The Health Minister is to initiate a review to determine if a second Emergency Department is needed in the MidWest.
HIQA has been asked to lead the review which will commence after the independent investigation by former Chief Justice Frank Clarke into the death of Shannon Teenager Aoife Johnston at UHL in December of 2022 has been published.
Accident and Emergency Departments at Ennis, Nenagh and St.Johns were closed as part of a reconfiguration in 2009, which favoured a centre of excellence at University Hospital Limerick.
Announcing this review, the Department of Health says this was based on clinical evidence at the time, but since those decisions were made, the population of the region has grown considerably, and has a larger cohort of older people, who have a greater need for urgent and emergency care.
The announcement has received a broad welcome including from the Friends of Ennis Hospital campaign group, members of the Oireachtas Health Committee; Meelick Fianna Fáil TD Cathal Crowe and Ennistymon Fine Gael Senator Martin Conway, Scariff Independent TD Michael McNamara and the Irish Nurses and Midwives Organisation.
Clare Fianna Fáil Senator Timmy Dooley has been telling Clare FM’s Daragh Dolan that while he’s hopeful of a positive outcome, the review must not become a distraction to providing urgent additional bed capacity across the MidWest.
Statement From The Department Of Health
The Minister for Health, Stephen Donnelly is to initiate a Review into urgent and emergency care capacity in the mid-west region to determine whether a second Emergency Department (ED) is required. EDs are part of larger hospitals (known as Model 3’s / Model 4’s).
The Review will consider the case for a second Emergency Department for the region, in light of a big increase in the population in recent years and ongoing pressures at the Emergency Department at University Hospital Limerick (UHL).
Smaller Emergency Departments in the region closed 15 years ago. This was based on the very clear clinical advice at the time, as there is a clear relationship between emergency teams providing high volume of service and better outcomes. The aim was to minimise the risk of a patient presenting at the Emergency Department whose time critical needs exceeded the capacity of the hospital, and specialties needed, to treat them. We also know that important services, including intensive care units, require a certain throughput so that clinicians can maintain their skills.
Since those clinical decisions were made, the population in the Midwest has grown considerably. The population is also older than it is in most other regions. Older populations have a greater need for urgent and emergency care.
There have been record increases in investment in UHL during the lifetime of this government. However, overcrowding at UHL’s emergency department continues with trolley numbers increasing by 39% so far this year. This contrasts with the national trend, with the average morning trolley count falling by 11% during the first four months of the year. Some hospitals continually have no patients on trolleys.
Investment in additional capacity includes:
· Staffing at the hospital has grown by over 1,183 since the end of December 2019/early 2020 – from 2,814 to 3,997 at the end of February 2024. That represents an increase in staffing of 42%.
· There has been a 44% increase in the UHL budget in 5 years. In 2019, UHL had a Budget of €265 million. This year, 2024, the budget is €382 million, meaning its Budget has grown by €117 million.
· 150 new beds have been opened in the UL Hospital Group (ULHG) since Jan 2020. This includes 108 beds in UHL (98 ward beds and 10 critical care).
Investment has also included additional capacity at St. John’s, Croom Orthopaedic, Ennis and Nenagh hospitals.
While some reforms are underway at UHL, significant changes are still required in terms of how UHL is run and how patient flow is managed. This was highlighted in the recent report by the Health Information and Quality Authority (HIQA). HIQA noted evidence of improvements in operational efficiencies, but said greater operational grip was also needed.
The Review will consider the additional capacity being added, as well as future reforms that are needed.
Terms of Reference will be finalised and published once the upcoming review by Mr Justice Frank Clarke (retired) has been considered, so that its findings and recommendations can be incorporated. The former Chief Justice is conducting a formal investigation into the death of Aoife Johnston. The Minister has asked HIQA to lead the Review.
Statement from the Friends of Ennis Hospital
“Friends of Ennis Hospital welcomes the announcement this morning by Minister for Health Stephen Donnelly that a complete review of Urgent & Emergency Care capacity in the Midwest is to take place.
“It is particularly helpful that HIQA are going to be involved in this review as they are the ones who have seen first hand the situation in UHL and the other emergency departments around the country.
“In our statement following Aoife Johnstons tragic death FEH called for a new clinical review into emergency services in the Midwest and we thank the minister for his prompt response.
“In our briefing document which we updated in light of Aoife’s inquest findings we had analysed & refuted the last clinical advice from 2023 and this review is very much welcome.
“FEH were the lone voice for many years calling for a second model 3 in the region. We did so without any political support apart from Deputies Cathal Crowe and Violet Anne Wynne. We thank them for their support in getting us to this place. We did so when some politicians told us we were wrong.
“We see today’s announcement as a vindication of our stance which has never wavered.
“We know that there are campaigners who have gone before us who would be delighted with this announcement, and we are thinking of those who lit the way for us and our campaign”.
Statement from the Irish Nurses And Midwives Organisation
Commenting on the announcement by Minister Donnelly that a review will commence on urgent care capacity in the Midwest, INMO Assistant Director of Industrial Relations for the Midwest region, Mary Fogarty said:
“A HIQA-led review into the emergency care options in the Midwest is very welcome. We look forward to engaging with HIQA and the Minister on the terms of reference.
“The issues that have dogged the emergency department in University Hospital Limerick have been well flagged by the Irish Nurses and Midwives Organisation. So far this year, 8798 patients have been admitted to University Hospital Limerick to be treated on a trolley, chair or in another inappropriate bed space.
“There is huge pressure on our members working in University Hospital Limerick due to capacity issues and staffing deficits coupled with changes in demographics in the Midwest region.
“Any review into providing additional urgent care capacity will be welcomed by the INMO and we want to have input into the drafting of the terms of reference.
“It is clear that at this point we will need a Model 3 hospital in the Midwest.”
You can hear more on this story on Clare FM’s Morning Focus this Friday morning from 9am.
