University Hospital Limerick- what can be done?

History Queen

There are lots of problems with the HSE-Long waiting lists, runaway budgets, trolley crises etc etc... but for those of us misfortunate enough to count UHL as our local hospital, all of these problems seem to be even more pronounced here.

The CEO recently went on leave and there have been at least three inquirys in to patient deaths there reported in the media in recent months.

Why has it become such a runaway train? And more importantly, what can be done?

karlitob

UHL is the Model 4 hospital in the region (UL Hospital Group) - the old regional hospitals. There are no Model 3 hospitals within the Hospital Group - the old General Hospitals. Model 3 hospitals are an incredibly important part of the Irish health care system - they’re the work horses that get through an enormous amount of work. They provide elective and general medical and surgical services. They also treat unscheduled patients through acute medical assessment units (AMAU). emergency departments (ED), and intensive care units (category 1 or 2 CU) and may cater for some specialist services such as obstetrics, gynaecology, or paediatrics.

ULHG is the ONLY HG in Ireland without a Model 3 hospital in its network. That means that UHL have to provide all services. It puts enormous pressure on the hospital.

ED. There’s often reference to an Emergency Department crisis. There is no ED crises - there’s a bed crisis. In fact, some suggest - and not unreasonably that we have too many EDs in Ireland (I would subscribe to that). There is simply no place to put patients on the wards who have been admitted from ED. The problem comes from those patients - who are nearly always older persons - requiring significant amounts of care on an ED which isn’t built for it. Meaning that care is missed for others who attend - which gives you the very sad output of those persons who recently died. Regrettably, it’s a system not adequately built for the demands on it.

Often mentioned is the closing of EDs in Ennis and St John’s, the issue is inpatient beds - UHL sends patients to beds all over the Hospital Group continually. Opening up EDs in those hospitals will result in worse care.

UHL has been underfunded per capita for decades. In 2019, the Clinical Directors published an open letter where they outlined that UHL serves a population of approximately 385,000 while Beaumont serves 290,000; Beaumont has 630 inpatient beds while UHL has 454; Beaumont has 31% more staff; UHL saw 63,850 new emergency patients while Beaumont saw 52,956. Beaumont has access to three Model 3s. This has changed in recent years - I haven’t researched the stats

Theres a lot that needs to improve in the health service. These deaths are tragic. But the notion that ‘better’ management can build a model 3 hospital, can build all the new beds it requires to meet the demands of a large region, can hire all the expert staff that it needs at a larger rate than other hospitals - it’s risible.

History Queen

Thanks for the detailled reply. Really interesting reading. I didn't know that about UHL being the only hospital group without a Model 3 hospital.

In my own interactions with the UHL group in recent years I've seen a huge disparity in service level and quality. Ranging from misdiagnosis in the ED to a missing patient file, to excellent patient care and diagnostics in the Breast Clinic.

The inability for local GPs to refer to some clinics such as ENT without patients going through A&E seems to be another issue. Those patients are not "emergencies" but they cannot access the ENT department without first presenting to the already overburdened ED. And because they aren't an emergency, they are inevitably in for a long wait following triage.

karlitob

And to be fair to government there’s been a lot of investment.

That said - 80,000 people is a lot.

https://www.oireachtas.ie/en/debates/question/2024-01-18/33/

The Emergency Department at UHL continues to manage high volumes of patients attending and like many EDs around the country is currently seeing a surge in patients with respiratory conditions. In 2023 the ED had 80,000 presentations,12% more than 2019.

Significant additional investment has been provided to University Hospital Limerick in recent years, including the opening of 150 additional beds in the UL Hospital Group since 1st Jan 2020 - 98 of these beds have been in UHL.

Over the past year the hospital has increased ED staffing and enhanced alternative care pathways to reduce demand on the ED and better facilitate patient flow. The Geriatric Emergency Medicine unit recently expanded to 24-hour operations during weekdays. Recruitment is complete following the Safer Staffing review that saw approval granted for 21.5WTE additional ED staff nurses. In the past year, an additional two consultants in emergency medicine have been recruited for the ED.

