Will new shape of HSE improve patient outcomes at UHL?
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Winter is coming and with the new shape of the HSE now in place across the country, patients relying on University Hospital Limerick (UHL) will want to know what is going to change for them.
In Limerick, the relocation of management teams back to the hospital from external offices in Raheen Business Park this month is understood to be one visible sign of change.
This follows the formal end last week of having hospital groups and community services run separate structures across the country. Instead there are now just six health regions including HSE Mid West.
It is understood that one of the senior managers joining the HSE Mid West team is a former chief executive of Beaumont Hospital, Ian Carter.
He was seen as instrumental in tackling what had been a severe overcrowding and trolley-numbers crisis in that hospital in previous years.
In a message to all staff, HSE chief Bernard Gloster said it will see “six regions, from the first of October, now commencing the next phase of their work".
He said they can expect to see services “shaped into a slightly different structure” but described how the emphasis is on the way they can now work together for patients.
More than 400,000 people live in Clare, Limerick, and north Tipperary. They will want to know what this new team can do to slash overcrowding and delays.
We already know operations and procedures were cancelled in five hospitals there in August to make way for crisis patients coming through the emergency department.
UHL did see a significant drop in patients delayed in the emergency department following that move. However delays began rising again last week.
The hospital said 92% of those postponed outpatient appointments were rescheduled by late September.
And while that must be a huge relief to those patients, it likely means a steeper workload for at least some specialities as they catch up.
A report on the death of Aoife Johnston at UHL by former chief justice Frank Clarke looked at communication and decision-making on that fateful night in 2022.
He also however took a detailed look at the environment.
He said although “overcrowding was not the only issue which impacted on the lack of treatment of Aoife on that occasion, such overcrowding was undoubtedly a material factor".
He also asked “whether the capacity in the hospital as a whole is sufficient to absorb all of the patients who need properly to be admitted”.
Winter is likely to be very challenging with only an extra 16-bed modular unit opening in December.
Asked if staff have been recruited for it, a HSE spokeswoman said on Friday a delivery plan is being developed to make the building ready.
June should see a 96-bed block opening with 71 of these new beds and the remainder replacing older wards.
Recruitment has started for this with a second 96-bed block under construction.
A plan to build an outpatient unit is also under consideration, regional executive officer Sandra Broderick said last month.
In the long-term, plans to move the maternity hospital on-site are at appraisal stage, the HSE spokeswoman said.
In light of all this, Mr Clarke’s report queried how many more buildings can physically fit on the campus, and he called for research to be “urgently carried out” in to what is practical.
The Health Information and Quality Authority (Hiqa) was separately asked by Health Minister Stephen Donnelly to assess whether a second emergency department is needed.
Its report is not expected until summer 2025.
This timeline has caused concern locally in light of delays facing the new children’s hospital with little prospect of acting on any Hiqa recommendations soon.
Mr Clarke also looked outside UHL, welcoming plans to boost rehabilitation care and expand opening hours for medical assessment units.
His report has been heavily criticised by the family of Aoife Johnston for not answering their questions and leaving them still unclear as to why their daughter died such a terrible death.
Despite these concerns, Mr Gloster committed to implementing the recommendations, as well as apologising for failings in her care.
The recommendations include for a detailed study on why more people need the emergency department at UHL than at other similarly-sized hospitals elsewhere.
Mr Clarke recommended systems changes are “possibly” needed to help more people before they get so sick they need a hospital.
Will the merger of hospital and community make that process more efficient for patients? Only time will tell.