Critically ill and unstable patients will no longer be brought to Navan Hospital by ambulance from 12 December.

At present, the hospital is already bypassed for stroke, trauma, cardiac arrest, paediatrics and obstetrics patients.

The updated ambulance bypass protocol has been agreed by the Minister for Health and the HSE, "to address urgent patient safety matters for the small number of patients presenting in ambulances to Navan who are critically or seriously unwell or likely to deteriorate".

However, the HSE said that no agreement had been reached with Mr Donnelly on the reconfiguration of the Emergency Department at Navan or a full ambulance bypass protocol.

Yesterday, staff at the hospital were informed of the change in a letter from Hospital management.

It said unstable or critically ill patients will instead be brought to another Level 3 or Level 4 hospital and that doing this means those patients "will be provided with the best chance of survival".

Staff were advised that this was the first phase of a transformation of services meant a "partial bypass of ambulances to OLHN", but that the National Ambulance Service would continue to bring patients who are less sick and who are not critically ill to the Emergency Department at Navan.

The letter said the second phase of the transformation would see the Emergency Department at Navan Hospital "reconfigured" to a 24 hour Medical Assessment Unit.

However, it said that Phase 2 has not yet been sanctioned by the Minister.

"A date for Phase 2 has yet to be confirmed", the letter said.

The planned downgrading of services at the hospital has been strongly opposed by local campaigners

In a statement today, the HSE said it has not received agreement with the Minister for Health to proceed with the reconfiguration of the ED at Navan or a full ambulance bypass protocol.

However, it said the Minister has agreed with "an update of the existing ambulance bypass protocols" from the 12th of December, "to address urgent patient safety matters for the small number of patients presenting in ambulances to Navan who are critically or seriously unwell or likely to deteriorate."

The HSE said it has submitted a capacity review to the Minister, which remains under consideration by Minister Donnelly and government.

'Scandalous'

Local Aontú TD and Chair of the Save Navan Hospital Campaign Peadar Toibín has described the planned move on 12 December as "scandalous".

"We think this is scandalous, in the middle of a winter surge, when hospitals are out the door with A&E pressure, that the HSE would proceed in this manner," he said.

The group is planning a public meeting on the issue next week.

'Deeply concerning'

Sinn Féin TD for Meath-East Darren O'Rourke said news of the transition in the coming weeks was very deeply concerning .

Mr O'Rourke said that elected TDs have sought to engage with a capacity review process that was undertaken, and have sought answers with regard to the findings of the review, but have so far had had "no sight" of it.

He said the second phase is what the HSE proposed during the summer, and he said that there was no evidence that concerns raised by the local community at that stage have been addressed.