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Child Item

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?

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textiles

https://www.boards.ie/discussion/comment/121814869#Comment_121814869

Thanks for the helpful information you've given on this thread - very informative. What is it about NHS Scotland that we should model (I understand the population/geography comparison) ?

weisses

https://www.boards.ie/discussion/comment/121814869#Comment_121814869

What is wrong with Nurses wanting to work for Agency?... Why should they be criticized ? The flexibility suits their needs in a rotten system that is the opposite

karlitob

https://www.boards.ie/discussion/comment/121815300#Comment_121815300

Those are the two main issues.

The third is their regionalised health boards. To be fair, we are now adopting that. It will take time to see change but we are doing it. It’s disingenuous to say that we’re bringing back the health boards - it’s not the same model.

Theyve had investment for decades - they’ve 22000 beds compared to our 12000 (approx last time I checked). Not that I’m advocating so many beds - just good to compare a geographically dispersed small population in a geographically / topographically difficult environment.

Finally - it’s less politicised. NHS Eng is a mess - a total mess (and they don’t have social care which we do - and rightly so). Need I say anything about NHS Northern Ireland. And NHS Wales does ok for itself.

In Ireland, we need to depoliticise Health. Far too many people want services on their doorstep. It’s not safe or sustainable to do so. 32 EDs for a country of 5 million - Madness. Demands for PCI centres in Waterford even though there’s one in Cork and Dublin because they get their nose put out of joint in Waterford - madness. Out of the 50 acute hospitals in the state - 20 (totally need to check that figure) are voluntary - own Board, own staff, but all money from public purse. I think that’s mad - though the output from those hospitals is world class in some areas (SJH, Mater, Beaumont). You’ll have seen the debacle with National Maternity Hospital (a voluntary Catholic hospital) going to St Vincent’s (a voluntary Catholic hospital) and them fighting about ‘independence’ - madness.

We have Dublin, Cork, Galway and Limerick. To be fair, the latter three are relatively small. So we should - and do - have major tertiary hubs in Dublin but we need to bolster our hubs in the other three.

We happily accept that UHL - the regional is the regional hospital in the area supported by other hospitals …Croom etc But we need to get into that mindset nationally also - instead of this professional protectionism.

There’s also a challenge needed to put on HCPs also. The most common ortho procedure on waiting lists related to back injections and the other is arthroscopies. The evidence base behind back injections is weak; far better hire bucket loads of specialist physios who provide better care and better outcomes than injections. The evidence base behind arthroscopies is even poorer - they should be stopped unless a high bar of justification. Have you ever tried to suggest to an orthopod not to operate. Ha!!!!

Not sure that made any sense now that I read back on it.

JP Liz V1

UHL has been an issue for many years with different health ministers failing to remedy the problems there or even coming close to solutions

If it's not Dublin, do they even care

Who are the main government TDs for Limerick, they need to be more vocal

I think another A&E for acute care near the area, in the county, might help

Has nearby Clare and Tipperary any open?

karlitob

https://www.boards.ie/discussion/comment/121815642#Comment_121815642

Well - and this shouldn’t be a surprise to you - not all nurses are Florence. Nightingale. Some are Nurse Ratchet.

An an employer, it’s incredibly hard for an organisation to plan its service on the fear that someone might be working on your ward on a Monday and in a different hospital on a Tuesday. The nurse doesn’t get more money by the way (not at macro level and when you consider absence of pension contribution). Some

agency nurses have been on the same line for years!! Same ward every day - they’re effectively employees. It’s not unreasonable for an employer to want to have a stable workforce and put staff where they are needed based on agreed ratios, patient acuity and patient dependency - that’s the fundamental basis of Safe Nurse Staffing that I referenced above.

If they want flexibility - off they go to private sector. I would caveat of course that the HSE is THE most flexible organisation in Ireland for nurses - more than any other organisation in Ireland, more than ANY other profession. They wouldn’t get it anywhere else.