The UEC Operational Plan contains measures to support the health system during the period of peak seasonal demand. There is ring-fenced funding to support specific named measures to provide additional capacity during the period of surge associated with exceptionally high level of respiratory illness. Funding and pathways are in place to facilitate hospital and CHOs to access additional hospital and community bed capacity in the private sector to facilitate optimum patient flow and to avoid congestion.

flutered

in other words re open st johns ennis and neneagh, a neighbour of mine was sent to neneagh 60 niles foe a tooth extraction, another was sent to tralee for camera up his bum 80 miles, this does not make sense

mohawk

It would take years to plan and build a Model 3 hospital. Plus the cost of it

Could one of Ennis, Nenagh ot St John’s be ungraded to a Model 3? It would still be expensive.

This isn’t the first time I have seen a link made between no Model 3 hospital in the region and the problems that hospital is having. The trolley crisis in UHL is constantly on the news. The Department of Health and successive Health Ministers know there is a problem in the UHL group and what action is being take ?

karlitob

https://www.boards.ie/discussion/comment/121814025#Comment_121814025

It does make sense. You’ll see why from my post.

karlitob

https://www.boards.ie/discussion/comment/121814028#Comment_121814028

I suppose that’s my point. Per capita, Limerick and the wider region have historically not been given the resources it deserves and requires. It’s not a management issue.

The reason why Model 3s are always linked is because it’s a key factor. That and the reduced number of staff when compared to other hospitals. Limerick doesn’t have the beds and doesn’t have the staff for the service and demands that are required.

I don’t understand your point about upgrading Ennis etc. Limerick doesn’t need a change in hospital grading - it’s needs more hospitals with more staff. There’s simply not enough beds and staff - regrading another hospital doesn’t do anything.

The purpose of the RHAs is that money follows the patient. So we’ll see.

As for being constantly in the news because of trolleys. I’m not sure what to say - bad news sells. Media love referencing that it’s the worst in the country but they never give the reasons why or what is being done to address it. Plenty of other hospitals have trolley issues but since they’re not as bad it’s not in the news. Trolley numbers are published daily. Remember - the issue is insufficient number of beds for admitted patients

https://www2.hse.ie/services/urgent-emergency-care-report/

The last thing I would say is - this is our health service, these are our health care staff, this constant negativity has a major affect on morale across the health service. Limerick performs very well on lots of metrics. We only hear the bad.

karlitob

https://www.boards.ie/discussion/comment/121814012#Comment_121814012

I understand that. Hospitals are merely collections of services - it’s normal in every hospital to have differing level of quality and service. To be fair, breast clinic is relatively straight forward and fully funded. ED isn’t. It’s as simple as that.

As for ENT, it’s a surgical speciality and the only way to be admitted is by the ENT consultants themselves electively by patients who attend their outpatients, and emergency (trauma…RTCs etc). Otherwise GPs can refer to their clinic as an outpatient. I haven’t heard of services refusing to take outpatient referrals from GPs and asking them to send people to ED. Not doubting you but if that’s true it’s done to maximise their efficiency so that they can see the right patient at the right time.

More to read below. Great to see this done but announcing, building and having an effect takes time. Regardless it’s still not enough for now. And we already know that the population is increasing, more people will go into the 65+ and 80+ bracket meaning that we’ll be running to stand still IF we’re lucky once they’re built.

https://www.oireachtas.ie/en/debates/question/2023-01-18/1518/

angel eyes 2012

https://www.boards.ie/discussion/comment/121814550#Comment_121814550

You have stated that Limerick Hospital doesn't have the staff for the service and demands that are required. They seem to have plenty of staff and tax payer funding for inclusion cakes, surely not a priority during a crisis? https://twitter.com/ULHospitals/status/1759882116785938887?t=RiitVodbQIWxDwlLD90NeQ&s=19

Igotadose

One thing it seems (from the outside) that the HSE doesn't followup on outcomes and the effectiveness of the treatment, especially time spent in hospital. Various people I've known that have had surgeries that, in other hospital systems would be brief stays in hospital, stay for days in hospital in Ireland. A plumber's wife due to have a second baby spends 3 days in hospital before going into labor. Surely 1 would be sufficient? Another woman having a hysterectomy, a week. Worst I've heard of is 2 days in the US, oh and there were no complications and, in fact, she was checked in a day early, unnecessarily.

