Extra beds only part of solution for University Hospital Limerick

Standing in the bright and spacious public waiting area of University Hospital Limerick’s state-of-the-art €25 million emergency department (ED), one could be forgiven for wondering why it consistently appears in news reports as one of the worst hospitals for patient overcrowding.

It’s eerily quiet. Less than a handful of people sit on comfortable couches at reception. However, beyond the swing doors, a different reality emerges. Fifty-two patients lie on seats, or trolleys waiting for a bed, according to the latest Irish Nurses’ Organisation figures.

Management, who invited journalists on a walk around, paint a grim picture. The hospital is starved of consultants to treat the Mid-West's population of 385,000, never mind those who come from beyond its catchment area, including North Cork, North Kerry, and South Tipperary.

Many parts of the six hospitals in the UHL Hospital Group (UHL; Limerick Maternity Hospital; Nenagh Hospital; Ennis Hospital; Croom Orthopaedic Hospital; St John's Hospital) are creaking with "old" and "not fit for purpose" infrastructure, says Noreen Spillane, chief operations officer.

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Each year the number of patients rises. Seven thousand patients are waiting more than a year for outpatient appointments. Management complains, too, that they did not get any funding last year to reduce waiting lists.

During the tour, management are keen to tackle “myths” about the hospital’s handling of the trolley crisis: “There has been a bit of a myth that building our new emergency department would alleviate overcrowding . . . [it] was never going to sort that problem out.We do require more beds for that,” Spillane says.

Lack of beds

The new ED is designed into three zones A, B, C, with 10 extra permanent nurses. The majority of patients are processed quickly. Because of a lack of beds in the hospital, however, those left in Zone C are left languishing.

"All of the departments within it work very well, apart from the area where we have patients who need admission. And, it's because we just don't have beds for those patients," Spillane tells The Irish Times.

Refreshingly candid, Paul Burke, chief clinical director, does not try to sugar-coat the hospital's daily challenges: "The attendances this year to date, nationally, are up about 7 per cent. But, they are up 17 per cent in our emergency department. So that in itself creates huge pressures.

“More days of the week now we have over 200 patients attending the emergency department, so, we probably are the busiest emergency department in the country right now. Certainly our figures [show this].”

Other hospitals have more beds, more consultants, and are complemented by more private hospitals who can take up the slack at busy times: “Compared to nationally, our problem is we have no get-out-of-jail clause here. We are doing our best,” Burke adds.

Media coverage of UHL’s challenges is fair and accurate, but the work being done by staff under “continual pressure” is not highlighted enough.

“The reality of it is, when you see [reports] of high numbers of patients on trolleys, you think this is a terrible place, and that you must not come here. Well, if [people] think it’s such a terrible place, how come we’ve got a 17 per cent increase in attendances; because people come,” he says.

“We can’t do anything about it ourselves, because we physically can’t make the beds. So we just have to work away as hard as we possibly can to try and improve things.”

Ageing population

Ireland now has one of the lowest number of hospital beds per head of population in Europe. Meanwhile, Ireland is ageing. By 2030, the number of over-75s will have jumped by 80 per cent; the number of over-85s will have doubled on today.

But not everything is about hospital beds. The public has a part to play in tackling the overcrowding situation, by visiting local injury clinics rather than heading straight for the nearest hospital emergency department.

Burke says he cannot ever see the emergency department crisis being solved, without drastic changes. The proposed extra 96-bed unit for UHL will help, but not cure: “It won’t make any difference to the numbers [attending], but it will allow us to process patients through [faster].

“And, of course, when that happens, you’ll have less overcrowding in your emergency department, and, if you’ve less overcrowding, you know what’ll happen then - more people will come.

“It’s a never-ending problem unless you change the model. If we keep doing it the same way, it’ll just keep happening.”