Health minister's crisis visit to Limerick hospital finds nurses and doctors 'burnt out'

Stephen Donnelly said the UHL trolley crisis will not be resolved unless consultants become more visible on the emergency department floor

Minister Stephen Donnelly, TD Kieran O'Donnell, Senators Róisín Garvey and Maria Bynre, and HSE CEO Bernard Gloster at UHL. Picture: Brendan Gleeson

The health minister met with "burnt-out" nurses and doctors as part of a crisis visit to University Hospital Limerick (UHL), which is struggling with persistent overcrowding.

Stephen Donnelly said that the trolley crisis at the hospital will not be resolved unless consultants become more visible on the floor of the hospital’s overwhelmed emergency department and engage with management on the Public Only Consultant Contract (POCC).

Health Minister Stephen Donnelly with Sandra Broderick, HSE regional executive officer at the 96-bed unit at University Hospital Limerick. Picture: Brendan Gleeson

The minister said frontline staff told him they needed more beds and more support from senior clinical decisionmakers on site.

Mr Donnelly said an additional 86 beds, including 16 rapid-build beds at UHL, 50 step-down beds in Nenagh, and 20 community healthcare beds in Clare, would be provided ahead of an expected winter surge of patients, to try to help alleviate pressure on patients and staff.

A 96-bed block, presently under construction on the grounds of UHL, is to open in 2025 and a second 96-bed block would also come on stream. However, Mr Donnelly said UHL consultants needed to step up and make changes to their workplace practices.

“In order for this to work, we have to see reform in the hospital. Limerick has one the lowest uptakes of the new public-only consultant contract; the level of weekend discharge is not where it needs to be,” Mr Donnelly said.

He added that "many" consultants are working "night and day" to tackle patient-flow issues, but he said he wants to see more "rostered on site" throughout the hospital after hours and at weekends. 

Colette Cowan, chief executive of the UL Hospitals Group, told a regional health forum last week that only 28% of emergency medicine consultants employed by her group had signed up to the POCC, which could see them being asked to work an extra five hours on Saturdays and an extra two hours on weekdays.

Mr Donnelly, who was accompanied at UHL by HSE cheif executive Bernard Gloster, told reporters: “UHL ranks ninth in the country for weekend discharges; that must improve, and there will be a progression to immediate rostering over six and, where contractually possible, seven days.” 

He said an “all-of-hospital approach” to treating ED patients was required, which would include “the presence of non-ED consultants to support ED colleagues in the emergency department when necessary”.

Mr Donnelly said that while trolley numbers had reduced in other hospitals, in spite of increased patient presentations nationally, UHL remained a “significant outlier, as they have seen about the same increase in presentations, but rather than a fall in trolleys they have seen a 50% increase in trolleys”.

Members of the Mid West Hospital Campaign (MWHC) protested outside the hospital, calling for the reopening of emergency departments in Nenagh, Ennis, and St John's Hospital which were closed and reconfigured to UHL in 2009.

Mr Donnelly conceded that reconfiguration had not worked as it was not properly resourced.

“It was not done properly. What should have happened here [at UHL] is this kind of investment should have happened first, so that this hospital had the capacity it needed to take on all those extra patients. That didn’t happen and that’s what we are now rectifying," he said.

When asked if he would consider reopening the regional EDs, the minister said “the latest advice” he had received from the chief clinical officer of the HSE Dr Colm Henry was “that it would not be safe for patients to open emergency departments in those hospitals”.

However, Mr Donnelly acknowledged that “the current situation here [UHL] is not tolerable, and not acceptable”.

Stephen Donnelly said 'the current situation here [UHL] is not tolerable, and not acceptable'. Picture: Brendan Gleeson

When asked if he was “satisfied with the quality of management at UHL”, he replied he was “not going to comment on any individual” but that all at the hospital were working hard to provide the best care for patients.

Mr Donnelly was also asked about several high-profile incidents at the hospital.

He said an ongoing investigation into the death of Aoife Johnston, a 16 year old who waited for care for 12 hours on a trolley before her death, would be completed in May.

Additionally, Mr Donnelly said he was "very concerned" at the details of an unpublished internal report into the death of UHL patient Martin Abbott who, it was revealed last week at the Shannon man’s inquest, had been dead on the floor of the UHL ED for over an hour before staff noticed his body.

Mr Donnelly said the report “catalogued a series of failures” in Mr Abbott’s care, and the report “also called out the fact that solutions to overcrowding which have worked in other hospitals have yet to be seen here [in UHL].” 

“What happened was not acceptable; it shouldn’t have happened,” he said.