Plus the repeat surgeries aren't a good look. Another friend going in for the same bladder surgery for the third time. Three times? Really? A friend's healthy daughter breaks a finger playing basketball, has surgery, gets an infection from the surgery, back again two more times. An infection from surgery? Don't they sterilize surgical tools in Irish hospitals? Let alone get hardware at woodies to perform scoliosis surgeries - rogue surgeon? Really? Never a systemic failure in the HSE, oh no.

You can have as many beds as you need, if the surgical and nursing care is poor (looking at NUI Galway and poor Savita H.), you'll fill them up soon enough.

Accountability is not the motto of the HSE.

weisses

We need to stop using EDs as a first contact source.... my experience during internship in an ED was that many patients who presented were not emergencies as such, EDs now function as a catch all hub... Patients should be seen in the community and only be transfered/referred to an acute hospital as a final option. I think the idea of slainte is adressing this issue but ofcourse the people who need to realize this are not up to the job while being massively overpaid at the same time.

History Queen

https://www.boards.ie/discussion/comment/121814678#Comment_121814678

Agree with much of this. But for lots of patients they are referred to A&E by GPs because there is no referral pathway direct to certain services. This is highly inefficient. Those services are overstretched but making it harder to access them doesn't help the matter it just pushes the queue of waiting patients in to the ED department. People say "oh when i was last in the ED there were people there that should not have been" well in some cases they may have had no choice. There should be some sort of triage service for access to particular specialist departments that GPs can engage with to avoid the ED being overrun.

As a result of constant overcrowding and poor patient service, tempers are frayed and many staff are working in a toxic environment. This creates a vicious circle and leads to poor patient outcomes. Mistakes are made, corners are cut, things are missed I would argue on a more frequent basis than should be the case. People who are very ill and elderly in particular are afraid to attend the hospital with the result that they linger at home and get sicker befire eventually being forved to present.

karlitob

https://www.boards.ie/discussion/comment/121814623#Comment_121814623

That looks like a patient support initiative in the paediatrics ward. I’d say you’re a lovely person in the flesh.

karlitob

https://www.boards.ie/discussion/comment/121814637#Comment_121814637

I’m not sure how to respond to that.

It’s a mish mash of things that you’ve combined in your head that represents the output of our Health Service.

There are millions of appointments, interventions, assessments, appointments and procedures every year in the health service. Millions. A hospital in an inherently dangerous place, and it’s full of sick people - so yes, incidents happen and lots of them. Your expectation of no harm ever is naive and unachievable in any health service anywhere in the world with all the money in the world.

angel eyes 2012

https://www.boards.ie/discussion/comment/121814728#Comment_121814728

You never answered my question, just got personal.

karlitob

https://www.boards.ie/discussion/comment/121814712#Comment_121814712

And I agree with much of this. I can’t account for it so not sure how to comment.

Efficiency depends on perspective. Lots of GPs refer to lots of services; and not all valid. Health doesn’t know which person to which service. There are 900,000 on waiting lists - we don’t know if it’s 900,000 unique people or 1 person with 900,000 referrals. Not all referrals are valid, or sensible. The only thing I can think of is that it’s more efficient to make GPs refer to ED than accept referrals from everyone and everywhere gumming up their waiting lists with inappropriate referrals. (Just cos the GP says you need ENT doesn’t make it true - that’s for ENT to decide).

