Consultants at Our Lady of Lourdes Hospital in Drogheda have written a letter to the Minister for Health and senior HSE officials expressing significant concerns around the closure of the emergency department at Our Lady's Hospital in Navan and the implications it will have.

The planned closure did not begin because Minister Stephen Donnelly "overruled it", the hospital's clinical director told Prime Time.

Gerry McEntee said that though the board of the HSE had arranged for the closure to start from Thursday, there was no change in arrangements at the hospital due to the minister’s decision.

Mr McEntee said he did not know when the closure would now commence.

A spokesperson for the minister said that he had not exercised powers under Section 10 of the Health Act to direct the HSE not to close the unit.

Mr McEntee also said that the planned closure would only mean up to a dozen new attendees each day at Our Lady of Lourdes emergency department in Drogheda.

Mr McEntee defended the planned closure, saying that the key concern was to ensure that people were sent to the place where they had the best chance of survival, and that the Navan hospital does not have the services to provide the critically ill with the best opportunity of survival.

Consultants at Our Lady of Lourdes in Drogheda wrote to the Minister for Health and senior HSE officials expressing significant concerns around the closure and the implications it will have.

RTÉ News has seen a letter was signed by 17 consultants at the hospital in Drogheda and sent to Minister Donnelly this week.

In the letter, the consultants expressed serious concerns regarding patient safety, should plans to close the emergency department in Navan go ahead, without adequate resourcing in place at Our Lady of Lourdes hospital.

They said that as things stand, the transfer of patients to Drogheda from Navan "will not provide the right care for patients at the right time or at the right place".

"The transfer of risk from an unsafe ED in Our Lady's Hospital in Navan to an under resourced Our Lady of Lourdes Hospital in Drogheda will lead to poorer clinical outcomes for patients," the letter stated.

The consultants said that while they understand the transitioning of smaller hospitals to Model 2 status, they have significant concerns regarding patient safety, if the plans to close Navan ED go ahead without adequate resourcing at Our Lady of Lourdes Hospital in Drogheda.

The consultants refer to data from the HSE unscheduled care performance report published in May, which ranked Our Lady of Lourdes Hospital as the fifth busiest emergency department in the country.

They said the hospital also has the second highest admissions from an emergency department in the country, while University Hospital Limerick is in first position.

The consultants also highlighted that the hospital has seen a 12% increase in emergency department admissions since 2019.

The letter notes that the diversion of patients with acute stroke from Our Lady's Hospital in Navan to Our Lady of Lourdes Hospital in Drogheda in 2020 happened "without clinical engagement or adequate resourcing".

The consultants said that clinicians only became aware of the move by national media shortly before the implementation.

They said that "no human or financial resources" were given to Our Lady of Lourdes Hospital in Drogheda to cope with the significant increase in demand, either before or since the transition.

They said that the hospital in Drogheda now receives the same number of acute stroke patients as St James's Hospital in Dublin – the largest in the country.

Despite this, the consultants said that a request to provide "one whole time stroke physician" in Drogheda was rejected earlier this year.

In the strongly worded letter, the consultants questioned the rationale behind the decision to close the emergency department in Navan.

They said that if the same principle of diverting patients to the hospital in Drogheda without appropriate front loading of necessary resources continues to be followed, "patient safety will become unsafe".

The consultants also referred back to closure of medical departments at the Louth County Hospital in Dundalk, highlighting demands on the hospital in Drogheda.

The letter states that there were 48,000 presentations to the emergency department in Our Lady of Lourdes Hospital in Drogheda in 2010 and 66,000 in 2021.

Consultants said the hospital in Drogheda is at full capacity, pointing to the pressure experienced at University Hospital in Limerick as an example of what may happen if the emergency department closure goes ahead in Navan.

They also said the hospital currently has limited access to the essential critical services to treat safely and appropriately patients with acute and serious illness.

The letter states that Our Lady of Lourdes Hospital currently has no full time neurology, stroke or rheumatology consultants and also lacks an on-site dialysis service and on-site vascular intervention radiology service.

The consultants said that the transfer of risk will only serve as an incentive for current clinicians in Drogheda to find alternative employment.

They also hit back at the assertion that the hospital can absorb the risk with the the allocation of two additional physicians, saying it was "fanciful and unrealistic".

The consultants end their letter by saying that a lack of proper planning and resourcing "is a recipe for poor patient outcomes and investment in essential critical services must be prioritised now".

The consultants said they would welcome an independent review of current and future needs.

'Facts about Navan'

Mr McEntee said everyone is entitled to their own view but "they need to understand the facts about Navan".

Speaking on RTÉ's Drivetime: "The hospital as it is at present is not in a position to provide the best opportunity for survival in the small proportion of patients who are critically ill and who come to the ED."

He said the alternative plan - for such patients to be assessed by advanced paramedics before being taken from the scene to the nearest Model 3 or 4 hospital, the majority [of the time] that would be Drogheda - "there is no doubt that would provide those patients with the best opportunity for survival".

Asked about the concerns of the clinicians who signed today's letter, he said any group would have concerns about being asked to undertake a further workload that may overpower resources.

But, he said, extra resources had been agreed with Drogheda, including two ICU beds and 10 additional hospital beds.

He warned that, in the meantime, critically ill patients in Navan are not getting the best care possible and "inevitably there will be fatal outcomes".

Public meeting

Chair of the Save Navan Hospital campaign Peadar Tóibin paid tribute to the staff at the hospital who he said have been "downgraded" by HSE officials.

Some of those attending this evening's public meeting

"It is long past time that the Minister [for Health] reintroduces his authority over the HSE," he said.

"The minister isn't a passenger on a bus. It is a minister's job to drive the direction of the bus," he added.

With additional reporting by Rita O'Reilly