There are physicians, surgeons, nurses and pharmacists - each with their own sub specialities. There ~ 30 Health and Social Care Professionals. If you think they all speak with the same voice asking for the same things and show no professional protectionism, then you’re naive to say the least. Why can’t a profession be criticised? All people who work in health care for the patient - nurses care more do they? So always listen to them? Doctors care more do they - so always listen to them.

The figures speak for themselves - just FoI Safe Nurse Staffing data. Based on international research, over decades, and agreed by unions in 2019, loads of wards are either over staffed or perfectly staffed for the service they provide on a ward. It’s just habit to mouth off.

karlitob

https://www.boards.ie/discussion/comment/121815900#Comment_121815900

And with respect, people of lettekenny say the same, Portlaoise, Waterford, Mullingar etc. everyone thinks that about their local hospital.

Limerick is a little more unusual - the public and the media are more critical of it than the other hospitals around the country. My only reasoning to that is that Limerick is not as big as Dublin and bigger than small towns and so it’s the right amount of focus on that’s not lost in Dublin and doesn’t peter out in small towns. Who knows? But it is more virulent that’s for sure.

For example, a few years ago - the first NPHET on CPE. Jesus - the staff were ripped out of it as if it was the hospitals fault. A community generated infection and the hospital gets national focus and national blame. Madness.

Interestingly, there was an ESRI report out a few years ago saying that community services were not being provided pro rata to the hinterland of Dublin - Meath, Kildare, Wicklow etc but instead being sent West because of political giving out. People and politicians saying that they’re not getting their dues cos Dublin gets everything. The data is there to inform this but - as I say - politics.

Finally - Noonan was Health Minister and did a good job. But he got caught with the HepC scandal. And because he didn’t get everyone what they wanted when they wanted he got slated. Since then all ‘scandals’ are highly politicised (see a pattern) and those affected get anything they want - even when the blame doesn’t lie with Health Service. Take a look for yourselves when you see how hard it is to say something about an affected group - madness.

https://www.bbc.com/news/world-europe-29735725.ampo

Igotadose

https://www.boards.ie/discussion/comment/121814741#Comment_121814741

Yes, and does HSE in fact gather data on the effectiveness of their treatments and make improvements? And perhaps publish it for taxpayers to see how our euros are being spent? Again, I only have anecdotes but it seems like Ireland does worse in terms of medical outcomes. If an otherwise healthy woman needs 2 days for a hysterectomy in the US, why is it a week in Ireland?

If you have a shortage of 'bed days' because people are in beds and not being treated, wouldn't it be more economical to send them home, or at least figure out ways to safely shorten the stays? A savings of 10% of stay time means a lot more capacity - for free.

karlitob

https://www.boards.ie/discussion/comment/121816332#Comment_121816332

Of course they publish it.

Performance Profile

NCCP

Cancer Registry

HIPE / ABF

NQAIS / NQI

HPSIR

MPSIR

NOCA

Annual Reports eg Sepsis, etc

HPSC

Dont forget - the HSE is cradle to grave. It includes environmental health - all assessments of dodgy Chinese restaurants to the quality of the seawater. There’s enough there to keep you going if you’ve any specific queries let me know and I can direct you

The HSE is one of the biggest data gatherers in the country / if not the biggest. Of course it publishes it - search there website. Of course they’re held to account - search oireacthas health committee.

We don’t have worse health outcomes.

As you can imagine to an organisation of 80000 + scientists - anecdotes is of limited use. Do you seriously want me to comment on why a women in the US only keeps a mother in for two days and a week here. Where to start:

Nothing about the US healthcare should ever form a basis of discussion
More women and babies die (yes DIE) in the US than ALL other developed countries. Off you go and your child there if you wanna take the chance.
I would have thought it obviously but they only stay two days because it’s based on cost, not need. Women stay in hospital here for as long as they need (not want).
We have the best maternity services in the world (says he confidently - close to if not the best).
You clearly no nothing about hysterectomies - some are laparoscopic but some include the removal of fallopian tubes, and their ovaries, all through their stomach. TAH BSO - look it up, you might learn something. Imagine thinking that the health service would be better if women were kicked out of hospital after 2 days post hysterectomy. I’ve treated many women post op - not a fun surgery.

