EXPANSION of University Hospital Limerick (UHL), either onsite or at a location nearby, or the development of a new Model 3 hospital in the region, with its own emergency department (ED), are the key recommendations from the long-awaited Health Information and Quality Authority (HIQA) report on emergency care in the Mid West.
However, the health watchdog’s report does not paint a positive picture of a new Model 3 hospital for the region as a viable solution in tackling the ongoing overcrowding crisis at UHL.
Some local campaigners have questioned claims that a new Model 3 facility would take too long to build and, in doing so, fail to address the immediate and urgent need for in-hospital bed space.
Issuing a strong statement on the report, Mayor of Limerick John Moran hit out that the lack of a single preferred option “risks creating more confusion” and “delaying action again”.
“We cannot lose any more time or we will lose more lives,” the Mayor said.
The report, published this Tuesday (September 30), is an independent review on urgent and emergency healthcare in the HSE Mid West region, covering Limerick, Clare, and North Tipperary. The report was requested in mid-2024 by then Health Minister Stephen Donnelly, and presented to Minister Jennifer Carroll MacNeill in recent days.
HIQA’s three recommendations include the expansion of capacity at UHL’s Dooradoyle site (Option A), the extension of the campus to a second site in close proximity (Option B), or the development of a new Model 3 hospital in the Mid West, to include a new ED (Option C).
HIQA was of the view that Options A or B “will likely yield the required inpatient capacity in the Mid West within a shorter timeframe, thereby addressing the immediate risk to patient safety”.
The health watchdog said that while a new Model 3 hospital and ED “may have the potential to meet longer-term bed requirements”, such a move “would be least capable of addressing immediate capacity deficits, while being associated with the longest lead times”, referencing delays and costs of the National Children’s Hospital.
Responding to the report, Mayor Moran suggested there is no explanation offered as to why other options were not considered, such as a new Model 4 hospital.
Dismissing Option A outright, the Mayor called on the Health Minister for “more action and more land”, adding that, given a “lack of clarity about the right future-proofed answer”, he is considering convening an expert group to “agree what we might believe is the right answer”.
He also hit out that the report gives only “three mutually exclusive options”, asking “why was there not a more ambitious blended Option D”?
The report comes on foot of chronic overcrowding at UHL, highlighted significantly this week when, according to figures from the Irish Nurses and Midwives Organisation (INMO), there were near record levels of overcrowding with 147 and 133 people, respectively, left waiting on trolleys for an in-patient bed on Monday and Tuesday.
In a statement on Monday, HSE Mid West apologised to patients facing long wait times.
Also critical of the report, Melanie Sheehan of the Mid West Hospital Campaign put no credence in HIQA’s opinion that a new Model 3 hospital would take too long to complete, referencing the turnaround time for the recently opened €213million Bon Secours hospital in Ballysimon.
“It took 16 months (to build the hospital), so we know it can be done,” Ms Sheehan told this newspaper.
As regards Options A and B, UHL’s expansion on or off-site, Ms Sheehan added that “the two 96-bed blocks have taken so long. I can’t see how that would have immediate effect where the overcrowding is concerned in terms of overcrowding at UHL.”
The HSE said this week that the opening of the first 96-bed block at UHL is “imminent”.
INMO welcomed the HIQA report and recommendations, but urged for “swift decisions to be made”.
It also called for barriers to filling 300 nursing posts at UHL to be lifted and an increase in nurse-led services.
Mary Fogarty, INMO assistant director of industrial relations for the Mid West, hit out that since the streamlining of services at Nenagh, Ennis, and St John’s hospitals in 2009, over 176,870 patients have been treated on trolleys at UHL – almost 2,500 this September alone.
HIQA’s findings mirrored Ms Fogarty’s statement, citing the 2009 reconfiguration of emergency departments at St John’s, Nenagh, and Ennis hospitals to UHL, along with a freeze on recruitment between 2009 and 2015, and a fall in government spending between 2007 and 2016, as driving factors in the current overcrowding crisis.
The health watchdog said that the demand-capacity gap at UHL and across HSE Mid West “presents a risk to patient safety”, adding that, in a national context, “the Mid West has the lowest number of inpatient beds relative to the number of people who attend the ED” and the “highest number of ED attendences of any Model 4 hospital” in Ireland.
HIQA highlighted analysis by the Ecomonic and Social Research Institute which projected that between 299 and 593 new beds will be needed in the Mid West by 2040 to keep up with demand.
“The planning for these beds needs to commence now,” HIQA said.
A spokesman for Health Minister Jennifer Carroll MacNeill said that the Minister “accepted the report and advice from HIQA” and will “report back to Government on these options and considerations”.
