UHL Crisis: 'Appointments cancelled, no replacement date given — does Limerick hospital even care?'
When Julie Malone was told in January she would see a consultant at University Hospital Limerick in August for severe breathing problems, the wait seemed long enough.
Then last Thursday, she received an apologetic phone call and was told her appointment on Friday was cancelled with no replacement date.
She is just one of hundreds of patients across five hospitals in Limerick, Clare and Tipperary who saw appointments — and even surgeries — cancelled at short notice.
The cancellations, recommended by an external three-person team working with UHL, are hoped to ease pressures so emergency patients can be seen across the hospitals.
Ms Malone, 62 and living in Clare, suffers with frequent chest infections and a severe cough, noticeable even on the phone.
Initially told in October she would need an appointment, she said: "I had a phone call from [a respiratory consultant)] and then the CT scan in January with the intention of meeting this guy very quickly afterwards. So that wait was from January 2 to August.”
She added: “And then my appointment gets cancelled.” Now she has “no indication whatsoever” when it might happen.
“A few years ago I was told I was pre-COPD and at this point I believe that I do have COPD but I have no definitive diagnosis,” she said, explaining this limits what her GP can do.
She also takes care of her elderly father and had already arranged homecare. “Then I had to go back and cancel them, and if I’m messing them around they’re not going to bother coming in again,” she said.
'There’s lots of prongs on this, and they [UHL] don’t think about this at all.”
Dozens of patients took to social media this week describing how work or childcare were affected and also saying they had no new date.
Many noted high trolley figures — reaching 127 last Wednesday — are happening in August, which makes them afraid for winter.
Melanie Cleary, from Corbally in Limerick, has heard many examples, even of colonoscopies cancelled.
A member of the Midwest Hospital Campaign, her daughter Eve, 21, died in July 2019, hours after being sent home having spent 17 hours on a trolley.
While the hospital apologised and pledged new protocols for the treatment of blood clotting, she is furious overcrowding has not lessened.
“When Eve died, they said to me this will never happen again,” she said.
It was “like a horror story” reading reports from the recent inquest into the death of Aoife Johnston in December 2022, Ms Cleary said.
“A lot of things in that took me back to that night , it made me so angry,” she said.
She now intends to run in the next election, saying: “I’ve learned it’s all about politics” and warned: "This has affected five hospitals, that’s a lot of patients and it is not the solution.”
A review into Ms Johnston’s death has not yet been published. A HSE spokesman could only say: “The CEO has confirmed he has received the report and is considering it”.
Sean Egan, director of healthcare regulation at health watchdog Hiqa, oversaw a number of critical inspections at UHL.
Overcrowding is “a symptom of wider issues” and gaps locally as well as bed shortages, he said.
Questions need to be asked, he said, like: “do you have enough stepdown care, do you have enough [space] for people who actually need to go into residential care?”.
He is hopeful HSE regional executive officer Sandra Broderick, who has eyes on hospital and community, could make a difference.
“It’s not to say there was never any communication but I think the formalistion of that, in principle, is a good thing. It all depends on how it plays out in practice,” he cautioned.
Inspectors have seen “incremental improvements” such as “much better" staffing levels, but concerns remain.
Buildings include, he said, “state-of-the-art blocks and then a lot of the old infrastructure is some of the worst you will see in the HSE”.
A new block is set to open next year, but he estimated: “I don’t think that it will be fully enough.
A second 96-bed block is planned as are further wards. Hiqa will shortly publish terms of reference for a review into whether a second ED is needed.
Health Minister Stephen Donnelly stood over the cancellations, saying overcrowding in the ED was "not acceptable" for patients or healthcare staff in the Midwest.
“The only solution is a radical increase in capacity coupled with radical reform at the hospital in terms of patient flow. This reset is part of that reform of patient flow," he told the .
He emphasised the need for reform, saying: “The recent report by the expert group was stark in making similar observations, including that some practices which are now standard in other hospitals have not been implemented at UHL”.