All in all it’s a symptom of a regional health service under pressure and services doing their best to meet the demand, mitigate the risk, and ensure effective outcomes for patients.

karlitob

https://www.boards.ie/discussion/comment/121814745#Comment_121814745

I got personal??? You called patients and staff ‘inclusion cakes’ - an obvious dismissive phrase to the work of staff and to the mental health of patients who attend.

in your ignorance to be smart, you are probably unaware that this is volunteer staff who’s role is to support the patient.

You also haven’t highlighted how a few badges and a tweet to show support for persons struggling with their sexuality can know it’s safe to speak with a health care professional while they are in hospital affects patient safety and how it isn’t a patient quality initiative. You haven’t said how this affects other care being provided. You haven’t said how this is a mental health initiative to support those who need to talk.

Instead you were just trying to be smart but denigrating people who care and people who need help

https://healthservice.hse.ie/healthcare-delivery/ul-hospitals-group/ulh-blogs/call-out-for-pals-volunteers-in-university-hospital-limerick.html

karlitob

https://www.boards.ie/discussion/comment/121814678#Comment_121814678

In the Oireacthas reference I put above you see the investment made into Ennis and St John to do exactly this.

Patients are seen in the community - GPs, Community Health Centres, Pharmacists, etc.

Can I ask your basis about people who are overpaid needing to realise this? What’s your basis for that?

karlitob

https://www.boards.ie/discussion/comment/121814712#Comment_121814712

And can I add - there is a central referral

system already in place for GPs. So not sure about the ENT having to come to ED but what you suggest is already there.

https://healthservice.hse.ie/healthcare-delivery/ul-hospitals-group/information-for-gps/

geotrig

https://www.boards.ie/discussion/comment/121813987#Comment_121813987

So how do they get a a "model 3 " Hospital into the group is their an option there or does it require a new build? The comparison between Beaumont/uhl is very interesting.

On a side note I was led to believe before that their is a lot of inefficiency s in the system due to double jobing in free amalgamation when the current health board was created is this still true ?

Also it's a bugbear of mine that certain departments run nearly 9-5 and an ED can be left waiting until it reopens,

karlitob

https://www.boards.ie/discussion/comment/121814816#Comment_121814816

It’s a new build and as I reference above there is none planned for the region but one in Dublin, Cork and Galway. Patients will be referred to them from Limerick.

So there are hospitals, hospital groups, community services, national operations and other national services. That’s being changed with the RHAs. In an organisation of 150,000 people no doubt there are roles that add little value but it’s not at the scale that people make out. Nor would it have the impact that people suggest. It’s a simple answer to a complex problem without understanding the question.

The 9-5 is an interesting problem. The simple answer again is capacity. If it takes 100 people working 40 hours to run a service 9-5; then it’ll take more staff at higher rates to open longer. You can’t underestimate the impact on other services.

Take Day Surgery - if the list overruns, everyone is under pressure. Nurses, porters, catering, kitchen, physio, surgical cleaning, MRI etc. It’s not so easy to open departments later.

I’ve been part of a few pilots - you’d be surprised who refuses later appointments.

L.Ball

We have a record record budget surplus but unfortunately throwing money on a broken system will produce nothing.

Speaking to other people's posts above, having spent over 100 hours in A&E's in the past 2 years with family members, they are clogged with people with sore legs, nauseu, drunks etc. and before you give out to those people, the fact is they cannot get a GP appointment, if I'm ill tomorrow I won't get an appointment at my GP till later in the week, so if my symptoms get bad I'd probably have to go to the A&E, and contribute to the number of "unnecessary" visits.

How do you even fix this? Build or expand clinics around the country, with today's building costs and lead times? Incentivize our newly graduate doctors nurses to stay in the country? How do we even do that when there's nowhere for them to live, and that also covers attracting the best doctors and nurses from abroad, because they're gonna wanna live in a country where they can buy a home or rent at a reasonable price. Fix the atrocious agency worker situation? How? there's contracts in place. If any political party could actually sit down and come up with a real concrete plan to address these issues and the many many more in the health service, they'd win by landslide.

thinkabouit

I think right there is why nobody’s ever going to fix health in Ireland.

