ANALYSIS:Services elsewhere in the region need to be beefed up so patient safety is truly ensured
THE REMOVAL of general surgical services from Navan hospital is not unexpected. However, it is likely to spell the beginning of the end for the Co Meath institution. Local people need only reflect on the inexorable cutting that took place at Monaghan hospital to see where the future of their facility lies.
The northeast has been the vanguard for the rationalisation of health services in the Republic. The HSE has long signalled its intention to concentrate on Cavan General and Our Lady of Lourdes Hospital in Drogheda as the providers of acute hospital care in the region. In 2006, UK consultants Teamwork recommended a new hospital be constructed in the northeast, but in the present economic climate it is difficult to see this happening.
In the meantime, the centralisation of acute services at Cavan and Drogheda has continued apace. Many changes have occurred without adequate infrastructure being put in place, leading to overstretched staff and the increased risk of healthcare error.
Indeed, yesterday’s announcement appears to recognise this reality, with the HSE lining up Dublin hospitals to provide surgery for some patients from the Navan catchment area. Beaumont and James Connolly in Blanchardstown are part of a rota system under which patients assessed at Navan’s emergency department will be referred for acute surgery. According to the HSE, this is an interim arrangement until capacity at Drogheda is increased.
No major general surgery has been carried out in Navan since 2006. This latest move means people who require urgent appendectomies or gall bladder removal will no longer be operated on at the unit. It is unclear whether minor surgery under local anaesthesia will continue to be performed; it seems more likely the consultant general surgeons will be deployed elsewhere in the region.
So what services remain for patients? Those with medical conditions such as heart problems, diabetes and stroke will still be admitted to Navan. The hospital will continue as the region’s orthopaedic unit, and its presence, more than any other factor, may delay further degradation of patient services. This is because the continued employment of anaesthetists at the hospital means serious medical emergencies requiring intensive treatment can still be dealt with. But without anaesthetic cover, the hospital could become little more than a cottage hospital, as it would be forced to stop treating acutely ill medical patients.
On the surface, at least, the move is driven by patient safety concerns. Low volume and low complexity in surgery may be linked to poorer outcomes. The HSE said yesterday the decision was “in the interest of providing the highest quality service to patients and following expert clinical advice”. And in fairness, local management has stepped up to the mark, with no apparent need for the Health Information and Quality Authority to intervene – as it was forced to do recently in the case of patient safety concerns at Mallow hospital.
But local supporters will yet again point to a chicken and egg situation, in which inadequate funding sets a hospital up for failure when staffing levels and other facilities are inadequate to ensure quality standards are met.
They will continue to argue that cost-cutting is the real agenda at play. While there may be some short-term savings to be gained from yesterday’s decision, these may not last if services elsewhere are not beefed up. With GP out-of- hours services in the region under threat, and gaping holes in health service finances, patient safety may yet be compromised.