The sun was still shining during a particularly warm July when the health service issued a plea for people to avoid attending the University Hospital Limerick (UHL) emergency department unless they required emergency care.
The hospital, consistently the most overcrowded in the State, was “experiencing sustained high demand”, the HSE said, with recent attendances “significantly above expected levels”.
Almost 1,000 people attended the hospital over a three-day period last week, the HSE Mid West said, describing it as an “exceptionally high level of activity for any time of the year”.
So far this year 55,467 patients have visited the emergency department at UHL, the highest number of emergency attendances at any hospital nationally.
RM Block
But given this scenario is arising in the middle ofsummer, questions are being asked as to how UHL will cope with winter pressures when serious respiratory illnesses make their annual appearance.
Senior health officials have acknowledged for some time that trolley numbers are no longer solely a winter problem; they are a year-round issue.
A number of factors are at play in the situation at UHL, these include an ageing population and a growing number of patients with chronic and complex conditions more regularly seeking hospital treatment. The midwest also has a high level of deprivation, which studies show leads to increased healthcare needs.
Hospital staff says the emergency department being the first port of call, , rather than more appropriate avenues such as injury units, is a problem. The HSE Mid West cited a trend in its notice to the public and stated that half of recent attendances were people without a GP referral.
“Many non life-threatening conditions can be safely treated through community healthcare services, including local pharmacies, family doctors, injury units and GP-referral medical assessment units at Ennis, Nenagh and St John’s Hospitals.”
Unfortunately for the health service, and the Government that funds it, overcrowding issues come down to maths: supply and demand.
UHL’s difficulties have widely been attributed to a decision more than 15 years ago to shut Ennis and Nenagh’s emergency departments, resulting in increased traffic to Limerick. Plans are in train to increase emergency capacity at the hospital, with a 96-bed facility opening last year and another expected.
Furthermore, the Government has accepted recommendations from the Health Information and Quality Authority to expand capacity at UHL, build an elective hospital nearby, and build a new hospital in the region with an emergency department.
Prof Mick Molloy, chairman of the Irish Medical Organisation’s consultants’ committee, said the difficulties will persist until significant progress is made in delivering those developments.
He said there have been “some attempts” to address the problem, but these have not been sufficient and “patients are suffering the consequences now”.
“The provision of healthcare facilities for the people of Limerick is critical and making that happen should not be delayed or scaled back because of the cost or amount of planning it involves,” Molloy said.
“We cannot expect any improvements unless these basic realities are addressed as a matter of urgency.”
Bank holiday weekends are notoriously busy for the State’s hospital system due to increased incidents, fewer rostered staff and delayed discharges.
Phil Ní Sheaghdha, general secretary of the Irish Nurses and Midwives Organisation (INMO), said the HSE making this type of announcement “in the middle of summer is a huge red flag warning for what’s to come in winter”.
Given the consistent, chronic pressures at UHL – notwithstanding the great work of staff, and increased Government resources – this week’s notice is not surprising.
Unless the needed additional capacity comes on stream quickly, UHL will face worsening pressures.