I don’t think iv heard a single person ever ask this question on the news or radio or anywhere actually.

Why are so many people getting sick & ill?

Look at the absolute crap we are buying and eating and drinking. Look at what goes into growing our food and how clean our water is. And women pretty much dont breastfeed anymore. Were feeding kids manufactured powder from another mammal. That’s absolutely detrimental to our health imo.

Take 1 or 2 Billion from the HSE Budget, give it too farmers as a subsidy on condition that they produce the highest quality food without the use of chemicals or fertilisers.

karlitob

https://www.boards.ie/discussion/comment/121814840#Comment_121814840

On agency, that issue is being addressed over the past number of years. There’s over €35m in funding for frontline nurses invested to date.

I would note that the savings made are the agency fee (around 5% plus VAT). It’s not the beast of money everyone thinks it is. I’d also say that nurses want agency - they don’t want to give this up. Criticism should go to these nurses also, not just management.

https://www.gov.ie/en/publication/671f3-framework-for-safe-nurse-staffing-and-skill-mix-phase-1/

I hear the point about GPs. But again, GPs are private sector staff. They are not health service staff. GPs controlled how many people who were allowed to be trained as GPs for years. They kept a closed book. And now you hear references to ⅓ will be retired in the next 10 years. Who’s the blame for that? Remember, the HSE don’t control colleges or training or the RCPI/RCSI. The HSE can’t dictate who will be trained, when, how many and to what standard.

All in all, the of capacity and demand is not an Irish only one. It’s a developed world problem. Quite simple healthcare has changed from treating singular diseases like heart attack on the cardiac ward to chronic disease management with interfaces of care between primary, secondary and tertiary services both public and private in older persons with more co-morbidities and more research, standards and guidelines to implement. To say it’s complex is an understatement.

All on the back of decades (and I mean decades of underfunding). When you compare health services internationally - NHS Scotland is probably the most comparable as is our geography (ish). They should be our model.

I know people won’t agree with me but we’re not doing so bad in the health service.

geotrig

I’ve been part of a few pilots - you’d be surprised who refuses later appointments.

I was thinking of this very fact as an issue myself

Is there a reason the me was overlooked for a model 3 new build?

Thanks to your posts I gave a better understanding of the issues faced there

karlitob

https://www.boards.ie/discussion/comment/121814864#Comment_121814864

Nail on the head. This is from the UK.

‘fixing healthcare’ is the wrong end of the stick.

karlitob

https://www.boards.ie/discussion/comment/121814873#Comment_121814873

I think simple geography. One for the big smoke and one south for Limerick, Kerry, cork. And one for west - Donegal, Cavan, Westmeath etc.

karlitob

https://www.boards.ie/discussion/comment/121814873#Comment_121814873

Not at all.

All given on the caveat that it’s only one persons perspective. If we could all accept that there’s so simple solution to complex problems which have multiple causes and no silver bullet then we’d all be in a better place.

All in, it really is a good health service. My heart does go out to people who’ve been harmed. You’ve no idea how much that affects health care professionals and how hard they work to improve the quality of the service they provide. Looking back at hard cases it’s easy to identify the problems - it’s no excuse, it’s just trying to explain why what happens, happens.

angel eyes 2012

https://www.boards.ie/discussion/comment/121814766#Comment_121814766

Yes, you did get personal, remember "hate the post, not the poster".

You actually have no idea whether I support this initiative or not, you just made an assumption, and didn't welcome diversity of opinion on the prioritisation of scant resources.

Fair enough, if this initiative was rolled out by staff volunteers on their own time.

I note the the majority of posters under the tweet on X are far more vocal and negative than I have been. Some of the comments have been hidden by UHL too, which makes me wonder does the hospital include the input and opinions of everyone.

karlitob

https://www.boards.ie/discussion/comment/121814932#Comment_121814932

Oh well of the majority of posters are more negative than you have been, then I must get your reward ready.

Too bad those posters didn’t teach you to ask first rather than post stupid comments.