Analysis: Hospital system operating in state of emergency

Ministerial inertia is just one of the myriad problems afflicting the health system

An ambulance arrives at the A&E Department of the Mid-Western Regional Hospital, Limerick. Photograph: Dara MacDónaill/The Irish Times

An ambulance arrives at the A&E Department of the Mid-Western Regional Hospital, Limerick. Photograph: Dara MacDónaill/The Irish Times


The latest highly-critical report on a specific part of the health system begs two questions: “Who is actually running the health service?” and “What is being done about unsafe conditions in our hospitals?”

The problems at the top are obvious enough, with a Minister for Health who lacks the respect, arguably even the support, of his Cabinet colleagues. James Reilly doesn’t believe any more in the cuts he must implement, but is unable to win the battle within Government to have them stopped. Yet he remains Minister while morale nosedives and the sense of drift increases.

No, Minister

But it isn’t just here that issues of governance arise. Dr Reilly has created new structures to run the health service but they aren’t working. Six hospital groups have been created but only one has a chief executive who isn’t on temporary loan or yet to be appointed. The HSE has dropped its chief executive, a chief financial officer and other senior post-holders in recent years. Top-level posts in the Department of Health are unfilled after the departure of incumbents.

In Limerick, whose hospital group is the focus of this report from the Health Information and Quality Authority, the chief executive is on the point of leaving for a top local authority job. Another senior post is being filled on a contract basis at a cost of €700 a day.

Almost three years since the Minister announced the formation of the group, governance is still a work in progress. There appears to be no discussion at board level about patient complaints, trends in clinical incidents, adverse event or the prevention of infection. The main hospital, University of Limerick Hospital, is overcrowded while the minor facilities are underused.

Alarm bells

The other central focus of Hiqa’s report is patient safety. There is unacceptable overcrowding in Limerick and the emergency department is not “fit for purpose”. Children are inappropriately treated in adult surroundings and there seems to be no privacy.

Yet again, so, the alarm bells are being rung about safety levels in an Irish hospital. Reports are issued and recommendations are made. But what is going to happen?

The risk remains for patients yet there is no mechanism for this risk to be removed. Hiqa has no power to close units that are unsafe, or even to impose sanctions on hospitals.

The funding isn’t there to relieve the overcrowding in the emergency department and, as noted above, leadership is lacking or entirely absent.

A new emergency department is due to open in Limerick in 2016 but if anything goes seriously wrong before then, people will know in which direction to point the finger.