Colin Peirce: Fixing hospitals in the Midwest requires a creative, collaborative response

More than 80,000 people attended the emergency department at University Hospital Limerick in 2023. Picture: Dan Linehan

The recent decision by the HSE to switch-off scheduled care across five hospitals of the University of Limerick Hospitals Group (ULHG) was not acceptable. 

For the hospitals’ patients and staff, and the region’s wider population of more than 400,000 people, it raises understandable questions, starting with “was this approach necessary?”

It has been evident for some years now that the persistent challenges faced by the hospital group, most notably overcrowding at University Hospital Limerick’s (UHL) emergency department (ED), are deep-rooted. 

The minister for health, HSE chief, and others locally deserve credit for acknowledging the scale of the problem and kick-starting the process of addressing it. 

Doing so is not easy. 

More than 80,000 people attended the ED at UHL alone in 2023. 

A further 240,000 people had an outpatient appointment in a Midwest hospital last year, 165,000 of these at UHL. 

The scale of these numbers speak to the region’s dependency on its hospitals.

The decision therefore to “de-escalate” outpatient appointments represents one of the most unusual healthcare acts of recent times.

In practice, de-escalation is the cancellation of essential medical services such as elective surgeries, medical diagnoses, and consultant appointments for patients at hospitals in Limerick, Ennis, Nenagh, and Croom.

Switching-off medical appointments for almost a quarter of a million people without any concrete timeline as to when they are to be switched back on is wrong, and dangerous. 

Choosing the nuclear option represents a dereliction of duty to the region, not least because, with creativity and collaboration, there are other routes available.

Despite all the negative sentiment associated with hospitals in the Midwest, there are examples of service and operational enhancements. 

For instance, patient throughput and pathway improvements, new virtual health tools, enhanced use of other regional facilities, and surgery volume increases are among the types of improvements achieved. 

The dynamics driving these positive measures are creativity and collaboration, with Allied Healthcare Professionals and hospital management coming together to activate practical solutions in a self-evidently imperfect situation.

Attempting to make improvements, knowing that capacity levels, consultant numbers, and wider staff resources are well below required levels, is not easy. 

But right now, in the Midwest, “not easy” is the reality.

For those overseeing care delivery where bed numbers are 238 below what is necessary, the level of applications for advertised roles remains strikingly low. 

In the first six months of this year, zero permanent consultant posts were approved for the Midwest. 

Just one additional permanent full-time consultant post has been approved in the past 18-months.

How has it come to this?

This chronic lack of capacity is central to where we now find ourselves. 

In 2009, an expert report recommended closing certain ED services in the region, but only at a time when capacity at UHL itself had been increased. 

Fatefully, the then government proceeded with the first part of the recommendation but not the second. 

Units at Nenagh, Ennis, and St John’s hospitals were closed before any corresponding capacity was delivered at UHL. 

Fifteen years later, we continue to pay the price, with capacity levels well below what was recommended. 

In the intervening period, the region’s population has increased, creating even further demands on already overstretched services.

Despite having the largest catchment area for a model 3 or 4 hospital, UHL has long suffered from under-resourcing and has the lowest number of beds and consultants in the country. 

With an existing 238-bed deficit, UHL urgently requires the rapid delivery of new beds. 

Specific new bed commitments have been made. 

71 new general beds and 16 rapid build beds are earmarked by March next year. 

A further 97 beds are promised to come on stream four years from now. 

These developments are commendable but given the circumstances, can they be fast-tracked as has been the case elsewhere? 

Some 40,000 people had an outpatient appointment in a Midwest hospital last year, 165,000 of these at UHL. 

The new Rock Wing at the Mater Hospital, Dublin, is a great example of how the government can deliver significant additional capacity when the will exists.

We also need to be collaborative rather than defensive on recruitment. 

That starts with being honest about the inadequate staffing levels for current bed levels, never mind future ones. 

While the minister can justifiably point to examples of recruitment successes elsewhere, UHL remains an outlier. 

In the first six months of this year, zero permanent consultant posts were approved for the Midwest. 

In the same period, 134 permanent posts were approved nationally, 38 of these in one hospital group alone. 

Approval of new permanent posts needs to be fast-tracked, a mindset of dedicated teams rather than stop-gap individual hiring adopted, with speedier recruitment processes activated.

These types of measures are not just necessary  — they are essential if we are to finally address the long-standing realities of Midwest hospital services. 

No one person or entity can achieve this alone. 

Only through creativity and collaboration can we start to deliver the kind of hospital services deserved by a region representing 36% of the dependent population.

Dr Colin Pierce is vice president of the Irish Hospital Consultants Association