The news that urgent changes are needed in the provision of emergency healthcare in the midwest will not come as a surprise to anyone who has been following the news.
University Hospital Limerick (UHL) is sometimes referred to as the “problem child” of the health service, often being the hospital with the highest number of patients on trolleys. On Tuesday morning 66 patients were on trolleys – a concern given the respiratory illness season has not yet begun.
When the Health Information and Quality Authority (Hiqa) was requested to carry out a review into emergency care in the midwest region following the death of 16-year-old Aoife Johnston in December 2022, public and patient voices were loud that there was only one solution: a second emergency department (ED).
But the recommendations of the review, published on Tuesday, put forward three potential options to the Minister: expanding UHL; turning UHL into a two-campus hospital; or establishing a new, smaller hospital with a new ED.
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Despite all three options being presented, Hiqa’s evaluation paints a clear image that this third option is not the most favourable. It is, the watchdog found, likely to be the most expensive option, as well as the slowest, and would require the most staff.
This will come as a surprise and disappointment to many, particularly patient groups.
It did, however, highlight what these groups have reiterated again and again, which is that the current situation can be tied back to the closure of three smaller EDs in 2009 in the midwest.
At that time, it was determined that an extra 267 inpatient beds would be needed at the Dooradoyle site, along with further reconfiguration and refurbishment of the site – including a new or refurbished ED.
These extra beds were sought to ensure capacity could manage demand. However, due to the financial crash the beds and ED capacity never materialised – playing a significant role in the current congestion at the site.
Regardless of the reason, the current situation cannot be resolved overnight by any of the options put forward. They each – to varying degrees – will take time and significant investment.
Hiqa puts forward various risks associated with each of the options.
The first option – expanding UHL – was described as being the least expensive and potentially the quickest, but there could be future space constraints as the demographic grows.
The second option – turning UHL into a two-building hospital – would be dependent on officials being able to find a suitable site and would require significant investment, though Hiqa believes it could cost less than building a new hospital.
The third option – another hospital with a new ED – would take a long time and be the most costly, but could potentially better cater for demographic growth.
Minister for Health Jennifer Carroll MacNeill has said she will consider the report and its advice, and report back to Government on these options.
The report provided answers, but its comprehensive nature also appeared to muddy the waters in terms of a straightforward solution.
It would appear the Minister will not simply be able to pick to most appealing option. Rather, it seems much more likely that there will be a need for a mix of the various options to meet the health needs of the region.
