Mum drives 200km to avoid taking son to overcrowded Limerick hospital 

Patients in the Mid-West are making the trip to Dublin rather than attending University Hospital Limerick, consistently the country’s most overcrowded hospital
Mum drives 200km to avoid taking son to overcrowded Limerick hospital 

Una Quish at home with son Noah in Castletroy, Limerick.

Collections of trolley beds line corridors, holding miserable patients as they wait to be seen by doctors and nurses who are burnt out — this is University Hospital Limerick (UHL) in 2022, consistently the most overcrowded hospital in the country.

The chaotic overcrowding is not a symptom of Covid-19. Old decisions made around healthcare in the region have come home to roost, with people across Limerick, Clare, and North Tipperary paying the price.

Patients in crisis

Una Quish lives less than 20 minutes’ drive from UHL but on St Stephen’s Day, she bundled her sick son into the car and drove to CHI at Crumlin in Dublin instead, desperate to avoid the overcrowded hospital.

“We just went straight to Crumlin. There was the thought of going into the Regional [Limerick] and waiting for another 12 hours with him in pain — he was just so sick — so I said it would be quicker to drive to Dublin,” she says.

Her son Noah, 4, has a number of health conditions, so Una is familiar with Crumlin as some of his specialist care is done there, but in this case there should have been no need to go.

“Everything was done there in two hours. Crumlin was very busy as well, but we had bloods done, everything done,” she says.

Just weeks before that journey, Una had taken Noah to UHL for treatment for a winter virus that can be devastating for him. “That was a 12-hour wait, I think everything seems to be at least 12 hours from what I’ve experienced with him. He already has a lot of health problems so he’s supposed to be prioritised,” she says.

The wait included hours in the emergency department, then in a separate room, before he was eventually seen.

By then the little boy was “thrown on the ground, vomiting constantly. He was given no pain relief because there was literally no doctors there.” Nurses convinced her to wait until a doctor was free, but Una decided that day would be the last trip to University Hospital Limerick.

Campaigners frustrated

Neighbouring Co Clare has no hospital emergency department. Marie McMahon from Ennistymon is advocating for this to change with the MidWest Hospital Campaign.

Her husband Tommy Wynne, 65, died, having been found unresponsive in UHL in April 2020 after 36 hours on a trolley in a corridor. She was with him for much of that time.

“We have the highest-paid executives in our health service and we can’t get a decent bed for our loved ones. It’s like they don’t care, there is no care,” says Marie.

“We don’t matter, the people don’t matter, the ordinary person in the street doesn’t matter.”

A photograph of Tommy is nearby as she speaks, her voice full of frustration that families continue to suffer. “The figures are a problem, we seem to be on a treadmill and there seems to be no will to sort it from anywhere,” she says.

“Limerick was one of the worst hospitals through Covid, and there were days when 40% of patients on trolleys throughout the country were in Limerick. The issue never went away.”

Marie McMahon: 'We have the highest-paid executives in our health service and we can’t get a decent bed for our loved ones. It’s like they don’t care, there is no care.' Picture: John Kelly
Marie McMahon: 'We have the highest-paid executives in our health service and we can’t get a decent bed for our loved ones. It’s like they don’t care, there is no care.' Picture: John Kelly

Roots of the problem

Many people hark back to a decision in 2007 to close emergency departments in three smaller hospitals in the region, leaving UHL as the sole contact for a population now close to 400,000.

Nenagh and Ennis hospitals instead offer local injury units seven days a week, 8am to 8pm, and St John’s local injury unit runs 8am to 6pm, Monday to Friday.

Figures provided by the UL Hospitals Group show 36,000 people attended these local units last year — higher than numbers attending the former emergency departments in 2007.

“We have an injuries unit in Ennis which works quite well but that closes early. If there was something there through the night, people could go there rather than go to Limerick,” says Marie.

“They close Ennis and it’s the same in Tipperary; they close Nenagh, so everybody has to go to Limerick, we don’t have a choice.”

In contrast, the South/South West Hospital Group has two emergency departments in Cork, and one each in Tralee, Waterford, and Clonmel.

Nenagh councillor Seamus Morris says people in Tipperary are reluctant to go to Limerick for treatment.

“The policy of reconfiguration has failed,” he said.

“People will only go into hospital in Limerick if they are really sick, in other words, they need more and more care when they get in there. The chances are people are dying at home rather than calling an ambulance.”

He says stories of “undignified” days on trolleys are a deterrent for others.

Canary in the coalmine

Niamh Cummins, lecturer in public health at the University of Limerick, describes overcrowding in any emergency dependent as “a real indicator that the health system is not functioning well”.

She points to wider issues like the shortage of GPs in rural areas for the growing crisis across the Mid-West, saying older people who do not have primary care then need more hospital care.

“Funding, obviously, is an issue, increased bed capacity, increased staffing — all of those need to be done. But we do also need to expand the services in the community,” she says.

“The demand is exceeding supply at the moment; there is only one way that is going to go.”

Dr Cummins says research also points to a growing level of burnout among Irish medical staff, feeding resignations and emigration, and that extra beds alone will not solve problems for hospitals like Limerick.

View from inside the hospital

UL Hospitals Group chief clinical director Brian Lenehan starts with the stats: 76,473 people came through the emergency department last year, up from 71,315 in 2019. “We are admitting more patients who are frail, elderly patients with significant co-morbidities. We have noted over the last 12 months an increase in our length of stay, that affects our bed capacity,” he says.

“These are patients, a lot of whom were at home cocooning, a lot of them were not accessing primary care never mind tertiary care.

