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University Hospital Limerick- what can be done?

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  • Registered Users Posts: 2,575 ✭✭✭karlitob


    Ah, the ‘I’ll tell you straight’ brigade. Never mind evidence, never mind discourse, never mind reason and debate. “You’ve challenged my uninformed view so I’ll attack you and threaten violence.”


    Brilliant!



  • Registered Users Posts: 2,575 ✭✭✭karlitob


    Very funny.


    You’ve clearly not read what I’ve posted. The question by the OP was not ‘please tell us all how bad it is over and over again’. The question was ‘what can be done’. I set out to narrow down the issue not to UHL broadly but to the ED in UL; why the ED is overcrowded; why it’s not a UHL only issue, how it’s systemic and historical; and how simple answers to complex issues by people who don’t even know the question is unhelpful to say the least. I gave facts, figures and evidence - not only specific to UHL but more broadly to the Health Service as the topic expanded to show that not as bad as people make out - merely that it’s bad from your perspective when you’ve engaged with the service. I’ve clearly expressed that any harm is unacceptable, I’ve shown compassion to those who attend and who have been harmed, and challenged commentators on here who think people don’t deserve to attend.

    You know nothing about me. You don’t know anything about my health history, my families health history or how many times I’ve been in a hospital or otherwise with a family member.

    I’ve never defended poor care - I’ve tried to explain WHY it has occurred so as to form a basis of how to improve it.

    If your mother wishes to die at home, might I suggest an EPOA where her will and preference is respected. (Hope you don’t mind the enormous, complex, decades long work it took to implement that.)


    The evidence you challenge you dismiss by challenging the methodology. All you have to do is click the link and read. All the details for you are there. But let me shorten it for you - as you seem to have difficulty comprehending these issues - even though it’s literally in the front page. 10,904 people; 44% response rate. It’s an internationally validated survey, comparable to a number of national patient surveys worldwide; where Ireland has one of the HIGHEST response rates of any country worldwide. (This must be hard for you).

    Here’s UHL as you can’t seem to find this information yourself.

    There’s 67 questions. Explore it yourself.

    Only 7% said they were not treated with respect and dignity. Going up to 33% in ED (see, not hiding anything)

    Areas to improve

    Areas they’ve done well on.



    But the best you can come up with is violence. Brilliant.



  • Registered Users Posts: 2,575 ✭✭✭karlitob


    I don’t doubt that they can only do so much. But they can do more, and outcomes are better. More community services can do more if then work that they do to offload pressure from the hospital but also because outcomes are better.

    A good example of course is COPD. The highest attendances at ED are for COPD; the highest across the OECD; the highest rate of admissions from ED is for COPD. COPD outreach services are excellent. Totally underfunded and totally need more nationwide. Of the 10 episodes that some one would present to ED with, it could be reduced by 5. Five attendances fewer to ED by the volume of COPD is a lot of pressure off the system and a lot of bed days freed up.


    Not more evidence!!!





  • Registered Users Posts: 181 ✭✭Toodles_27


    If you'll refer to my previous post, I wasn't actually quoting you - I was answering @L.Ball. Your advice was also neither requested nor sought.

    I have no wish to engage with you.



  • Registered Users Posts: 2,575 ✭✭✭karlitob


    I don’t care who you were or won’t quoting. You stated that you would ‘hold a second cavity block’ - it was a violent response due to an inability to engage on the content.

    The advice wasn’t for you - it was for your mother. You stated that she said that she wanted to die rather than attend the Regional for reasons of dignify and respect. I gave you the evidence on which she could base they decision and if still wishes to not attend ED then that decision could be formed into an EPOA. Whether you accept it or not, is your mothers choice.



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  • Moderators, Category Moderators, Social & Fun Moderators, Society & Culture Moderators Posts: 22,249 CMod ✭✭✭✭Ten of Swords


    @L.Ball threadbanned



  • Registered Users Posts: 2,575 ✭✭✭karlitob


    For interest, nearly €800m paid to GPs in 2022 - all private sector.

