Sir, – I refer to the article that states the Health Information and Quality Authority (Hiqa) identified risks at Our Lady’s Hospital Navan that “cannot be fully managed” due to the lack of acute on-site surgical services (“Patient safety risks identified at Navan Hospital,” Health, April 2nd).
I support that statement wholeheartedly but would point out these risks have been identified and highlighted by the management and staff of the hospital for several years now.
The hospital has had no acute surgical services since 2010. In 2013, following a meeting of the then minister for health, HSE management, a number of medical experts and Hiqa, it was decided in the interest of patient safety that the emergency departments (EDs) in nine smaller hospitals around the country would be replaced by medical assessment units.
These units would only accept patients deemed appropriate for the medical services provided in these hospitals. No surgical patients would attend because these nine hospitals would no longer have acute surgical services.
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Thirteen years later the emergency department at Navan is the only one in these nine hospitals to remain open to critically ill “walk-in” surgical patients (not ambulance-delivered) despite no acute surgical services being present there since 2010.
In 2015, a further meeting was convened. It included HSE executives, medical experts from several specialities including surgery and emergency medicine, members of the regional health authorities and the National Ambulance Service and discussed specifically the future model of care for Navan.
They concluded the hospital “should undergo transition to a model-two hospital”, similar to the other eight smaller hospitals. Eleven years later that transition has not occurred.
In December 2022, phase-one reconfiguration took place, whereby all surgical and medically ill patients deemed not suitable for treatment at Navan by the National Ambulance Service would be brought not to Navan but to the nearest model-three or model-four hospital. This decision has significantly reduced the risks associated with the ED in Navan but the risks associated with “walk-in” surgical patients persist three years later and will remain until the hierarchy of the HSE and the Department of Health implement phase-two reconfiguration.
While there are concerns that phase two could add significantly to overcrowding of nearby hospitals, a number of local audits have indicated the number of surgical patients requiring admission since phase-one reconfiguration occurred in December 2022 averages only one to two patients per day.
Meanwhile, the staff of Navan, particularly the staff servicing our ED, are working under serious pressure on a daily basis to expedite assessment of surgical patients, initiate prompt baseline patient management and facilitate urgent patient transfer out to the appropriate nearby model-three or model-four hospitals.
There have been several critical incidents as a consequence of the failure to reconfigure Navan to a model-two hospital and these have all been highlighted to previous ministers for health and HSE chief executives. But, 13 years later, they have failed to make the decision that is clearly in the best interests of the patients of Co Meath. – Yours, etc,
GERRY McENTEE,
Clinical Director,
Our Lady’s Hospital,
Navan.
