UHL failures caused by limited nearby services, nursing shortages and ageing population

A sharply critical report published by health watchdog Hiqa (the Health Information and Quality Authority) found one patient waited 116 hours for a hospital bed, another for 85 hours, and a third for over 71 hours.

It found patients’ confidentiality was compromised as trolleys were so closely packed together their private information was easily overheard.

Hiqa found some management plans to address the overcrowding are paper-only and were not implemented on the day they visited.

A State policy of reconfiguration saw emergency departments closed at St John's Hospital, as well as Ennis and Nenagh, leaving patients with no alternative but to attend UHL.

Sean Egan, director of healthcare regulation and lead inspector, said: “When you do centralise services, there are benefits but there are also risks.

“The example of Limerick is becoming the single point of failure in the midwest region because it is the only door in for unscheduled care.” 

He urged health service planners to focus on “properly designing” for demand. He also said planners currently working on changes for Navan hospital, which could see its emergency department closed, should be mindful of the situation in the midwest.

“This report in terms of Limerick does highlight the importance of making sure any altering arrangements that are put in place are properly planned and that the necessary capacity is provided at wherever services are moved to,” he said.

He said concerns have been raised with senior HSE officials.

“I think Limerick is an extreme example of the mismatch between capacity and demand, but it is not entirely unique,” he said. 

“There needs to be a collective learning around this.” 

However, Hiqa also found other reasons for the crisis.

“I don’t think it is fair to say the reason there is overcrowding in Limerick is solely as a consequence of how things were reconfigured,” he said.

During an inspection on March 15, inspectors found the emergency department saw 290 people, and Mr Egan described demand as “phenomenal” at all times.

“Patients should be triaged within ten minutes of arrival; that’s the standard,” he said referring to the first assessment on arrival.

“We found on the morning of the inspection that there were eight patients waiting over an hour and one patient for three hours to be triaged. That was accounted for by them not having enough nurses.” 

These nurse shortages are of “significant concern”, he said.

“They were down nearly a fifth in terms of what they should have relative to what was there,” he said.

“Obviously notwithstanding the fact that you have massive overcrowding, you should still staff the place properly.”

Population changes are another key issue with a “growing, ageing and more infirm” population.

“This pattern was there before the pandemic,” Mr Egan said. 

“There was massive overcrowding and it is actually worse now. The pandemic masked that natural trajectory.”

Inspectors also found "a mismatch” between demand and the number of beds.

“They have the second-highest presentations to emergency departments in the state, and among the larger hospitals they have the second-lowest bed stock,” he said. 

They are operating at quite a significant deficit.

UHL has 530 beds and 149 day-case beds, the report states. 

“A shortfall of over 200 beds on the UHL site has been identified,” it said.

The report recommends building a Model 3 hospital to support UHL, which is a Model 4 hospital, in the way that Cork University Hospital works with University Hospital Kerry in Tralee.

In the midwest, there is no middle-tier hospital so everyone who is more seriously ill must attend UHL. Hospitals such as Ennis operate at a lower level of care.

Hiqa recommended exploring the construction option in addition to existing construction plans.