The Save Navan Hospital Campaign group has said it will not give up without a fight, but it is the tug of war between the HSE and politicians that has really upped the ante in recent weeks.

For the last decade there has been concern about the future of the emergency department at Our Lady's Hospital in Navan.

While the HSE wanted to press ahead with closing the emergency department, replacing it with a medical assessment unit, it never happened.

Last autumn, another push was made to close the ED, but it did not go ahead.

On 13 June the HSE issued a press release before lunchtime and confirmed the move was proceeding.

The news came on the day that local politicians were meeting the Minister for Health Stephen Donnelly and senior HSE officials at the Department of Health.

Afterwards politicians from all sides expressed surprise that a decision, still understood to be under consideration, had been finalised.

The following morning, however, Minister Donnelly reminded everyone who was in charge, issuing a statement stating categorically that no decision had been made.

He said that several issues, including capacity in other hospitals, had to be addressed and he put the onus on the HSE to fully address these issues before the proposed transition happened.

Minister Donnelly asked the HSE to pause its plans to allow for further consultation with public representatives.

Yet, this day last week, the HSE's Chief Executive Officer Paul Reid said plans to reconfigure the ED at Our Lady's Hospital Navan were going to proceed.

Speaking on RTÉ's This Week, Mr Reid said that "it would be a mistake" for the minister to use his powers under Section 10 of the Health Act to direct the HSE to call a halt to its plans.

While he acknowledged the minister’s concerns, he said the HSE "ultimately" had to do this.

Later that evening Minister Donnelly said there was no approval for changes to the ED in Navan and the minister reiterated that patient safety concerns would need to be addressed before any changes in Navan would be considered.

Clinical director Gerry McEntee said patient safety is a key concern

Clinicians in Navan

Senior clinicians in Our Lady's Hospital in Navan are backing the plan.

Gerry McEntee, clinical director at the hospital, has said the key concern is patient safety.

He has been forthright in expressing his concerns, telling RTE’s Prime Time earlier this week that critically ill patients in Navan are not getting the best care possible and "inevitably there will be fatal outcomes".

"Do the people realise," Mr McEntee asked, "that this is the only cohort of critically ill patients in the entire country who, by virtue of the fact they are brought to Our Lady's Hospital, Navan, are not provided with the best opportunity for survival as in every other county in the country? Is that right? How long can that continue?"

He said the closure would affect just 10% of Navan’s acute attendees, the critically ill, with 90% of acute attendees still treated at Our Lady’s Hospital in Navan.

Surgical emergencies would also go to other hospitals.

However, consultants in Drogheda are concerned about the impact the closure will have on their hospital, which they say is already at full capacity.

They put pen to paper this week, telling Minister Donnelly and other senior HSE officials, that they will not be able to cope with the extra demand.

In fact, they went so far as to say, the transfer of risk from an unsafe ED in Navan to an under resourced hospital in Drogheda will lead to poorer clinical outcomes for patients.

"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 read.

So where does this all leave the decision to close the ED in Navan?

On Thursday night a packed room in Newgrange Hotel in the town heard calls for Minister Donnelly to reverse the decision.

Meetings like this, organised by the Save Navan Hospital campaign group, have been taking place for years.

As a journalist with LMFM radio, the local radio station covering counties Louth and Meath, I attended many of them.

There was more urgency about this one, more concern.

Every person in that room had their own story, their own reason for wanting to keep the ED open.

"The extra capacity that was promised was never put into the surrounding hospitals"

Many people at the meeting said they owed their lives to Navan Hospital.

Some of those who attended the meeting at the Newgrange Hotel

Dr Seamus McMenamin, a GP in Navan, was among those who took to the floor to express his concerns.

"I look at it in a very practical way and I look at the other nine hospitals that were reconfigured and I say has that decision improved the lot of patients," he told the packed room.

"When I talk to colleagues in Monaghan and the message coming back is that it didn’t and that the extra capacity that was promised was never put into the surrounding hospitals.

"When the CSO figures come out, it also looks like we’ll go from having the third lowest number of GPs per head of population in the country to the lowest."

Dr McMenamin believes the context has changed and the population will only grow.

"I think we haven’t considered the option of investing in the ED, put in the services that have been removed and taken away over the last ten years," he said.

"I think it’s possible to restore the ED in Navan and help improve patient care in Meath."

However, the HSE is adamant that the decision, which they say is about saving lives, is going ahead although they have accepted they need to work assuring everybody it is the right decision.

On Friday the head of the HSE Paul Reid, who on Monday announced he was leaving the job later in the year, said dialogue is continuing between the HSE, the Health Minister and the Department.

He accepted that further assurances and clarity are needed before any closure takes place and he specifically referenced the concerns around capacity in Drogheda and also the strength of the national ambulance service.

Next weekend a rally will take place in Navan and many questions remain.

Ultimately though, amid all the political wrangling, the people in Co Meath just want to know where they will go the next time they are very unwell.