Health Minister Stephen Donnelly announced a raft of measures to alleviate overcrowding at University Hospital, Limerick, when he visited the hospital in April and met with management, including Regional Executive Officer Sandra Broderick, HSE CEO Bernard Gloster consultants and other clinical leaders.
He said the continued problem with the number of patients being treated on trolleys was not acceptable to him as Minister, and it most certainly was not acceptable to the people of the region.
In an effort to alleviate the problem, he said he had agreed with the HSE a number of measures which he hoped would help the situation. These included:
- “A procurement process has been initiated for the operation of the new 50 bed Community Nursing Unit in Nenagh as a step down sub-acute and rehabilitation facility for this hospital for one year until the first 96 bed block is opened.
- We have decided to change the bed profile in this new block from 48 new beds to 71 new beds. I have also asked that recruitment commence 2024 for immediate readiness in 2025.
- I have mandated that all steps are taken to accelerate the second 96 bed block to be built here at UHL, having sanctioned enabling works for that project last year. Those works have begun.
- A further 20 permanent step-down transition and rehab beds will be procured in Clare.
- 16 additional fast build beds are to be commissioned onsite with this capacity to be available in advance of next winter’s surge.
- The opening hours of the region’s three Acute Medical Assessment Units at Nenagh, Ennis and St John’s are to be extended to 24/7 on a phased basis.
- Safe staffing will be extended to all wards in UHL as per the national rollout.
- UHL is to be one of two national test sites for Acute Virtual Wards.
- UHL will provide GP and Advanced Nurse Practitioner-on-the-door services for the ED in an effort to alleviate overcrowding and allow the ED staff to treat urgent and emergency patients in a more timely manner.”
The Minister said these new measures came on top of a 41% increase in staff at UHL since 2019, and an addition of 108 beds since 2020. The budget allocation for the Hospital had increased by 44% since 2019 to €383 million in 2023.”
Minister Donnelly also met with representative groups of nursing and NCHD staff. The Minister impressed on everyone he met, that those hospitals that performed best in terms of trollies were those which had changed the way they worked to better suit the needs of the populations they served.
He said, “Those hospitals that are improving their performance, are doing so through a combination of increased resources – we have more beds and more staff right across our health service albeit not to the same extent as here in Limerick – and reformed work practices.
“Therefore, I have asked and expect that we will see here in UHL the following:
- That senior decision makers are rostered on site, both in the Emergency Department and throughout the hospital, after hours and at weekends. UHL ranks ninthh in the country for weekend discharges, that must improve There will be a progression to immediate rostering over six and where contractually possible seven days.
- An All-of-Hospital approach to treating ED patients, including presence of non-ED consultants to support ED colleagues in the Emergency Department when necessary.
- A strong patient flow team in place 7 days per week.
- Weekend access to scheduled diagnostics for ED.
- That there be community and Health and Social Care Professional support for weekend discharge, with 7-day rostering.
- A targeted campaign to increase the number of consultants on the Public-Only Consultant Contract in UHL. An improved deployment review of those on the POCC to extend decision-making capacity.
- A single Mid-West Bed Management System and Patient Flow Team: All non-long stay beds – hospital and community will now come under one bed management system and with one person managing flow.
- That a Social Inclusion Hospital to Community Team will tackle the demographic and social challenges which lead to overutilisation of hospital pathways.
- That the CAMHS Paediatric Liaison Team provide in reach into the paediatric wards to support children with mental health needs.
- In terms of Community Chronic Disease Management team – we will redistribute CDM and ICPOP Teams to highest need areas of population.
- All national clinical and reform programmes are to be deployed for the immediate benefit of the hospital. Central Referral Management and Patient-Initiated Reviews in scheduled care are to be introduced.
- Senior Management on the Floor early mornings: There will be a reorganisation of working plans of Executive Management Team on site at UHL across the week to provide operational leadership and support to staff across the hospital. This is a proven method of enhancing performance.
“These measures have proved to be successful when deployed in Waterford, Mullingar, Beaumont and elsewhere and I expect that they will be successful when they are rolled out here in Limerick.
“Reform and change are difficult, they challenge us all, but reform and change are required here in UHL if we are to provide the service the people of this region expect and deserve.”
The Minister said that nationally, so far this year we had seen an 11.5% (37k) increase in the number of people presenting at Emergency Departments (EDs) versus the same period in 2023. For those aged 75+ patient group the increase was 16% (7,000).
In spite of this, additional capacity coupled with on-going reforms meant that the number of patients on trollies had fallen by 10.4% (3.3k).
“UHL has consistently the highest number of people waiting on trollies for admittance to a hospital bed in the country. In 2024 to date, 17% of those who waited on trollies did so at UHL, a hospital which has 6% of Emergency Department attendances, and 6% of attendances of those over 75 years.
“In UHL, in 2024 we have seen a 14% (2.4k) increase in the number of people presenting at ED versus the same period in 2023. The number of patients on trolleys has increased by 49% (1.6k).
“Of the five hospitals with the highest numbers of patients on trolleys, UHL is the only one showing an increase in trolley numbers for 2024.”