As for bed days; approx half of all bed days are used by people 50+. Of the delayed transfers of care, those numbers more or less match those waiting for admission. But here’s the kicker - while those patients do not need acute medical care they do need care - lots of it. Healthcare in the developed world is chronic disease

management of older persons. Loads of people live alone and rely on care provided by their families. It’s exhausting for them. It’s not so easy to say ‘right, acute needs are finished, off you go home’. Frailty is an accumulation of health conditions which is staff intensive. It can’t be fixed by a tablet.

Even if you magically found beds in nursing homes or care in the community to meet demand we’d still run at 100% occupancy - which is unsafe. International guidelines are 85%. That is, 15% of beds should be empty for safety. We run at 120% usually.

I don’t mean to sound sarcastic but of course that’s been thought of. Of course that work has happened. Of course there’s a HUGE and I mean HIGE focus on discharge; there’s too many people coming to our services. And when we do discharge - then something happens and the health service is slated. There’s no winning. All on the presumption that discharge was incorrect of course

https://www.irishtimes.com/crime-law/courts/2024/01/19/woman-21-who-died-hours-after-discharge-wanted-to-leave-hospital-hse-claims/

https://www.irishtimes.com/crime-law/courts/2023/10/02/family-of-vulnerable-woman-expresses-concern-over-mental-health-services/

https://m.independent.ie/life/health-wellbeing/girl-died-after-hospital-discharge/25949814.html

All very sad. And all have their specific details that can’t be rounded up. It’s just to highlight the point.

History Queen

Alan Kelly was speaking about UHL in the Dáil today. Much of what has been discussed in this thread was mentioned by him. He's calling for a model 3 hospital.

https://labour.ie/news/2024/02/26/government-have-lost-confidence-to-deal-with-uhl-situation-mid-west-needs-a-model-3-hospital/

[Deleted User]

https://www.boards.ie/discussion/comment/121815653#Comment_121815653

I didn't know there are 32 EDs in the country.

Which ones would you close? Is it not better to have an ED to stablize someone before shipping them off to a more specialized hospital to continue their care? Or should there be more helicopter transfers to replace closed EDs? Helicopters have their own drawbacks as well, can't be used in rough weather for example.

L.Ball

https://www.boards.ie/discussion/comment/121816464#Comment_121816464

Your posts all seem to long winded versions of "everything's fine stop complaining other places have it worse". If all the data indicates that out health service isn't an abject disaster, then why is it so hard to find anyone with anything good to say about their experience with it?

Podge_irl

https://www.boards.ie/discussion/comment/121830094#Comment_121830094

Is it not better to have an ED to stablize someone before shipping them off to a more specialized hospital to continue their care?

It is potentially counterintuitive but (to a point at least) the answer is no.

ED treatment is a perishable skill so to speak, those who see fewer acute emergencies simply won't be as good at treating them. I'm going off memory here, so the exact numbers may be wrong, but for example when they shut the 24 hour Roscommon ED much of the coverage failed to mention that the cardiac fatality rate was something like 4 times as high as in Galway ED. You were better off staying in the ambulance, with well trained paramedics, to get to a large, experienced and resourced ED. The ambulance service probably isn't good enough overall though.

[Deleted User]

https://www.boards.ie/discussion/comment/121830165#Comment_121830165

That's interesting, that patients would be better staying in an ambulance to a better ED further away.

I'm shocked there's so many EDs. I don't think many people realise that.

Which should be closed? I guess Ballinasloe is close enough to Galway and motorway all the way in.

unknown

This content has been removed.

karlitob

https://www.boards.ie/discussion/comment/121830094#Comment_121830094

There are 29 24/7 EDs and 11 Injury Units.

