Weekend rostering of consultants in University Hospital Limerick’s emergency department (ED) requires “urgent attention”, the most senior civil servant in the Department of Health has told the Health Service Executive.
The conditions in the hospital have come under consistent public scrutiny due to understaffing, overcrowding, and the death of 16-year-old Aoife Johnston in December 2022 after she waited more than 13 hours for antibiotics to treat suspected sepsis.
Secretary general of the department Robert Watt wrote to Bernard Gloster on October 11th last about rostering in the midwest hospital’s emergency department during weekends.
The letter, obtained under Freedom of Information laws, was written more than a month after the publication of a report by former chief justice Frank Clarke into Johnston’s death, which noted staff shortages in the hospital as a contributor to her “avoidable” death.
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Mr Watt said that on the previous four weekends, senior decision-makers were on site until 8pm on Friday, with one consultant on call after this time.
On Saturdays and Sundays there is one ED consultant in place from 8am until 1pm, with the consultant on call after that, he said. He added that across the weekend, it is one named consultant who covers both days.
“As previously communicated to you the expectation is that adequate cover will be provided at weekends,” his letter said.
“Given the findings in the Clarke Report that the understaffing of both nurses and doctors was a factor that played a material role in the devastating outcome for Aoife Johnston, this issue requires urgent attention.”
Mr Watt said based on the rosters submitted to the department, there “appears to be a set number of consultants and hours for which cover is routinely provided and the overall numbers of ED consultants don’t vary from weekend to weekend”.
“This suggests that the rostering has not generally been adjusted according to expected demand or in response to conditions on site,” he said.
“I would also ask that you are assured of the appropriateness of the practice of having one ED consultant covering a period of 48 consecutive hours (Sat/Sun).”
Mr Watt welcomed the “priority” given to the implementation of the Clarke report recommendations, adding that department officials will “work closely” with the HSE’s chief operations officer to progress this work.
“I would request your immediate attention to this matter,” he added.
Last week Minister for Health Jennifer Carroll MacNeill said the spike in the number of patients on hospital trolleys cannot be explained by infrastructure issues when jumps happen after weekend periods.
In March 2023, the Government introduced the public-only consultant contract (POCC) in an attempt to remove private healthcare from the public system and increase the number of consultants working weekends and evenings.
“So I have two challenges; making sure we have the infrastructure to make sure that most people don’t need to be in acute hospitals,” said Ms Carroll MacNeill last week.
“And making sure that the levers we have for people who are working in the healthcare system, that they are working right across that seven-day period, so that people when they’re sick get treated and people when they’re better, get discharged.”
Asked about the concerns raised in the letter, a HSE spokeswoman said UHL has “consistently increased” consultant cover across the site at weekends and the consultant contract is “being utilised to its maximum potential”.
“The POCC contract is being utilised to its maximum potential by the hospital chief executive and regional clinical director with structured overtime for old contract holders,” said the spokeswoman.
“While UHL has a way to go, the corresponding weekend discharges achieved when compared to previous years reflects this change in rostering,” she added.
The Health Information and Quality Authority is undertaking a review to ascertain whether there is a need for a second ED in the midwest region, in order to reduce overcrowding and demand on UHL.
The authority said it is working towards a May deadline for completion of the review.
