Medics’ grave concerns at changes to acute care
By Clodagh McKeon
“The conditions people are being left in are inexcusable,” said Laura O’Neill during a protest at the Midlands Regional Hospital Mullingar on Monday.
Laura and her mother, Jean O’Neill, are just two of the many concerned about the plans to reconfigure Navan hospital. From Monday, patients from the south and west of County Meath are being diverted to Mullingar and those from the north and east of the county to Our Lady of Lourdes Hospital Drogheda.
In a letter addressed to the health minister, Stephen Donnelly, (see below) medical and ED physicians in Mullingar stated that the hospital is “already struggling” to maintain current activity and they “simply do not have the capacity to take on any more patients”.
Ray McIntyre from Mullingar, at yesterday’s protest, said plans to reroute people from Navan to Mullingar or Drogheda are inappropriate and unfair.
“To not have a decent emergency operation in Navan is unacceptable. Department money should be put into supporting the infrastructure of these hospitals and developing them as the population grows. We need to build on the Navan, Mullingar and Drogheda hospitals so that the services are there for people.
“People in the offices can sit back and make changes to the system like this but they might never have driven from Navan to Drogheda or Navan to Mullingar. I have and it’s not a nice drive. If you’re sitting in the back of an ambulance bouncing around, it’s awful.
“Drogheda is a major centre and so it could take you an hour just to get through the gates of the hospital with traffic. In regards to getting from Navan to Mullingar, it’s ridiculous too.”
Laura O’Neill added: “We’re here because four consultants from Mullingar hospital and 11 from Drogheda have written to the Dept of Health about the closure of Navan ED and told them the impact on them.
“Last week in Drogheda there were ambulances stalled outside with patients inside for five hours. There was also a family who went to Drogheda paediatric ED.
“When they got there, they were told they’d have to sleep outside in their car.
“It’s not the staff – they are doing the best they can with the resources they have but they are being put under far too much pressure by a government that is completely out of touch.”
'Dear Minster Donnelly' - Letter from senior physicians
Dear Minister Donnelly,
We are writing to express our grave concerns at the planned reconfiguration of acute care in Navan Hospital, announced last week. From the media coverage, we understand that from the 12th December 2022, the sickest medical patients (category 1 and 2) will no longer be brought by ambulance to Navan Hospital. Instead these critically ill patients will be diverted to another Model 3 or 4 hospital.
From the geography of the county of Meath, it is clear to us that patients from the South and West of the county will be diverted to Mullingar Hospital, while patients from the North and East of the county will be diverted to Our Lady of Lourdes Hospital, Drogheda. Over the last 5 years, we have already seen a substantial (23.6%) increase in medical admissions to Mullingar Hospital for patients from Meath. This activity is only going to increase further with this proposed re-direction of Meath patients. Mullingar Hospital is already struggling to maintain our current activity level, as evidenced by our high Trolleygars in recent months.
As of 8am this morning, there were 17 adult patients on trolleys in the ED department in Mullingar. This is due to a combination of an inadequate capacity of acute medical beds for the population we serve and significant staffing shortages. We are all too well aware of the impact this has on older frailer patients particularly. Overcrowding in the ED leads to concerns regarding patient safety, longer lengths of stay and reduced patient satisfaction. As it stands, we simply do not have the capacity to take on any more patients.
In February 2020, Navan Hospital came off acute stroke call. Patients from Meath with a suspected acute stroke are now diverted to Connolly Hospital, OLOL Drogheda and Mullingar Hospital. This change came into effect with minimal notice. We were not consulted in that decision, nor were we given any additional resources to deal with the increased patient load. Now it appears that this is happening again. To date, we have yet to be informed officially about the planned ambulance diversions from next week. Our colleagues in OLOL Drogheda were afforded a meeting on November 29 to discuss this proposal and the potential impact on their hospital. We have not been afforded that courtesy.
We are more than happy to engage with all relevant stakeholders to support the planned transformation of Navan Hospital. However, in order to ensure patient safety and maintain confidence in the health care system, it is essential that all necessary resources are put in place before any changes are made. This includes improvements to infrastructure and increased clinical staffing in the hospitals that will be impacted by this proposed change. It also involves the development of clinical pathways to ensure seamless patient care between hospital sites. This includes repatriation pathways back to Navan Hospital as well as onward community referrals. Historically we have struggled to access community services in Meath to facilitate discharges from the acute hospital so this needs to be addressed. We also have significantly fewer Non Consultant Hospital Doctors (NCHDs) than Navan despite much higher activity levels. If acute activity is reduced in Navan Hospital, then there needs to be a re-distribution of their NCHDs to the Model 3 hospitals taking on the additional workload.
A complex change like this needs to be planned carefully and deliberately and takes time. It cannot happen in a 2 week timeframe as has been proposed. The timing of this change is also poor – happening in the lead up to Christmas while we are all under severe pressure with high ED activity nationwide. It also comes on the back of a very tough three years of Covid. Our frontline workforce are exhausted and morale is at an all-time low. We have seen a huge exodus of clinical staff to community posts over the past 12 months. If extra demands are put on our staff, without adequate resourcing more will leave. This will lead to more staff shortages and worsening issues with recruitment and retention. Inevitably this will have a detrimental effect on patient care as well as increasing the risk of burnout in the remaining front line hospital staff.
We echo the concerns voiced last week by our colleagues in OLOL Drogheda. We are very concerned that if this proposal goes ahead as planed on December 12, that patient care in Mullingar Hospital will be compromised and patients will die. We have neither the infrastructure nor the staffing to take on this additional workload, without additional resources. We respectfully request that you reconsider this decision and delay any implementation until adequate resources are in place in Mullingar Hospital.
Kind regards,
Dr Hilary Cronin, Consultant Geriatrician
Dr Clare Fallon, Consultant Geriatrician
Dr Senan Glynn, Consultant Respiratory Physician
Dr Ultan Healy, Consultant Endocrinologist
Dr Shu Hoashi, Consultant Endocrinologist
Dr Inam Khan, Consultant Cardiologist
Dr Murat Kirca, Consultant Gastronterologist
Dr Sam Kuan, Consultant Emergency Medicine
Dr Richard Lynch, Consultant Emergency Medicine
Dr Mark Sheehy, Consultant Respiratory Physician