    Total HSE payments to GPs, not including Covid-19 supports, amounted to €254,000 per doctor in 2022. When the pandemic payments are included, the average payment was €287,000.

    This does not include about the same amount in prescriptions that they write and are filled by the other private sector group - pharmacists.




  • Registered Users Posts: 2,575 ✭✭✭karlitob


    A piece by Paul Cullen in Irish Times this weekend. Not a big fan of his to be honest but thought I’d reference it for this thread.



    “There is evidence to suggest the hospital is not coping with demand as efficiently as it might. UHL has the second-lowest level of weekend discharges of any hospital. The fewer patients dealt with at weekends, the more remain in the hospital early in the week, contributing to overcrowding.

    The hospital’s emergency department has also been providing less consultant cover during the week than other model 4 hospitals, resulting in fewer decision-makers on-site to make key decisions about admitting and discharging patients.

    Just one consultant was rostered after 5pm on weekdays (working up to 8pm and on-call after that), whereas in University Hospital Waterford, which has the lowest number of patients on trolleys, senior staff are on-site up to 11pm.”


    Id like to see the evidence. It might be second lowest but by how many. Discharges are a function of community service, not always the hospital. If there’s no community service it can be hard to discharge. Still you’d expect a consultant cover that is comparable to other Model 4s.


    “The midwest has the second lowest bed capacity in the country, a spokesman said.

    The midwest also has the lowest private bed capacity of all regions, while 200 out of the current 530 beds in UHL are in multi-occupancy wards”

    I had forgotten to mention how important private hospitals are to the public system. I don’t agree with them but they take a lot of pressure off especially day to day stuff. So the absence of private hospitals is not something UHL can lean on unlike all the other Model 4s, combine that with no Model 3!



  • Registered Users Posts: 9,430 ✭✭✭weisses


    HSE is rigid when it comes to contracts etc... I wittnessed on multiple occasions scenarios where nurses wanted to cut back on hours for various reasons and only the ultimate threat to resign resulted in a positive outcome for said Nurse.

    On the topic of agency staff, what i experienced first hand is that agency staff is being assigned on the day what ward they are going to they present themselves to the person in charge of allocation and will be asigned accordingly, many agency staff are even working between community Hospitals and acute hospitals because it gives them a break of the madness in the acute setting. The majority of agency staff wants a certain flexibility which surprise surprise the HSE cannot provide. From the various settings i was in over the years I know 1 Nurse who is on the same ward all the time working Agency.

    As for your comment of wards being over staffed or perfectly staffed, this shows you have no clue whatsover as to how things are on the wards. Do you have that opinion from personal experience on a ward or from a pdf file?



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  • Registered Users Posts: 3,452 ✭✭✭History Queen


    There is also the fact that there is a staffing issue in UHL across most departments. That goes from Consultant to nurse to junr doctor to specialists like audiologists. The hospital is in a dangerous position and as an outsider/sometimes patient, it feels like there is no will to fully address the issues.


    Situations like this are just inexcusable,

    https://www.thejournal.ie/scheduled-activity-deferred-at-ul-hospitals-group-6317114-Mar2024/



  • Registered Users Posts: 12,977 ✭✭✭✭Igotadose


    My original point was, the HSE doesn't follow up on outcomes. You said of course they do and listed a large number of publications that do. I took a look through one of them:

    What this is, is a monthly data dump showing statistics. That's nice, but it's not followup. One can gather data till the cattle come home, if there's no plan driven by this data, it's a nice job for administrators is all.

    Are they all this way? I skimmed another I can't find the link to now, and it was more of the same. This is just one monthly set of data, there are probably hundreds of these across all the hospitals and whatnot. Not particularly useful for the consumer per se, but should form

    Can you point out such a plan, one with measurable targets? Like, we'll reduce the number of 70+ year olds contracting MRSA in our hospitals by taking this, that and the other action, by such and such date? Because otherwise it's just... data gathering and jumping to the media and politician's tunes.



  • Registered Users Posts: 4,313 ✭✭✭Tefral


    The 150 bed private hospital being built by the Bons in Ballysimon, what model hospital is that?



