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University Hospital Limerick overcrowding: Reduction in scheduled care a short-term answer creating long-term problems

While health watchdog Hiqa assesses whether the midwest requires a second ED, the latest moves suggest the answer is obvious

In University Hospital Limerick on Wednesday evening there were 84 people awaiting care on trolleys and a further 58 patients in surge capacity. Photograph: Alan Betson
In University Hospital Limerick on Wednesday evening there were 84 people awaiting care on trolleys and a further 58 patients in surge capacity. Photograph: Alan Betson
Shauna Bowers's picture
Shauna Bowers
Sat Aug 10 2024 - 06:30

It is August and University Hospital Limerick (UHL) is under pressure.

News emerged this week that there would be a “significant” reduction in scheduled care in the midwest region in order to “de-escalate” the strain on Ireland’s most overcrowded hospital.

HSE chief executive Bernard Gloster said he was “shocked” when he visited UHL on Wednesday evening, a point when there were 84 people awaiting care on trolleys and a further 58 patients in surge capacity.

Health officials have long said bed pressure is no longer a seasonal problem, but rather a year-round issue that worsens in the winter months. But UHL having to take such drastic action in the late summer is a surprising intervention.

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The hospital consistently tops the national counts when it comes to patients on trolleys. The Health Information and Quality Authority (Hiqa) has warned on several occasions about the potential impact of this problem on patient safety.

At the end of April, a support team was deployed to UHL in an attempt to help tackle the issue. They recommended that a “reset” would be required “periodically”, during which time scheduled care would be postponed or deferred. There is a logic to the recommendation, which ensures beds are available for those with the most urgent needs.

Gloster said there is a “backlog” of emergency care at UHL. In the recent past, there have been tragic cases in which the hospital was so overcrowded that people died as a result of them being unable to access timely treatment.

But the health service is not just for emergencies; it is supposed to serve the entire population. Taking such a disruptive action in August does not bode well for the coming winter when respiratory viruses will be back circulating at much higher levels.

And if this is to become a regular or even semi-regular occurrence, what does it mean for the people in the midwest on waiting lists for procedures?

Pressing pause might be a short-term solution, but it certainly cannot be a long-term one. If it is, the already long waiting lists will grow further. But Gloster said the consequences of this decision is “better than the alternative” – people requiring urgent care languishing on trolleys for even longer.

While Hiqa works on an assessment as to whether a second emergency department is required in the midwest region, this action being deemed necessary in August seems to indicate that the answer is quite obvious.

Until reforms of the way patient flow is handled, or capacity is sufficiently addressed, it seems likely that we will see headlines about postponed scheduled care at UHL again.