In light of the distressing revelations last week during the inquest into the death of 16-year-old Aoife Johnston at University Hospital Limerick (UHL), the national health monitor issued its third report on Thursday, highlighting the continued deficiencies of the nation’s most congested hospital.
While the Health Information and Quality Authority (Hiqa) inspectors recognised certain advancements at UHL, they offered little incentive for anticipation of immediate solutions to the hospital’s myriad issues.
These issues can be categorised in various ways, with the first being the reorganisation of the midwest’s health services over a decade ago. Local residents argue that UHL never received the necessary funding to meet demand. The hospital is the only model-four institution serving a population of 400,000, and unusually there is no model-three hospital within this region.
The latest Hiqa report refers to a “disparity” between UHL’s emergency admissions – the second highest in the country – and its capacity of 536 beds, which is among the lowest for model-four hospitals.
Nevertheless, budget constraints, if they previously existed, are no longer the issue. Spending at the hospital has risen by 75% since 2016 – the highest increase in the country. Staffing numbers have increased by over 1,000 since the end of 2019, up 40%, and the budget has seen a 45% rise. UHL has seen more new developments than any other hospital, including the construction of a 96-bed block and another one planned.
Despite various evaluations indicating a shortfall of several hundred beds, the problem of chronic overcrowding persists, given that these beds cannot be provided instantly.
While other hospitals have effectively dealt with their trolley crises, the situation in Limerick is deteriorating, repeatedly setting new overcrowding records. This year, while many hospitals have seen a reduction in trolley numbers, there’s been an increase of 50% at UHL. This situation can no longer be justified by allegations of historical underfunding.
Over half of the patients who arrive at University Hospital Limerick (UHL)’s Emergency Department (ED) are self-referring, indicating a struggle to access General Practice (GP) services. Furthermore, the hospital suffers a lack of step-down options and faces opposition to its proposals to use a new community care centre in Nenagh for convalescent care.
The tragic demise of Aoife Johnston was a prime example of the issues plaguing UHL, and unfortunately, a foreseeable one. Critics have long been highlighting the risks associated with the overcrowded ED in Limerick. Ms Johnston is not the lone casualty of these shortcomings and, regrettably, was the youngest.
Only nine months prior to Ms Johnston’s death, Hiqa, in a disparaging report, emphasized the need for UHL to enforce escalation protocols during surges in patient numbers. However, during the weekend of her death, only a single ED consultant was on call, and not one was physically present in the hospital. The VIP patient safety protocols were neglected, even with around 55 patients awaiting a bed.
Ms Johnston fell victim to sepsis; however, the hospital also ignored the clinical guidelines regarding sepsis treatment. The inquest into Ms Johnston’s death uncovered that decision-making authorities failed to respond appropriately to this situation. Hospital manager, Fiona Steed, tried to alleviate the pressure on the overcrowded ED by proposing the transfer of nearly 40 patients to different areas within the hospital. Yet this suggestion was ignored— for reasons that remain unknown.
It is eagerly awaited that the upcoming report by former judge Frank Clarke, encompassing both the circumstances of Ms Johnston’s death and the governance issues at UHL, will provide deeper insight into how the hospital is managed and why, despite multiple reports of dangerous conditions and preventable fatalities, little has been done to rectify these issues.