  • Registered Users Posts: 2,575 ✭✭✭karlitob


    Private hospitals don’t have models. Models were established by the Acute Medicine Programme (and Surgical Programme) over a decade ago.

    Private hospitals help by taking procedures off the public list. Don’t get me wrong - the tax payer pays for it and pays well. I’m not convinced that all procedures are required. Remember - private hospitals make their money by procedures and investigations. But it’s another pressure release valve that UHL doesn’t have that every other Model 4 hospital has.



  • Registered Users Posts: 2,575 ✭✭✭karlitob


    I've given you quite a lot. I’ll leave you go off and research it yourself.

    In general, health works on standards and guidelines. Some of the data points that you dismiss are actually markers of care that have been shown to lead to better outcomes. For example, number 13 - the number of patients with a hip fracture (trauma) who have surgery within 48 hours. The research is clear - those who have surgery earlier have better outcomes either respect to mortality and morbidity; this metric is a marker of their progress. UHL aren’t performing well on that for the reasons outlined in this thread. If you want to know what they plan to do you can read the Irish National Hip Fracture Database procured by NOCA (HSE funded) that I referenced and you can see the work that the hospitals are doing to improve.


    To address the specific issue that you referenced there is the following:

    This is the Irish governments plan to reduce infections. Each hospital has a fully funded AMRIC team which implements this plan


    I would caveat though that quality of care is a function of the issues that we’ve highlighted. If EDs are run off their feet, if there aren’t enough beds so that procedures are cancelled, if the systemic issues aren’t addressed - then all these quality of care markers are going to suffer.



  • Registered Users Posts: 2,575 ✭✭✭karlitob


    It should be pretty clear to everyone that I work in a hospital. I’ve been on the wards for 20 years. but as I mentioned in some of my first posts, this is part of the problem. Everyone sees it from their perspective and think that they know it all or have the answer. Even if I didn’t work on the wards for so long, it still doesn’t mean that I can’t form a view. I’ve never worked in community but that shouldn’t stop anyone having a position.


    As mentioned earlier, as an employer the HSE has the right to organise itself so as to provide the best output for patients. It’s my view that the HSE is a particularly flexible organisation for nurses who get far more air time that all other professions put together.


    And you will see that I said some wards are perfectly staffed. This is all available data on FoI. It shouldn’t be too unreasonable to say that not all wards require staff. You will also know that safe staffing is rolling out to hospitals first (model 4, then rest) then ED and then community.



  • Registered Users Posts: 521 ✭✭✭mykrodot


    and yet another avoidable death in UHL under investigation. Can anyone stand over this….. how anyone can defend UHL regardless of staffing and bed issues beggars belief? All of the deaths recently reported in UHL were down to mismanagement and patients not being checked up on or their symptoms being dismissed.

    https://www.rte.ie/news/2024/0327/1440386-inquest-limerick-hospital-death/



  • Registered Users Posts: 4,313 ✭✭✭Tefral


    Not enough people are up in arms over it. The whole of the midwest should get out for a protest for this, but they wont.



  • Registered Users Posts: 12,977 ✭✭✭✭Igotadose


    Since the HSE polices itself, rather than a truly independent board (like the one brought in for the Savita case,) nothing will change. It's "regulatory capture" at its finest, no consequences. The HSE gets to decide what the "Best output" is that's mentioned above. Whether that actually means 'do good' or 'do no harm' is up to their decision makers.



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  • Registered Users Posts: 8,745 ✭✭✭893bet


    as a farmer, while I would be happy with the money I would say the “raw material” food produced in Ireland are amoung the healthiest world wide.

    There are already organic options for consumers (but sales are low as consumers are price sensitive).

    The real problem is the food manufacturers. Pick up a random packet of food and there are 20 ingredients/sweetners/preservatives /numbers. The “meat” or “grain” from the farmer is not the problem IMO. This is the bread I am eating. It’s quiet a list.




