Government must act on HIQA Mid-West report

No hospital in the Irish health service reveals the depth of the capacity crisis more clearly than University Hospital Limerick (UHL). Despite major investment in UHL in recent years, the crisis persists. The new report from the Health Information and Quality Authority (HIQA) lays out what many already know: There are simply not enough hospital beds to meet the needs of patients.

The report, commissioned by the previous Minister for Health in mid-2024, set out to examine how urgent and emergency care is delivered in the HSE Mid-West region – covering Limerick, Clare, and North Tipperary – and to consider whether a second emergency department (ED) is needed. HIQA worked with the Economic and Social Research Institute (ESRI) to project future healthcare demands up to 2040.

The report points out that UHL has the lowest number of inpatient beds relative to the number of emergency attendances of any model 4 hospital in the country. It also treats some of the sickest patients, as many less serious injuries are managed in local injury units elsewhere in the region.

There are plans in place to increase capacity. However, even with 224 new beds planned for the hospital – 128 due by the end of 2025 and another 96 delayed until 2029 – demand will outpace supply.

HIQA has urged the Government to re-evaluate the national Acute Hospital Inpatient Bed Capacity Expansion Plan 2024-2031 to speed up delivery and consider adding even more beds in Limerick or nearby hospitals.

ESRI projections show the region will need between 36 per cent and 71 per cent more beds by 2040 compared with 2023 capacity levels.

HIQA stressed that plans must be flexible and monitored closely to ensure they match local needs.

The report presents three options for the Minister:

Option A – Expand UHL further on its existing Dooradoyle site.

Option B – Develop a second linked campus nearby under the same management.

Option C – Build a new model 3 hospital with a second ED in the region.

HIQA concludes that options A and B would deliver extra capacity faster and address immediate safety concerns. Building a new hospital could help in the long-term, but would take many years and carry massive costs – similar to recent national projects like the New Children’s Hospital.

Doctors have come out in support of the report. Both the IMO and the Irish Association for Emergency Medicine  said it is vital that the recommendations are acted upon as soon as possible.

Dr Anne Dee, President of the IMO and a Public Health Consultant based in Limerick, said: “While the IMO welcomes the publication of the HIQA report, its findings are hugely concerning for patients and the medical workforce working in the region. The serious deficit of beds is at the root of the problem in the mid-west, and a quality, safe service for patients cannot be delivered without these beds as well as the right number of staff.”

Dr Dee pointed out that patients in the region “have lost trust in the system”.

“If that trust is to be rebuilt we need to see a clear, resourced plan with targeted supports. In addition to a longer-term decision, short-term measures to increase capacity must be initiated with supports both in terms of beds and services within the community – we need an immediate short-term plan to run alongside a longer-term ambition.”

As the report shows, crowding at UHL is due to a fundamental lack of capacity. Without swift action to expand bed numbers, improve coordination across hospitals and community services, and plan for future growth, the people of the mid-west will continue to face unsafe and unacceptable delays in care.