I’d close Portlaoise, for one.

https://www.laoistoday.ie/2020/01/09/hse-chief-calls-for-fewer-accident-and-emergency-departments-in-irish-hospitals/

The type of patient that I think you’re thinking of is a major trauma patient. Ireland has way too many hospitals that deal with major trauma. We don’t have much major trauma - at least not the major trauma that I think you’re thinking of…..car accidents, exploding buildings, etc. Major trauma in a developed countries health service is hip fractures in people over 65. It’s actually very interesting stuff. The point about an ED or major trauma centre is to stabilise but then to treat as soon as. Why would you have an ED, in a small hospital, understaffed and staffed by people who don’t have the same experience or exposure to lots of trauma to build that expertise, without experienced clinical oversight just to stabilise a person before sending them another hospital which has ICU or surgery. Lots of our EDs have no surgical specialities required for the trauma that presents. The notion of speed to ED is an outdated one. We’re in a small country - we can get around it very quickly. Yes we should have more helicopter transfers.

https://assets.gov.ie/10116/70fd408b9ddd47f581d8e50f7f10d7c6.pdf

https://healthmanager.ie/2021/09/five-year-strategy-for-development-of-emergency-medicine-in-ireland/

karlitob

https://www.boards.ie/discussion/comment/121830165#Comment_121830165

Exactly. It’s often forgotten that Frank Feighan lost his seat in Roscommon and was effectively shunned for years by people of Roscommon. No one said thanks for the fantastic health centres that have been put in / developed which gave the sick of Roscommon exactly what they needed - the right treatment, to the right people at the right time.

If Ireland wants to improve its health service us citizens have to play our part too and not expect every service on our doorstep.

https://www.thejournal.ie/frankie-says-relax-2509066-Dec2015/

God forbid I mention Cancer Centres of Excellence or PCI centres in Waterford.

karlitob

https://www.boards.ie/discussion/comment/121830663#Comment_121830663

Thanks. To be fair, what I’ve said is no secret, fully in public domain, well known by politicians and departments, known by healthcare professionals governing bodies etc.

Yes, I agree. Population increase is a significant factor in my view. As I mentioned above, health care in the developed world can be boiled down to chronic disease management among older people. That’s who’s in our ED, that’s who’s in our ICUs, that’s who’s in our Major Trauma Services.

Every person over 80 will use significant resources of the health service. Most people over 65 will. Not that many under-8s getting a GP card will. Don’t take this as criticism of older people - far far from it. We need to respond to it better. It will of course - eventually - be us.

karlitob

https://www.boards.ie/discussion/comment/121830123#Comment_121830123

Thanks for your contribution. I’m not sure you’ve read my posts closely enough.

I have provided you with a wealth of objective evidence of the state of outcomes of our health service, I have acknowledged the prolonged waits for admission to ED (inc a link to where it’s measured daily), I have given some reasons from my perspective (with supportive evidence) as to why this occurs and what could be done, I have referenced tragic cases in which these issues where a contributory factor in those deaths, I have highlighted that in a service which provides millions and millions of appointments, procedures and investigations that lots of error and harm occurs, and I have challenged a lad who said he’s mothers, cousins, brothers sister - in AMERICA of all places - thinks our Health Service is poor (or the dreaded ‘third world’ BS); and you want to know why there’s such bad press.

Well maybe because these cases are sad, maybe because people are seeking validation for themselves or their loved ones for the difficult time that they’ve been going through, maybe some people like to moan and moan and moan, maybe some people don’t like evidence as it challenges their perceived notions based on nothing but anecdote, maybe some people want to have an ED in the back end of Roscommon, and maybe not all journalist or media are insightful intellectuals. Take your pick.

But since you brought up the topic, I’m sure you’re aware of the National Patient Experience Survey. A fantastic piece of work by many dedicated people.

In 2022 Ireland’s fifth National Inpatient Experience Survey was carried out. Patients aged 16 years or older, who spent at least 24 hours in a public acute hospital and who were discharged from hospital during the month of May 2022, were invited to participate in the survey. 82% of participants rated their overall experience of hospital care as good or very good.

