'Sense of hopelessness' among staff at Limerick hospital

The people of the Treaty City want a hospital to be proud of, but UHL is proving inadequate, says Health Correspondent Niamh Griffin

The number of patients on trolleys at University Hospital Limerick continues to rise, reaching 143 last Monday. Picture: Brendan Gleeson

In January, more than 11,000 people who marched in Limerick against hospital overcrowding believed it could galvanise real change, yet cancelled surgeries have occurred once more.

“We thought that this was the line in the sand, everyone was there for it,” recalled one man who protested.

Junior Franklin, owner of Franklin’s Shoe Store in the city, said he thought it would be like the ‘grey army’ protests against pension changes in 2008 which did bring change.

“I was on that [hospital] march. I thought then that ‘this is a movement’, it was great,” he said.

Instead, numbers of patients on trolleys continue to rise, reaching 143 last Monday, according to the Irish Nurses and Midwives Organisation.

Responding to the crisis, UL Hospital Group temporarily cancelled elective surgeries at University Hospital Limerick (UHL) to make room, saying 245 people attended the emergency department daily on average in the week to March 4.

Mr Franklin said the overcrowding is a constant topic among his customers, saying “a state of emergency” should be called with more help coming in.

“That’s where I would find fault [with the Government], not with the amount of money they’re sending — they need to come in and help,” he said.

It’s not going to get better on its own — what is happening is more records are being broken. It is going to take something special [to fix it].”

Walking around the city, there is a strong sense people want to be prouder of UHL and want these problems to be solved.

Niamh McNicholas said simply: “They are all up the walls in there, I don’t know where you would start.”

She was recently a patient in UHL, and said her medical care “was a very good experience”.

However, like hundreds of others, she said: “At the beginning I was lying in a hallway too; there was nothing they could do about that.

“People are giving out about the staff but it’s not their fault. They don’t want it to be like that. I just think they are overworked and spread very thin.”

Many people pointed to the closure of emergency departments in Ennis, Nenagh, and St John’s hospitals in 2009 as a pivotal moment, echoing arguments made by Midwest Hospital Campaign and march organiser Mike Daly.

However, Rita Ryan thinks the problems go further back.

“I was here when Barrington’s was closing, we all marched to keep that open,” she said, referring to a hospital which closed, including its emergency department, in 1988.

“It’s a private hospital now. That was a mistake. The HSE should definitely have bought that.”

Bon Secours Hospital Limerick at Barrington’s now operates there, but moves next year to a 150-bed hospital in Ballysimon that is currently under construction.

This will take insured patients and public patients funded by the State, according to Taoiseach Leo Varadkar.

Ms Ryan echoes comments about good medical care at UHL but emphasises: “The emergency department is nowhere big enough, there are no other options now. UHL is for Clare and Tipperary as well, it’s ridiculous.”

Junior Franklin, owner of Franklin’s Shoe Store in O'Connell St, Limerick, said UHL overcrowding is a constant topic among his customers. Picture: Brendan gleeson

These pressures were seen by Katie Hickey when her father became ill in May 2023.

“He was in the emergency department for a week on a trolley. I had to take a week off work to be with him in there, they are not set up for that,” she said.

She remembers watching porters, saying: “The staff were moving people in and out, moving one trolley to get someone else out, it was like Tetris.”

In her experience, extra nurses and more staff would help across the hospital.

Staffing was one of the issues raised in an internal review of the death of Aoife Johnston, 16, with references to shortages of nurses and non-consultant hospital doctors among other serious concerns. Her death is now under external investigation.

For Mick Molloy, emergency medicine consultant on the Irish Medical Organisation’s (IMO) consultant committee, staffing is part of the UHL solution, but even more urgently needed is hospital beds.

A 2008 report for the HSE recommended UHL as a “regional centre of excellence” and that it should have 642 in-patient beds, but instead it has 535 with more in the smaller hospitals.

“When you’ve got 245 patients a day in the emergency department, you are going to have roughly 20% to 23% of those admitted from the emergency department who require a bed, so the more of those beds you have available, the easier it is to move patients up to a ward,” said Dr Molloy.

As the number of emergency patients increases the bed situation develops into “a big competition” with elective patients, he said.

“When you have 700 or 800 beds like some of the Dublin hospitals have, it is easier to play with that number and move things around,” he added.

There were also consequences from closing those smaller emergency departments.

“Limerick was an experiment with the reconfiguration,” said Dr Molloy. “It was removing emergency departments from other units and having all your emergency admissions funnelled into a hospital, which wasn’t made any bigger.”

A new emergency department was built at UHL, but “it really wasn’t designed for the volume of people who are attending”, Dr Molloy said.

Those smaller emergency departments were open in 2006 when Matthew Sadlier worked at what was then the Mid-Western Regional Hospital (now UHL).

Now chair of the IMO’s consultant committee, Dr Sadlier said: “Limerick was already at capacity when they closed Ennis and Nenagh.”

Those emergency departments were closed for patient safety reasons following analysis.

“The IMO was never against closing smaller emergency departments, but we were against closing smaller emergency departments without having first built up the emergency department to which those patients would have gone to,” he said.

An additional concern now for doctors is cancelling elective surgeries, something not unique to UHL.

“The Irish healthcare system is very very good at treating people with urgent health problems. The problem is if you delay care, then quite often chronic problems become acute,” said Dr Sadlier.

Would-be patients cancel work shifts or change childcare arrangements to prepare for an operation, he pointed out.

It is not easy to work in overcrowded conditions, he said: “In a workplace environment, hopelessness is the worst, and from our members we are getting a sense of hopelessness."

Niamh McNicholas: 'They are all up the walls in there, I don’t know where you would start.' Picture: Brendan Gleeson

Some 1,716 patients attended the emergency department in the week up to March 4, UHL said.

“We apologise to anyone who has had a long wait for admission to University Hospital Limerick in recent days, and to all who have been impacted by deferrals of surgery.”

A 96-bed block is under construction, although 48 of those beds will replace older wards being closed.

“We also welcome the commitment by the Minister for Health Stephen Donnelly and the HSE to accelerate the delivery of the second 96-bed block at UHL. This next phase of additional works has commenced and excavation works are due to begin in the coming weeks.”

A report by Deloitte, commissioned by UHL, found “a requirement for 302 additional inpatient beds and 63 day beds in this region by 2036”.

HSE chief Bernard Gloster has said he is confident for people to use services at the hospital.

“If you need to go to hospital, you can go to that hospital, you should go to that hospital. I live in that area myself, my family go to that hospital,” he said.

However, in that RTÉ interview, he declined to say whether he had confidence in management, only saying he would not prejudge findings of reviews under way.