Overcrowding crisis in UHL affecting entire region

The current overcrowding crisis in University Hospital Limerick (UHL) is causing major disruption to healthcare in North Tipperary.

Emergency actions taken in an attempt to ease congestion and remedy what was described as a 'major internal incident' on January 2 are continuing to upset normal services at UHL, where staff are described as overstressed and working under very strenuous circumstances.

Professor Declan Lyons said conditions at the hospital are “inhumane” and patient safety is at risk. Reductions are in place for day and elective surgery in UHL, Ennis, Croom, St John’s and Nenagh since Monday (Jan 9).

Tipperary Labour TD, Alan Kelly, told the Tribune that what is happening currently "is a travesty for the people of Tipperary, Clare and Limerick but it was entirely predictable given what we have come through over the last few years".

Images of chronic overcrowding in hospital emergency departments throughout Christmas and over the early days of 2023 cannot have come as a major surprise to the HSE, the Minister or the Department of Health as warnings have been issued for months, Independent Tipperary TD, Michael Lowry said.

Deputy Kelly blames the decision to close local A&E’s and critical care units before the total infrastructure was in place to create a centre of excellence in UHL and across the hospital network of UHL, Nenagh, Ennis and St. John’s. 

"We in the midwest were the guinea pigs for testing HSE's reconfiguration for the rest of the country. We were sold a pup. It has not worked", Deputy Kelly said.

He said the public have lost confidence and that the midwest area is "just too big for a hospital network conformed the way it currently is".

"UHL has less consultants, staff and beds pro-rata than other similar size hospitals. The former Chief Clinical Officer of the UHL network of hospitals, Dr. Gerry Burke, pointed this out continuously and fought for equal resources until he retired", Deputy Kelly said.

He said the midwest needs "more capacity, more beds, more consultants, more staff and more transportation", which, he said, is "plainly obvious". 

"We also need an elective only hospital in the midwest. This could be based in Limerick or Nenagh where there is ample space beside the current hospital, which is close to the M7 motorway. We also need better transportation in a rebooted ambulance and paramedic service" he added.

"In the short term, there needs to be a complete refocus on better community care outcomes. The relationship between acute and community care needs to be a hand in glove relationship, especially to facilitate timely acute discharges and keeping people living at home as long as possible. 

"The Government needs to step up here with better pay and conditions for staff working in home care. People won’t do this work as pay and conditions aren't good enough. I’m sick and tired of saying that an employment order needs to be in place for home care workers.

"I also believe that the HSE should purchase Barringtons Hospital in Limerick to help with capacity. It’s already set up and would need little modification to act as an elective hospital in the short to medium term. We need more public capacity, not more private hospitals", Deputy Kelly said.

"There needs to be a massive recruitment drive for consultants and staff. This needs to happen immediately outside the state as well as inside. We need full cooperation between GPs, hospitals and community care providers. Getting people speedily through the HSE service and prioritising patients based on need is critical now more than ever. 

"The idea that GPs can pick up the slack at all times during critical periods like now just isn’t realistic. Everyone has to work together", Deputy Kelly said.

‘Warnings went unheeded’

Independent Tipperary TD, Deputy Michael Lowy said the current crisis is a clear indication that removing A&E services at Nenagh, Ennis and St. John’s in 2009 was a mistake and  that enhanced services in these hospitals are quite clearly required to meet the needs of the 400,000-strong population in this region.

Deputy Lowry said there had been numerous warnings that demands on hospitals over the winter months would likely surpass anything seen in the past and that an advance plan was crucial to meet the inevitable needs of seriously ill patients.

"We were all made aware in late 2022 that a ‘Twindemic’ of covid and flu would strike this winter. This unfortunately became a Tridemic when RSV was identified as the third dangerous respiratory illness to strike this year, placing even greater demands on our struggling hospitals and healthcare staff.

"The crisis we are now witnessing is both worrying and heartbreaking, but it cannot be considered a shock or a surprise. The warnings sounded well in advance. We could have been better prepared,’ Deputy Lowry told this newspaper.

He said it comes as no surprise that University Hospital Limerick has topped the list of overcrowded Emergency Departments nationwide on an almost daily basis and blamed the 2009 decision for the current situation.

Since the decision to downgrade Nenagh, Ennis and St. John’s Hospitals’ in 2009, the Centre of Excellence Model 4 University Hospital Limerick has provided the only 24-hour A&E service for the entire population of Limerick city and county, North Tipperary and Clare. 

"This has meant that ambulances in the midwest region could only transport 112/999 patients to UHL’s Emergency Department, while bypassing Nenagh, St Johns and Ennis Hospitals on the way", he said. 

"A lot has changed in the intervening 14 years and the population in all these areas has grown significantly. UHL has long been unable to cope with the growing demand", Deputy Lowry said.

"It is imperative that the suffering we have seen people endure in A&E’s is addressed. It is crucial that their fear of being referred to hospital is removed. That the terror of being left suffering endlessly on a trolley endlessly is eliminated. People deserve nothing less", Deputy Lowry said.