Consultants need to be more visible in Limerick’s ED to tackle trolley crisis, Donnelly says

Minister for Health meets with ‘burnt out’ nurses and doctors who say facility needs more beds and support

Consultants need to be more visible on the floor of University Hospital Limerick’s (UHL) emergency department in order to tackling the trolley crisis there, Minister for Health Stephen Donnelly has said.

Fixing the issue of overcrowding will not happen unless consultants engage with management on the public-only consultant contract (POCC), Mr Donnelly said in a crisis visit to UHL, where chronic overcrowding has led to a number of patient deaths.

The Minister said he met with “burnt out” nurses and doctors who said they needed more beds and more support from senior clinical-decision-makers on site.

Mr Donnelly said an additional 86 beds, including 16 rapid build beds at UHL, 50 step-down beds in Nenagh, and 20 community healthcare beds in Clare, would be provided ahead of an expected winter surge of patents, to try to help alleviate pressure on patients and staff.


A 96-bed block, under construction on the grounds of UHL, is to open in 2025 and a second 96-bed block would also come on stream, however Mr Donnelly said UHL consultants needed to step up and make changes to their workplace practices.

“In order for this to work, we have to see reform in the hospital. Limerick has one the lowest uptakes of the new public-only consultant contract, the level of weekend discharge is not where it needs to be,” Mr Donnelly told reporters gathered at the hospital.

“Many” consultants were “working night and day” to help tackle patient flow, but Mr Donnelly said he expected more to be “rostered on site, in the emergency department and throughout the hospital, after hours and at weekends”.

“I’ve been very clear with the management team, that what I, and the Government, and the people in the region now need to see, is a step change in the leadership from the senior clinical community in this hospital so that we can drive down the trollies.”

Colette Cowan, chief executive of the UL Hospitals Group, told a regional health forum last week that only 28 per cent of emergency medicine consultants, employed by her group, had signed up to the POCC which could see them being asked to work an extra five hours on Saturday and an extra two hours on weekdays.

Mr Donnelly, who was accompanied at UHL by HSE chief executive Bernard Gloster, told reporters: “UHL ranks ninth in the country for weekend discharges, that must improve, and there will be a progression to immediate rostering over six and where contractually possible seven days.”

He said that an “all-of-hospital approach” to treating ED patients was required, which would include “the presence of non-ED consultants to support ED colleagues in the emergency department when necessary”.

Mr Donnelly said that while trolley numbers had reduced in other hospitals, in spite of increased patient presentations nationally, UHL remained a “significant outlier, as they have seen about the same increase in presentations, but rather than a fall in trolleys they have seen a 50 per cent increase in trolleys”.

Members of the Mid West Hospital Campaign (MWHC) protested outside the hospital calling for the reopening of emergency departments in Nenagh, Ennis, and St Johns Hospital which were closed and reconfigured to UHL in 2009.

Minister Donnelly conceded that reconfiguration had not worked as it was not properly resourced: “It was not done properly, what should have happened here (at UHL) is this kind of investment should have happened first, so that this hospital had the capacity it needed to take on all those extra patients, that didn’t happen and that’s what we are now rectifying.”

Mr Donnelly said he was “very concerned” at details of an unpublished internal report into the death of UHL patient Martin Abbott who, it was revealed last week at the Shannon man’s inquest, had been dead on the floor of the UHL ED for over an hour before staff noticed his body.

Mr Donnelly said the report “catalogued a series of failures” in Mr Abbott’s care, and the report “also called out the fact that solutions to overcrowding which have worked in other hospitals have yet to be seen [in UHL].

“What happened was not acceptable it shouldn’t have happened.

“We need to make sure the healthcare professionals in this hospital have the supports they need and the patient flow they need in place to make sure that things like that don’t happen [again].”