82%.

And if you have any interest you can go in and see each individual hospital, each year for the last five years, each main component of their care, and a big long list of projects undertaken and completed to improve the care you and your family receive each time they attend our health service.

https://yourexperience.ie/inpatient/national-results/

And the last thing I’d say is that it’s not so hard to find anyone to say anything good about the health service - sure, you found me!!!! Lucky you.

karlitob

For those seeking more data, the DoH Health Trends 2023 was published yesterday. As always, very interesting reading. Well done all in the Health Sector.

https://www.gov.ie/en/press-release/a5d21-minister-for-health-publishes-health-in-ireland-key-trends-2023/#:~:text=Key%20Trends%20shows%20us%20that,population%20in%20the%20same%20period.

https://www.gov.ie/pdf/?file=https://assets.gov.ie/285459/9f30e75f-c961-425f-80a9-92ed7bb279b1.pdf#page=null

BobMc

another problem as someone else mentioned, the ED is the access point to the hospital, I've a 19 year old with a confirmed long term medical condition, if he needs access to his team for care during a flare up its thru the ED he has to go, I should be able to call and see the specialist rather than thru ED, they dont know him or his condition

I also believe Dr's are too quick to dismiss patients off to ED, has an issue years ago with a smally attended urgent care Dr, barley looked at the kid, straight to ED, its wasnt a medical emergency, but a Paeds Dr the following morning would have sufficed in UHL instead your're forced to endure the ED for 24hrs

next is the going to ED for crap complaints, my mother witnessed a person in the Q ask about getting a pregnancy test at the ED reception window I mean is cop on a rare commodity now !

credit to the staff they've a shitbag to deal with and for the most part try there best, its a big problem with no easy solutions

karlitob

https://www.boards.ie/discussion/comment/121831351#Comment_121831351

Again, there are only a few ways to be admitted to a ward.

Planned admit - planned, for procedure or investigation. You get a letter saying please present at x.

Admit from clinic - you’re so unwell that the outpatient clinic admits you from outpatients.

As you will appreciate, both of the above are highly dependent on there being beds available. Some beds are protected, not a lot, but some are. If there’s too many people in ED who require admit, planned procedures and investigations are cancelled.

Then there is admit from ED. I’m afraid that in the context of what capacity we have, admit through ED is correct.

If you have a flare up, that’s where nurse coordinators are invaluable - a hospital point persons that patients can call; Primary Care Centres need to be better equipped to deal with (as I’ve said above) chronic disease management inc long term illnesses of young people rather than attending a hospital to see a consultant. But people want to see consultants - I get it, but they only work in a hospital.

if you want to know why a General Practicioner sent a child to a paediatric hospital with barely a look then I invite you to read this. A highly litigious society and as you will know, there’s been nothing but protests and personal attack on doctors in UHL. Of course they’ll refer - doctors are human

https://www.businesspost.ie/news/medical-negligence-claims-make-up-majority-of-states-e5bn-legal-liabilities/

As for your final comment, I utterly disagree with you. It’s not for you or me to decide who does or doesn’t deserve to attend an ED or a public funded health service. You know nothing about these people. They’re not there for you to judge. Everyone gets treated on the basis of need.

Your mothers son brothers fathers cousins saw something once when they were sick in an ED and that anecdote is supposed to inform the debate on health services. This is drivel.

She could have been in a mild Road traffic collision, told by a doc or someone she spoke to to go to the ED, and been so worried about losing her long wanted baby that she wanted a pregnancy test to make sure the baby was ok. (Something that I’ve come across many many times).

