University Hospital Limerick- what can be done?

in other words re open st johns ennis and neneagh, a neighbour of mine was sent to neneagh 60 niles foe a tooth extraction, another was sent to tralee for camera up his bum 80 miles, this does not make sense

It does make sense. You’ll see why from my post.

I understand that. Hospitals are merely collections of services - it’s normal in every hospital to have differing level of quality and service. To be fair, breast clinic is relatively straight forward and fully funded. ED isn’t. It’s as simple as that.

As for ENT, it’s a surgical speciality and the only way to be admitted is by the ENT consultants themselves electively by patients who attend their outpatients, and emergency (trauma…RTCs etc). Otherwise GPs can refer to their clinic as an outpatient. I haven’t heard of services refusing to take outpatient referrals from GPs and asking them to send people to ED. Not doubting you but if that’s true it’s done to maximise their efficiency so that they can see the right patient at the right time.

More to read below. Great to see this done but announcing, building and having an effect takes time. Regardless it’s still not enough for now. And we already know that the population is increasing, more people will go into the 65+ and 80+ bracket meaning that we’ll be running to stand still IF we’re lucky once they’re built.

https://www.oireachtas.ie/en/debates/question/2023-01-18/1518/

One thing it seems (from the outside) that the HSE doesn't followup on outcomes and the effectiveness of the treatment, especially time spent in hospital. Various people I've known that have had surgeries that, in other hospital systems would be brief stays in hospital, stay for days in hospital in Ireland. A plumber's wife due to have a second baby spends 3 days in hospital before going into labor. Surely 1 would be sufficient? Another woman having a hysterectomy, a week. Worst I've heard of is 2 days in the US, oh and there were no complications and, in fact, she was checked in a day early, unnecessarily.

Plus the repeat surgeries aren't a good look. Another friend going in for the same bladder surgery for the third time. Three times? Really? A friend's healthy daughter breaks a finger playing basketball, has surgery, gets an infection from the surgery, back again two more times. An infection from surgery? Don't they sterilize surgical tools in Irish hospitals? Let alone get hardware at woodies to perform scoliosis surgeries - rogue surgeon? Really? Never a systemic failure in the HSE, oh no.

You can have as many beds as you need, if the surgical and nursing care is poor (looking at NUI Galway and poor Savita H.), you'll fill them up soon enough.

Accountability is not the motto of the HSE.

I’m not sure how to respond to that.

It’s a mish mash of things that you’ve combined in your head that represents the output of our Health Service.

There are millions of appointments, interventions, assessments, appointments and procedures every year in the health service. Millions. A hospital in an inherently dangerous place, and it’s full of sick people - so yes, incidents happen and lots of them. Your expectation of no harm ever is naive and unachievable in any health service anywhere in the world with all the money in the world.

And I agree with much of this. I can’t account for it so not sure how to comment.

Efficiency depends on perspective. Lots of GPs refer to lots of services; and not all valid. Health doesn’t know which person to which service. There are 900,000 on waiting lists - we don’t know if it’s 900,000 unique people or 1 person with 900,000 referrals. Not all referrals are valid, or sensible. The only thing I can think of is that it’s more efficient to make GPs refer to ED than accept referrals from everyone and everywhere gumming up their waiting lists with inappropriate referrals. (Just cos the GP says you need ENT doesn’t make it true - that’s for ENT to decide).

All in all it’s a symptom of a regional health service under pressure and services doing their best to meet the demand, mitigate the risk, and ensure effective outcomes for patients.

In the Oireacthas reference I put above you see the investment made into Ennis and St John to do exactly this.

Patients are seen in the community - GPs, Community Health Centres, Pharmacists, etc.

Can I ask your basis about people who are overpaid needing to realise this? What’s your basis for that?

So how do they get a a "model 3 " Hospital into the group is their an option there or does it require a new build? The comparison between Beaumont/uhl is very interesting.

On a side note I was led to believe before that their is a lot of inefficiency s in the system due to double jobing in free amalgamation when the current health board was created is this still true ?

Also it's a bugbear of mine that certain departments run nearly 9-5 and an ED can be left waiting until it reopens,

On agency, that issue is being addressed over the past number of years. There’s over €35m in funding for frontline nurses invested to date.

I would note that the savings made are the agency fee (around 5% plus VAT). It’s not the beast of money everyone thinks it is. I’d also say that nurses want agency - they don’t want to give this up. Criticism should go to these nurses also, not just management.

I hear the point about GPs. But again, GPs are private sector staff. They are not health service staff. GPs controlled how many people who were allowed to be trained as GPs for years. They kept a closed book. And now you hear references to ⅓ will be retired in the next 10 years. Who’s the blame for that? Remember, the HSE don’t control colleges or training or the RCPI/RCSI. The HSE can’t dictate who will be trained, when, how many and to what standard.

All in all, the of capacity and demand is not an Irish only one. It’s a developed world problem. Quite simple healthcare has changed from treating singular diseases like heart attack on the cardiac ward to chronic disease management with interfaces of care between primary, secondary and tertiary services both public and private in older persons with more co-morbidities and more research, standards and guidelines to implement. To say it’s complex is an understatement.

All on the back of decades (and I mean decades of underfunding). When you compare health services internationally - NHS Scotland is probably the most comparable as is our geography (ish). They should be our model.

I know people won’t agree with me but we’re not doing so bad in the health service.

Nail on the head. This is from the UK.

‘fixing healthcare’ is the wrong end of the stick.

Not at all.

All given on the caveat that it’s only one persons perspective. If we could all accept that there’s so simple solution to complex problems which have multiple causes and no silver bullet then we’d all be in a better place.

All in, it really is a good health service. My heart does go out to people who’ve been harmed. You’ve no idea how much that affects health care professionals and how hard they work to improve the quality of the service they provide. Looking back at hard cases it’s easy to identify the problems - it’s no excuse, it’s just trying to explain why what happens, happens.

Oh well of the majority of posters are more negative than you have been, then I must get your reward ready.

Too bad those posters didn’t teach you to ask first rather than post stupid comments.

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

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?

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

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

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

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.

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

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.

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.

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