Transformation programme in the coming months and years.
When the economy improves it may well be a brave bookie who would offer decent odds on the hospital being built before the Shannon is drained.
Some services transferred prior to Teamwork report
- Cavan General Hospital:
- Acute medical surgical and gynaecology services
- Emergency and complex care
- Medical assessment unit
- Paediatrics, including AE paediatrics
- Maternity services Oncology and geriatric day units
- CT and MRI service
- Renal dialysis service
- Day services
Monaghan General Hospital is now a non-acute hospital and provides:
- Minor injury clinic, operating 12 hours per day, seven days per week
- Outpatient services
- Day case surgery
- Day medical services, including ear, nose and throat, and diagnostic urology
- Elective endoscopy
- Radiology and phlebotomy
- Dentistry
Louth/Meath Hospital Group: (* refers to services proposed to transfer in the future)
Orthopaedic trauma (from Navan)
- Inpatient paediatrics and AE paediatrics (from Navan and Dundalk)
- Centralising emergency, acute general medicine and critical care services in Drogheda, commencing with Dundalk services and subsequently Navan*
- Integrating the general surgery service at Navan into the joint Drogheda/Dundalk Department of Surgery*
- Expanding day and out- patient services in Dundalk and Navan hospitals*
When Teamwork has been fully implemented Dundalk and Navan hospitals will provide:
- Day medical services
- Day surgical services
- Elective endoscopy
- Orthopaedics
- 12-hour ED (then 12-hour MIU)
- Step down unit
- Rehab unit
- Outpatient services
- Laboratory radiology
- Stroke rehab
- ENT
- CT Scanning
- Care of elderly assessment
‘Reconfiguration and reform is necessary and inevitable’ – debate
The fourth Irish Times/ Pfizer Health debate will be held in Dundalk next Tuesday. The topic, "That this house believes hospital reconfiguration and reform is necessary and inevitable", will be addressed by a number of leading experts in the field.
Proposing the motion will be Mr Colm Quigley, clinical adviser for the North East Transformation Programme, HSE and Finbar Lennon, consultant surgeon, Our Lady of Lourdes Hospital, Drogheda.
Speakers against the motion are Dr Bill Tormey, consultant chemical pathologist at Beaumont and Connolly Hospitals. Also speaking against the motion will be writer and PRO of the Health Services Action Group, Marie O'Connor. The debate will take place at DkIT, Dublin Road, Dundalk and will be chaired by Fintan O'Toole, Irish Timescolumnist and assistant editor.
Log onto healthdebates@ ogilvy.com or call Orla Dormer at 01-6690030