New hospital for Mid-West among options given to Govt

A new hospital in the Mid-West with a second emergency department is one of three options presented to the Government by HIQA following a review of urgent and emergency healthcare services in the region.

Expanding capacity at University Hospital Limerick in Dooradoyle, or extending the UHL campus with a new second site in close proximity, are also among the options.

The Health Information and Quality Authority, which was tasked with conducting the review in May 2024, said expanding capacity or extending the site are most likely to increase the number of beds at UHL in the shortest timeframe, addressing the immediate risk to patient safety.

UHL consistently has the highest number of patients being treated on hospital trolleys or corridors in the country.

The Irish Nurses and Midwives Organisation said there are 133 admitted patients waiting for a hospital bed at UHL today.

A 96-bed unit, which UHL has said is due to open “imminently”, will not meet the capacity needed at the hospital.

The Government’s own report – The Acute Hospital Inpatient Bed Capacity Expansion Plan – published last year, said 382 hospital beds are required in the region by 2031.

A separate report by Deloitte commissioned by UHL in 2022, found 302 extra inpatient beds and 63 day case beds were needed in the region to meet demand.

Today’s HIQA report confirms the findings of those reports.

It said: “The core issue is that there are not enough inpatient beds in HSE Mid-West which are capable of treating the sickest patients who present for urgent or emergency care.

“We recommended immediate action and investment to address current risks to patient safety in the shortest timeframe and safest way possible.”

Urgent and emergency healthcare services in the Mid-West were reconfigured in 2009, with the closure of three smaller EDs at Ennis, Nenagh and St John’s Hospitals, and the centralisation of ED care at UHL.

HIQA said that while there has been investment in bed capacity at UHL in recent years, demand for healthcare services in the region has also grown in line with demographic changes.

Its data analysis indicates that the total volume of emergency care presentations in the Mid-West is similar to that in other regions on a per head of population basis, but the single ED configuration for the region is different.

It said the pattern of urgent and emergency care service usage in HSE Mid-West differs from other health regions with a higher proportion of this care provided by local injury units. The overall acuity of patients who attend the ED at UHL was found to be higher than for other EDs around the country, likely due to these service usage.

The report said there is continued use of surge capacity with a substantial number of patients receiving care on trolleys in the ED and inpatient areas of the hospital.

“Within this context, patient safety risks will persist until the demand-capacity gap is resolved,” it said.

According to census data, Limerick and the Mid-West has a higher older population compared to the East of the country, which leads to a bigger demand for hospital services.

A higher proportion of Limerick’s population has chronic disease and disability, and social deprivation in the city also leads to ill health, meaning more bed capacity at the hospital is required.

Options A, B and C

The report offers three options to deal with the problems.

Option A would involve expanding capacity at the existing UHL site in the Dooradoyle area of Limerick.

HIQA says this is doable but warns that the planning process could impact on the timeframe for completion. This scenario envisages an expansion of the ED, in line with other departments, with no change to existing service delivery arrangements.

In essence, this means that UHL would still offer the only 24/7 ED in the region, with Medical Assessment Units (MAU) in Ennis and Nenagh, augmenting services.

This option is said to be potentially the least costly one, allowing for ongoing recruitment at UHL and the associated clinical competencies this brings.

The second option would involve the construction of a new hospital, close to the existing one.

The two site hospital campus in Limerick would allow for delivery of beds in line with the ESRI projections, give agility for the development of services and therapies in the future, and allow for greater flexibility in the functionality of operations.

Option B envisages the ED staying on the existing site, along with the infrastructure for critical and complex surgical procedures. Other aspects of healthcare could be provided at the newly built facility.

HIQA cautions that this option would require major investment to ensure interoperability and integration of services, involving significant capital costs.

Option C presents an alternative to the current configuration of healthcare in the Mid-West, with the development of a Model 3 hospital, that would offer 24/7 critical care at another location.

The report does not identify where this might be.

It says there is no justification for a second Model 4 hospital in the region, but that a second ED would distribute attendances across two locations and improve geographical access to services for some of the population.

Any decision would need to consider whether an existing facility should be upgraded, or if a new build on, a green field site, was preferable.

This option is the one that represents “the greatest amount of change” to the existing situation and would also be the most expensive one.

It is billed as a longer term option only, as it would not allow for a quick response to the need for demand to meet capacity. It would also require a restructuring of governance, structures and care processes in the HSE Mid-West region.

The report also identifies possible staffing issues if this option were to be selected. It says that given challenges in attracting staff to locations outside main urban areas, it is not certain how quickly or successfully recruitment might proceed.

The scale of resourcing needed for Option C is also viewed as greater than that required for the other scenarios.

HIQA says the work carried out for today’s report “was not conclusive” in terms of advising the Minister for Health to pick one option over another.

But the Authority says it feels Options A or B are more likely to yield increase bed capacity in a quicker timeframe.

It says complex decisions will have to be made and that “proactive engagement” with the public is essential to build trust and improve services. Whatever decision results, the HSE must demonstrate that it will reflect Government policy and best practice; provide a costed implementation plan and measure the impact of any increase in bed capacity on the provision of services in the shorter term.

HIQA says that as well as devising a way to meet infrastructural demands, there is a need for the HSE to focus on leadership, governance and management at UHL.

It also calls for enhanced pre-hospital emergency care services, to reduce demand at the ED there.

The report says this could be further augmented with enhanced community care and GP access across the Mid-West; more workforce investment and the refurbishment and optimisation of existing services in the region.