What your mothers brothers sisters aunts cousin didn’t say is - our ED receptionists are not dopes; they register and send into the triage nurse. She’s - usually - the bees knees of a legend who’s incredibly experienced. She does an assessment and if someone only wants a pregnancy tests she either tells them to feck off and but their own in a pharmacy, or she treats this persons with care and compassion; gets her a pregnancy test, gets her to use the test in the bathroom, then back into her triage room to talk about the results. When she informs the mother that all is ok, she’ll ask if she can call anyone to pick her up, put a hand on her arm to connect, and maybe even a hug - all takes five minutes to show show care and compassion. But you’re mothers brothers uncles father said he saw something once

I could easily say that I know many 19 year olds with long term illnesses who do not mind their health - drinking, not exercises, not eating healthily / and then they show up to an ED expecting to be admitted to a bed more than someone else who needs it.

BobMc

I agree with you but the general point I was trying to make is there's alot of attendance to ED where the patient needs alternative care rather than an ED,

I also get the negligence side too, but thats another subject of perhaps compo culture, they need to make a best judgement call sometimes as is their job,

but alas when that lands them in trouble its game over and off they send the patients, surely we've all been in the ED and witnessed plenty antics

Geuze

https://www.boards.ie/discussion/comment/121830572#Comment_121830572

The number 29 is in my head, for some reason.

Yes, in the Roscommon case, the accreditation body was going to take away the status of the ED, as there were so few patients.

Of course the locals wanted the ED to stay.

After the Govt made the correct decision to convert the ED into a MIU, one local TD left the Govt in protest, and another local TD lost his seat.

It was a while later that the doctors stated that it was the medically-correct decision, but that was too late for the TD who lost his seat.

cnocbui

This will put some backs up.

I'm an Australian. UHL is bloody joke, it's an overcrowded, pokey cramped rabbit warren. The staff are excellent, but the hospital is unfit for purpose given the size and nature of it's catchment.

There is only one sane answer and that is to replace UHL instead of trying to constantly patch it with sticking plasters, and build a new, large modern hospital. The government just had the largest surplus in the EU at €10 billion, and I have seen at least one headline about the problem of what to do with it.

Anyone with an interest in a hospital that works and doesn't kill people due to poor performance and is free of patients on trolleys as a permanent operating practice for over 20 years straight, might have some ideas on how to spend it.

I would be familliar with the QE2 medical centre in Perth Australia. When I first set foot in UHL I could hardly believe what a cramped rabbit warren it is.

The problem I suspect is getting the bleeps in Dublin to spend a sizable amount of money beyond the pale.; €2 billion on a electrical interconnector with France is ok, though. You could buy a stupidly cost inflated children's hopital for that.

cnocbui

https://www.boards.ie/discussion/comment/121830123#Comment_121830123

Some years ago I came across a site that detailed user ratings of healthcare. Ireland was on equal footing with Romania, that is to say, it scored very badly.

L.Ball

https://www.boards.ie/discussion/comment/121833015#Comment_121833015

The data says otherwise.

Toodles_27

https://www.boards.ie/discussion/comment/121834064#Comment_121834064

You've worded this much better than I have.

He's all the paragraphs and stats in the world but it's patently clear he has never had to attend UHL regularly with a elderly parent or a child with a chronic condition. It's indefensible and inhumane the experiences my family have endured in that Hell that manifests as an A&E dept. My mother has told me next time her condition flares up to let her die at home with dignity rather than spend x amount of days being treated worse than an animal in that A&E department.

And that "National Inpatient Experience Survey" 82% score is a load of ... aswell. It'd be interesting to see how many were sent out against how many were returned. I'd imagine its a very small fraction. And it also incudes the outpatient department.

I'll hold a second cavity block for you.

breezy1985

https://www.boards.ie/discussion/comment/121814794#Comment_121814794

GPs, community, pharmacies can only do so much.

The almost first sign of trouble they send you to some version of ED/GEMU

karlitob

https://www.boards.ie/discussion/comment/121832932#Comment_121832932

No.That’s not the only sane answer. In fact, it’s a terrible suggestion.

karlitob

https://www.boards.ie/discussion/comment/121833015#Comment_121833015

Oh well if you read something, somewhere once that said something that you agreed with, well then what else is there to say.

It’s clear of course that you haven’t read the thread.