Review to determine if second emergency department required in mid-west

Minister for Health Stephen Donnelly is to initiate a review into urgent and emergency care capacity in the mid-west region to determine whether a second emergency department (ED) is required.

The review will consider the case for a second ED in light of the large increase in the population in recent years and ongoing pressures at the ED at University Hospital Limerick (UHL).

According to a Department statement: “Smaller emergency departments in the region closed 15 years ago. This was based on the very clear clinical advice at the time, as there is a clear relationship between emergency teams providing high volume of service and better outcomes.

“The aim was to minimise the risk of a patient presenting at the emergency department whose time critical needs exceeded the capacity of the hospital, and specialties needed, to treat them. We also know that important services, including intensive care units, require a certain throughput so that clinicians can maintain their skills.”

Since those “clinical decisions” were made, the population in the region has grown considerably. The population is also older compared to most other regions.

“There have been record increases in investment in UHL during the lifetime of this Government,” added the Department. “However, overcrowding at UHL’s emergency department continues with trolley numbers increasing by 39 per cent so far this year. This contrasts with the national trend, with the average morning trolley count falling by 11 per cent during the first four months of the year. Some hospitals continually have no patients on trolleys.”

It said staffing at the hospital has grown by over 1,183 since the end of December 2019/early 2020 – from 2,814 to 3,997 at the end of February 2024. This represents an increase in staffing of 42 per cent.

There had also been a 44 per cent increase in the UHL budget in the past five years. In 2019, UHL had a budget of €265 million. This year, it is €382 million.

150 new beds had been opened in the UL Hospital Group (ULHG) since January 2020, including 108 beds in UHL (98 ward beds and 10 critical care).

“Investment has also included additional capacity at St John’s, Croom Orthopaedic, Ennis and Nenagh hospitals,” according to the Department.

“While some reforms are underway at UHL, significant changes are still required in terms of how UHL is run and how patient flow is managed. This was highlighted in the recent report by the Health Information and Quality Authority (HIQA). HIQA noted evidence of improvements in operational efficiencies, but said greater operational grip was also needed.

“The review will consider the additional capacity being added, as well as future reforms that are needed. Terms of Reference will be finalised and published once the upcoming review by Mr Justice Frank Clarke (retired) has been considered, so that its findings and recommendations can be incorporated. The former Chief Justice is conducting a formal investigation into the death of Aoife Johnston. The Minister has asked HIQA to lead the review.”