Health Minister to launch review assessing if mid-west region needs new emergency department

The Department of Health said the review is to consider the case for a second ED 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).”

Last month an inquest into the death of 16-year-old Aoife Johnston returned a verdict of medical misadventure after the young girl waited over 15 hours in UHL on December 17, 2022 to receive antibiotics.

The teenager, who had meningitis and sepsis, had been lying on two chairs in a storeroom, in the hours before her death.

Overcrowding has continued to blight UHL’s ED, with trolley numbers rising by 39pc so far this year, the Department admitted.

And while smaller EDs had been closed down in the region, 15 years ago, this had been, the Department said, based on “very clear clinical advice at the time.”

“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,” a Department spokesperson said.

“We also know that important services, including intensive care units, require a certain throughput so that clinicians can maintain their skills,” they added.

Since the “clinical decisions” were taken 15 years ago, however, it has become apparent, the population in the Midwest has “grown considerably,” the spokesperson added.

While the population is also older than it is in most other regions. The Department explained that older populations “have a greater need for urgent and emergency care.”

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 retired judge Mr Justice Frank Clarke, has been considered, to allow its findings and recommendations to 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.

“There has 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 39pc so far this year,” the Department spokesperson said.

This figure “contrasts with the national trend, with the average morning trolley count falling by 11pc during the first four months of the year,” they added.

“Some hospitals continually have no patients on trolleys.”

The Department of Health said it has investment in additional capacity, which includes: Staffing at the hospital, which 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 42pc, it said.

There has been a 44pc increase in the UHL budget in five years, the Department stated. In 2019, UHL had a budget of €265 million. This year, 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.