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UHL is no longer starved of funds. Why is it still so far from satisfactory performance?

Another week, another damning report on the overcrowded Limerick hospital

Trolley numbers are down in many hospitals this year, but they are up 50 per cent in University Hospital Limerick. Photograph: iStock
Trolley numbers are down in many hospitals this year, but they are up 50 per cent in University Hospital Limerick. Photograph: iStock
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Paul Cullen
Thu May 02 2024 - 19:17

After last week’s harrowing inquest evidence into the death of 16-year-old Aoife Johnston’s death in University Hospital Limerick (UHL), the State’s health watchdog on Thursday issued a third inspection report highlighting the underperformance of the our most overcrowded hospital.

Inspectors from the Health Information and Quality Authority (Hiqa) did find some improvements in UHL, but there was little in their report to encourage optimism about an early fix to its many problems.

These problems need to be broken into different categories. The first relates to the way health services in the midwest were reconfigured more than a decade ago. Locals claims UHL was never given the funding it needed to cater for demand. The hospital is the only large (model four) hospital for a catchment area of 400,000 people and unusually, there is no model-three hospital in the region.

The latest Hiqa report talks of a “mismatch” between the number of people attending the hospital’s emergency department – the second highest in the country – and the hospital’s capacity of 536 beds, one of the lowest among model-four hospitals.

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Even if the hospital was starved of funds at the start, this is no longer the case. Spending on the hospital increased by 75 per cent since 2016, a recent report showed – the highest in the country.

Staffing has grown by more than 1,000 since the end of 2019 – an increase of 40 per cent. The hospital’s budget is up 45 per cent. UHL has benefited from more new developments than any other hospital, including one 96-bed block under construction and another in planning.

The hospital is, by various assessments, still several hundred beds short of what it needs. These can’t be provided overnight, so the second problem, that of chronic overcrowding, remains to be tackled.

Other hospitals have succeeded in getting on top of their trolley crises, but Limerick has been going in the opposite direction, repeatedly setting new records for overcrowding. Trolley numbers are down in many hospitals this year, but they are up 50 per cent in UHL. This can’t be explained by claims of historical underfunding.

The origin of some of UHL’s problems lies outside the hospital. More than half of patients arriving in ED are self-referring, which points to a difficulty accessing GP services. The hospital lacks step-down options, yet plans to use a new 50-bed community care centre in Nenagh for convalescent care are reportedly meeting resistance.

Arguably the worst thing about Aoife Johnston’s death was that it was so eminently predictable. Critics had been warning about the dangers of Limerick’s ED for years. Hers wasn’t the only needless death to have occurred; she is only the youngest victim. Only nine months before, Hiqa had published a damning report highlighting the hospital’s problems, which stressed the need for escalation protocols to be implemented when overcrowding occurs.

[ Patients in University Hospital Limerick face ‘significant risks’, says watchdog ]

[ University Hospital Limerick: Overcrowding persists on morning after team appointed to tackle ED pressures ]

Yet on the weekend the teenager died in the hospital, only one of the ED’s 11 consultants was on call for the whole weekend, and none was physically present.

Escalation protocols were not adhered to, despite up to 55 patients waiting for a bed, and neither were clinical guidelines on the treatment of sepsis, which Ms Johnston had developed.

Last week’s inquest heard evidence that the most senior manager on call on the night she was brought to hospital, described as an “executive on call”, actually had no executive powers.

This manager, Fiona Steed, said she contacted the clinical director but did not receive a reply that night. She did not have the power to compel consultants to come in, she concluded.

Ms Steed wanted staff to transfer up to 40 patients to wards and other surge capacity, thereby taking pressure off the overcrowded ED. She assumed her advice had been followed, but it wasn’t, for reasons that remained unclear at the end of the inquest.

Hopefully, the forthcoming report by former judge Frank Clarke, which is covering both Ms Johnston’s death and governance issues, will shed light on who is actually running the hospital. And why, despite a plethora of reports, interventions and needless deaths, so little has changed.