“Eventually, it gets to the point where they need care and the route of admission here is UHL.”

UHL has 530 in-patient beds, he says. This compares with 605 at University Hospital Galway, 645 in Cork University Hospital, and 680 in St James’s Hospital.

Prof Lenehan says 83% of the beds are taken up with patients admitted through the emergency department, which often means elective procedures are delayed as a result. “We have more ED attendances and less in-patient beds,” he states.

Comparisons with Dublin hospitals, which the HSE made recently, do not take account of the high number of children attending UHL, he says.

Patient numbers are also up in the smaller hospitals, with around 50 beds in Nenagh and Ennis, but some beds at St John’s are closed due to nursing shortages.

“Cancer surgery, time-critical vascular surgery is affected, when only 17% of your bed stock is used for that,” says Prof Lenehan.

“Our most recent analysis shows that to meet the current demand we need 200-plus new in-patient beds.”

Like all HSE hospitals, staffing is a critical issue, especially for nurses — staff shortages mean empty beds lie unused.

When a 60-bed block opened in late 2020, Seamus Morris says: “The biggest problem was getting the budget for staff.”

There were a record 111 people on trolleys and chairs at UHL on January 26, according to the Irish Nurses and Midwives Organisation.
There were a record 111 people on trolleys and chairs at UHL on January 26, according to the Irish Nurses and Midwives Organisation.

Working with trolleys

There were a record 111 people on trolleys and chairs at UHL on January 26, according to the Irish Nurses and Midwives Organisation.

“Time and time again, University Hospital Limerick is the most overcrowded hospital in Ireland,” says Mary Fogarty, INMO assistant director of industrial relations.

She points out that UHL was already overstretched even before the pandemic. Back in February 2020, she was highlighting a then-record 92 people on trolleys, bluntly describing the situation as “unsafe, unsustainable, and completely avoidable”.

Other workers are also “burnt out”, says Ger Kennedy, Siptu representative for porters, catering staff, cleaners, and healthcare assistants. “Everything
in the hospital, to a degree, centres on the emergency department. When they are under pressure that has a domino effect right across the hospital,” he says.

He describes it as often so busy that “you couldn’t swing a cat” on the corridors. “The emergency department, since 2010, has seen a 20% increase year on year. That is fuelled by the fact that the emergency departments in Nenagh, Ennis. and St John’s were effectively shut down.”

A new emergency department opened in Limerick in 2017 to great fanfare. It cost €24m and was three times bigger than the old one.

“It was resourced and staffed for a capacity of approximately between 150 and 200 presentations per day,” says Ger.

“We are now dealing with presentations in the region of 270 and 300 per day. That’s a problem right there.”

Waiting on a trolley

Brian Downes’s father spent 30 hours in the emergency department of UHL in early December.

“It is clearly not big enough, you had people on trolleys the whole night and the unit was jam-packed,” he says.

“Where was the forethought and planning back in 2017?”

His father’s case was reported in the Irish Examiner at the time, and he was in contact with the hospital.

“They were very sympathetic and apologised for the delays,” he says, but what he really wants is change. “It is up to the management, to the senior leaders in the HSE. There does not seem to be a lot of political will either to change the system.”

Solutions are needed

Some hospitals have turned around similar problems, including Tallaght University Hospital, which was the subject of a scathing report by the Health Information and Quality Authority (Hiqa) on overcrowding in 2012.

Prof Lenehan argued there is an urgent need to create a separate elective hospital where operations are not affected by the demands of emergency care.

Talks are under way with the international healthcare group UPMC to deliver a new hospital that would take the pressure off UHL.

“We have, as a group, worked closely in the last year with UPMC, and we have a proposal which we have shared with all key stakeholders in health to develop a 150-bed hospital in Coonagh in Limerick,” says Prof Lenehan.

This proposal could see UHL staff working on a site built by UPMC. Prof Lenehan says while they would welcome HSE investment in a building that has also been proposed, his understanding is that a private partnership could be faster.

In the meantime, UHL has added 98 beds and 10 ICU beds since the start of the pandemic, says a spokesman. It has planning permission for a 96-bed block, with the contract expected to be awarded before the end of June.

However, Prof Lenehan points out that 48 of these rooms would simply replace older multi-bed rooms which need to be closed for infection prevention reasons.

Una Quish says she doesn’t understand why Covid has hit UHL so hard.

“I would never open my mouth like this usually, but it is never going to get better if people don’t speak out,” she says.

Whatever action is taken, it needs to be done “urgently,” according to Marie McMahon, adding that the crisis continues whether it is being discussed in the Dáil or not.

Unions, meanwhile, want an external investigation by Hiqa.

“The INMO is once again calling on Hiqa to urgently investigate the overcrowding issue in the hospital and make recommendations,” says Mary Fogarty.

Siptu supports the nurses in their call, adds Ger Kennedy.

Hiqa would not comment directly on this but confirmed that it has engaged with the hospital directly over the past few weeks on overcrowding.

It has received detailed updates from UHL and been in touch with the HSE at a national level to “seek clarity” around how this can be addressed over the medium-term, according to a spokesperson.

It is clear everyone involved with or potentially affected by the growing crisis in Limerick hospital wants a solution.

The Sláintecare reform programme promises universal access to timely, integrated care for everybody in Ireland.

However, to get there from what people in the Mid-West are experiencing now will take a coming together of everyone, including Department of Health officials and senior executives in the HSE, to find solutions before another tragedy strikes at University Hospital Limerick.

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