There are now about 20,000 fewer people waiting for a first consultant's appointment there than at the start of 2022, he said, adding: "We need to see this same level of improvement for those patients in the ED”.
A spokesman for UHL directed questions to earlier comments by Ms Broderick.
“We’ve seen an enormous increase in attendance for unscheduled care,” she told Clare FM, saying it was an 8% increase compared to 2023.
“Unfortunately, and I’m really sorry, we had to make this decision.” She highlighted exceptions including for cancer and cardiology.
What critical steps or mis-steps have left patients in Limerick, Clare and Tipperary in crisis again some 20 years since hospital reforms began?
An emergency department in the Mid-Western Regional Hospital (now called University Hospital Limerick UHL) was supported by EDs in Ennis, Nenagh and St John’s hospitals.
The Hanly report advised nationally having small emergency departments was “not sustainable, either from the viewpoint of patient safety or staffing”. It picked the Mid-West as one of two pilots for reform, detailing needs for more staff, beds and other changes.
The HSE Mid-West Acute Hospital Services Review (Teamwork report) found three consultants covering the four EDs. It advised the small units were not “viable, stand-alone A&E services” and recommended increasing supports at UHL, including bringing bed numbers to 642.
The three EDs were closed under then health minister Mary Harney despite widespread opposition and predictions of chaos.
Hiqa (Health Information and Quality Authority) published a critical report on Ennis hospital following concerns raised by patients. This said the Ennis 24-hour ED was unsustainable and recommended reforms for the region.
A new ED opened in UHL, at a cost of €24m.
Tommy Wynne, 65, from Ennistymon, Co Clare, died in UHL after spending 36 hours on a trolley. His widow Marie McMahon later co-founded the Midwest Hospital Campaign.
Eve Cleary, 21, from Corbally, Limerick, died three hours after she was discharged from UHL, having spent 17 hours on a trolley.
A High Court case taken by her parents Melanie and Barry was held in January 2024.
Martin Abbott, 65, from Shannon, Co Clare, died in the ED. His inquest, held in March 2024, heard he may have been dead on the floor for an hour before being found.
Hiqa inspectors found a patient waiting 116 hours for a bed and said patients had “little to no privacy or dignity”.
Professor Colette Cowan, UL Hospital Group chief executive, told the Oireachtas Health Committee UHL had only 530 beds that month.
Construction work began on a 96-bed unit with an estimated finish date of October 2024.
It has since emerged this means 71 new beds and 25 replacement beds. It is expected to open next year.
Aoife Johnston, 16, died in the ED after spending 12 hours on two chairs, having come with a doctor’s letter querying sepsis, a life-threatening condition requiring urgent treatment.
Medical staff at her inquest, in April 2024, described the ED as “a death trap” and “not a safe environment” and “intolerable” and “like a war zone”.
UHL declared a major internal incident due to severe overcrowding, leading to cancellations for patients among other measures.
This reflected chaos nationally with the Irish Nurses and Midwives Organisation counting 931 patients on trolleys on January 3, including 97 in Limerick.
The Irish Medical Organisation and Irish Hospital Consultants Association called for immediate changes to bed numbers and staffing.
An estimated 11,000 people marched through Limerick against overcrowding, co-organised by Mike Daly.
A second block of 96 beds was confirmed, with planning for four more 24-bed wards by Health Minister Stephen Donnelly.
During the year, UHL received additional funding for nurses and non-hospital consultant doctors.
The Committee on Public Petitions received a petition with 15,000 signatures organised by the MidWest Hospital Campaign calling for re-opening of the EDs.
Among various crisis measures, a HSE support team led by Grace Rothwell, a HSE national director, was sent in. Hiqa was asked to carry out a review to see if a second ED was needed in light of the growing population.
UHL cancelled many out-patient surgeries and appointments in all five hospitals in the region, blaming high ED patient numbers.