  • Registered Users Posts: 521 ✭✭✭mykrodot


    it frightens me. I have a daughter with 3 little ones under 5 years old in a rural area close to Limerick, UHL is her hospital. The other day the 4 year old got sick suddenly , high temperature and a deep cough. Doctor gave steroids and antibiotics and said if no improvement in 6 hours to go to UHL A&E. I was petrified, all the recent bad press and deaths does no instill confidence. Thankfully the child responded to the medication.

    Going forward if there is any emergency UHL is the place for her and her children to go ………..and take their health and sometimes their life in their hands by doing so.



  • Registered Users Posts: 521 ✭✭✭mykrodot


    to be fair until you get to emulsifiers on that list most of the ingredients are natural…………..but I get what you're saying. Make your own bread, cakes, cookies………..it only takes a few ingredients.



  • Registered Users Posts: 4,313 ✭✭✭Tefral


    I totally get you, I have a 3 year old and a 5 year old. My first port of call with them is the Laya centre over at ivans cross.

    To be honest, theres people going to the A&E that shouldnt be, they need to see their doc first like you did. The proof of this was how empty the A&E was during covid.

    GPs have a lot to answer for too, they are sending people to the A&E instead of seeing them also.



  • Registered Users Posts: 3,452 ✭✭✭History Queen


    Just to pick up on the GPs thing two issues I've also noticed are : people who can't get GP appointments going to A&E (GPs in our area are overburdened) and as I've stated upthread sometimes the refferal pathway is through A&E which seems bonkers to me. My daughter needed an ENT referral but couldn't be referred direct, instead was sent through A&E.



  • Registered Users Posts: 3,452 ✭✭✭History Queen


    I'm in a similar situation as your daughter and absolutely empathise with the fear of having to deal with UHL.



  • Registered Users Posts: 23,406 ✭✭✭✭zell12


    Are people not currently canvassing in the area, y'know this with power to change things? Or maybe they are part of the problem, this from 2022

    “Limerick has seven councillors on the Regional Health Forum and, despite being contacted by the campaign, not one of them responded. When there were 111 people on trolleys in January, they were absent for the February meeting of the Forum. All seven Limerick members were also missing from the March meeting. This level of engagement is unacceptable. The Mid-West Hospital Campaign calls on all members of the Forum from Limerick to now use this opportunity to advance the urgent case for a Model 3 Hospital in the region which would mean the return of another 24/7 emergency department,” the statement from the Hospital Campaign explained.

    The seven Limerick councillors on the Regional Health Forum are John Egan, Dan McSweeney, John Sheahan (FG); Francis Foley and Kevin Sheehan (FF)  Sean Hartigan (GP). Frankie Daly (Ind).



  • Registered Users Posts: 1,461 ✭✭✭Downlinz


    People did protest against it extensively to prevent the downgrading of Nenagh and Ennis during the FF government, there were massive Labour led protests at the time to prevent it from ever happening. We knew what would happen and the overcrowding it would lead to having everything concentrated in UHL so none of this is a surprise. What's happening now isn't shocking, it was entirely predictable and the reason for all the protests back then at a point when it could and should have been prevented.

    Then Labour who led the protests got into power and implemented it anyway. There's a huge sense of betrayal and anger among the public but also a sense of futility when previous protests were ignored and politicians across parties backtracked on promises.

    Take a look at this from 2009 for some nauseating hypocrisy:

    https://www.alankelly.ie/blog/2009/02/21/nenagh-hospital-protest/



  • Posts: 0 ✭✭✭✭ [Deleted User]


    I just posted this on another old thread about A&E general crisis. Plan to put GPs at the door to make quick assessment and redirect the non-serious cases / ones that can be treated elsewhere. Plan is to establish centres to manage those cases that don’t need complicated in-patient care.



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  • Posts: 0 ✭✭✭✭ [Deleted User]


    that is absolute madness! GP should be able to refer directly to an ENT hospital dept. Never heard of anyone being directed to A&E for that sort of thing ¯\_(ツ)_/¯ crazy stuff altogether. I say that as a Dublin person who thankfully has not had any dealings with medical services in Limerick, yet anyway. You’d definitely need a 24 hour chaperone/carer in UL Hospital make sure you are at least still alive.



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