Hiqa warns Limerick hospital crisis needs urgent action with beds running out in Midwest

Health watchdog warns University Hospital Limerick faces dangerous overcrowding, urging immediate plans to expand capacity or add a second hospital

University Hospital Limerick. Picture: Dan Linehan

Hiqa has told the health minister she must either expand University Hospital Limerick, provide a support hospital, or build a new hospital to address chronic overcrowding.

The health watchdog told Jennifer Carroll MacNeill “planning for these beds needs to commence now.” 

It called for urgent action, warning overcrowding continues to pose an ongoing risk to patient safety at University Hospital Limerick.

While campaigners have called only for a new hospital offering emergency care in addition to University Hospital Limerick, Hiqa has presented alternative options.

Option A is to “expand capacity at University Hospital Limerick on the Dooradoyle site,” referring to adding beds at its current location.

Option B is to “extend the UHL hospital campus to comprise a new second site in close proximity under a shared governance and resourcing model.”

This would mean building a smaller nearby hospital to handle non-crisis care or clinics, relieving pressure on UHL.

Option C is to “develop a Model 3 hospital in HSE Mid West, providing a second emergency department for the region.”

This would involve building a hospital similar to Mercy University Hospital in Cork or University Hospital Kerry in Tralee. It would include an emergency department, meaning the Midwest counties would have two such facilities.

In advice to health minister Jennifer Carroll MacNeill, published on Tuesday, Hiqa urged: “immediate action and investment to address current risks to patient safety in the shortest timeframe and safest way possible.”

It added: “Each of the options has merits in terms of addressing the capacity challenges.” 

Hiqa advised that Options A and B are the “most likely” to increase bed numbers quickly, saying this would address the immediate risk to patients.

However, it acknowledged that Option B also requires construction and could face delays, without easing pressure on UHL in the short term.

For the option of building a new hospital with an ED, Hiqa cautioned that experience with large-scale public hospital projects shows this could face “a long lead time.”

The report directly referenced the spiralling cost of the new children’s hospital and warned that building another hospital would impact other health plans in the region.

Hiqa stressed there is “a pressing need” for extra beds now.

“Options A or B, or a variation of same, would offer the potential to provide this capacity in a shorter timeframe than Option C,” Hiqa said.

“In the context of addressing ongoing risks, they may be more appropriate near-term options than Option C.”

The Hiqa review followed a series of tragedies at UHL, including the death of 16-year-old Aoife Johnston in December 2022. The inquest into her death heard the ED described as a “war zone” by medics working there.

The 56-page report includes feedback from both the public and healthcare workers.

Hiqa noted that while patients focused on overcrowding in the ED, medical staff highlighted the bed shortages driving the problem.

The report states: “the Mid West has the lowest number of inpatient beds relative to the number of people who attend the ED.” 

Hiqa also warned of planning delays that could push a second block of 96 beds back until 2029.

This is particularly concerning, as new ESRI data shared with the review team shows that by 2040 the Midwest will need between 299 extra beds (a 36% increase) and 593 (a 71% increase) compared with 2023 levels.

Commenting on the Hiqa report, a spokesperson for Ms Carroll MacNeill said she has accepted it and will consider the "comprehensive and detailed reports and advices". 

"The Hiqa report is detailed and comprehensive and includes their advice to the minister, along with a number of detailed output reports from the review workstreams, which included stakeholder consultation, regulatory inspections, data analysis and international evidence reviews. Hiqa'sreview identifies three potential options for Ministerial consideration.

"A substantial volume of work was undertaken for this review by Hiqa, the ESRI, the Expert Advisory Group and all the stakeholders who contributed to the various workstreams in particular to the public consultation. The Minister is grateful to all for their time.

"The minister has accepted the report and advices from Hiqa. Along with her officials, she will consider the comprehensive and detailed reports and advices provided by Hiqa, including the three options identified, and report back to Government on these options and considerations."