Ambulances to take non-critical patients to Nenagh rather than UHL to reduce overcrowding

Ambulances also expected to start bringing patients to St John’s Hospital, Limerick to alleviate pressure

National ambulance protocols introduced in January allowing midwest region ambulances to take certain non-critical 999/112 patients to Ennis Hospital to alleviate overcrowding at University Hospital Limerick are to be extended to Nenagh Hospital in north Tipperary.

It is also anticipated the protocols will be extended to St John’s Hospital, Limerick to further alleviate pressure on the UHL Emergency Department (ED).

Correspondence circulated to all NAS staff in the midwest on Friday afternoon stated: “From Tuesday February 7th, 112/999 patients can be transported directly to the medical admissions unit (MAU) in Nenagh Hospital providing patient meets the agreed clinical criteria, and the patient has been accepted by the MAU physician in Nenagh.”

“The pathway is accessible Monday to Friday 0800-1800 (excluding public holidays). Patients cannot be referred to Nenagh MAU outside of these hours.”


UHL was the most overcrowded hospital nationally on Friday with 70 patients on trolleys in the ED (25) and on wards (45).

The new protocols were first initiated on January 9th at Ennis Hospital after the UL Hospitals Group declared a “major internal incident” at UHL following persistently high attendance at its ED.

Off duty staff were summoned back to work, all outpatient appointments were cancelled and only urgent elective surgeries were conducted to help tackle the crisis.

Nenagh, Ennis, St Johns, Croom Orthopaedic Hospital, and local nursing homes, have been providing surge capacity for UHL.

Thousands of people participated in a protest march in Limerick City, on January 21st, calling for the reopening of accident and emergency units in Ennis, Nenagh and St John’s, which were reconfigured to UHL in 2009. There has been no indication the HSE is planning to reverse the policy.

UHL remains persistently overcrowded, despite its ED being replaced in 2017 with a €24m state-of-the-art unit. The upgraded ED, which routinely treats over 240 patients per day, was built for a maximum of 190 patients per day.

Over a hundred new beds were opened during the height of the Covid-19 pandemic. Half of a new 96-bed unit, currently under construction on the grounds of UHL, will count as additional beds, as half will replace existing capacity in UHL’s nightingale wards which are no longer considered fit for purpose.

Earlier on Friday a spokesman for the UL Hospitals Group said it was “pleased with the progress of this initiative in Ennis” and that following an evaluation of it “we expect to shortly expand this initiative to our Medical Assessment Unit at Nenagh Hospital and we will issue an update in the coming days”.

The group also said it has “every expectation” the new protocol will be reintroduced at the MAU in St Johns Hospital.

However, a senior source working within the UL Hospital Group was sceptical about the impact of the measures on the overcrowded ED.

They raised concern that Nenagh does not have enough MAU beds to alleviate UHL’s surge capacity.

“There are only six beds available at the Nenagh MAU at the weekends, which has traditionally been the busiest time of the week for UHL,” they said.

“Would six patients going into Nenagh at the weekend have much of an impact on UHL’s ED, is that really taking away from the problem in Limerick?”

“Maybe it would make more sense to move Nenagh’s weekend MAU staff into UHL rather than move the patients out to Nenagh, because, after all, UHL needs all the staff it cant get.”

UHL consultants wrote to the hospital’s chief executive last July expressing “deep concern” over patient safety at the hospital due to “intolerable” overcrowding in the ED.

Brian Lenihan, chief clinical director UHL has said the hospital requires at least another 200 beds to meet current demand.