University Hospital Limerick- what can be done?

I agree with you but the general point I was trying to make is there's alot of attendance to ED where the patient needs alternative care rather than an ED,

I also get the negligence side too, but thats another subject of perhaps compo culture, they need to make a best judgement call sometimes as is their job,

but alas when that lands them in trouble its game over and off they send the patients, surely we've all been in the ED and witnessed plenty antics

This will put some backs up.

I'm an Australian. UHL is bloody joke, it's an overcrowded, pokey cramped rabbit warren. The staff are excellent, but the hospital is unfit for purpose given the size and nature of it's catchment.

There is only one sane answer and that is to replace UHL instead of trying to constantly patch it with sticking plasters, and build a new, large modern hospital. The government just had the largest surplus in the EU at €10 billion, and I have seen at least one headline about the problem of what to do with it.

Anyone with an interest in a hospital that works and doesn't kill people due to poor performance and is free of patients on trolleys as a permanent operating practice for over 20 years straight, might have some ideas on how to spend it.

I would be familliar with the QE2 medical centre in Perth Australia. When I first set foot in UHL I could hardly believe what a cramped rabbit warren it is.

The problem I suspect is getting the bleeps in Dublin to spend a sizable amount of money beyond the pale.; €2 billion on a electrical interconnector with France is ok, though. You could buy a stupidly cost inflated children's hopital for that.

GPs, community, pharmacies can only do so much.

The almost first sign of trouble they send you to some version of ED/GEMU

Oh well if you read something, somewhere once that said something that you agreed with, well then what else is there to say.

It’s clear of course that you haven’t read the thread.

Very funny.

You’ve clearly not read what I’ve posted. The question by the OP was not ‘please tell us all how bad it is over and over again’. The question was ‘what can be done’. I set out to narrow down the issue not to UHL broadly but to the ED in UL; why the ED is overcrowded; why it’s not a UHL only issue, how it’s systemic and historical; and how simple answers to complex issues by people who don’t even know the question is unhelpful to say the least. I gave facts, figures and evidence - not only specific to UHL but more broadly to the Health Service as the topic expanded to show that not as bad as people make out - merely that it’s bad from your perspective when you’ve engaged with the service. I’ve clearly expressed that any harm is unacceptable, I’ve shown compassion to those who attend and who have been harmed, and challenged commentators on here who think people don’t deserve to attend.

You know nothing about me. You don’t know anything about my health history, my families health history or how many times I’ve been in a hospital or otherwise with a family member.

I’ve never defended poor care - I’ve tried to explain WHY it has occurred so as to form a basis of how to improve it.

If your mother wishes to die at home, might I suggest an EPOA where her will and preference is respected. (Hope you don’t mind the enormous, complex, decades long work it took to implement that.)

The evidence you challenge you dismiss by challenging the methodology. All you have to do is click the link and read. All the details for you are there. But let me shorten it for you - as you seem to have difficulty comprehending these issues - even though it’s literally in the front page. 10,904 people; 44% response rate. It’s an internationally validated survey, comparable to a number of national patient surveys worldwide; where Ireland has one of the HIGHEST response rates of any country worldwide. (This must be hard for you).

Here’s UHL as you can’t seem to find this information yourself.

There’s 67 questions. Explore it yourself.

Only 7% said they were not treated with respect and dignity. Going up to 33% in ED (see, not hiding anything)

Areas to improve

Areas they’ve done well on.

But the best you can come up with is violence. Brilliant.

A piece by Paul Cullen in Irish Times this weekend. Not a big fan of his to be honest but thought I’d reference it for this thread.

“There is evidence to suggest the hospital is not coping with demand as efficiently as it might. UHL has the second-lowest level of weekend discharges of any hospital. The fewer patients dealt with at weekends, the more remain in the hospital early in the week, contributing to overcrowding.

The hospital’s emergency department has also been providing less consultant cover during the week than other model 4 hospitals, resulting in fewer decision-makers on-site to make key decisions about admitting and discharging patients.

Just one consultant was rostered after 5pm on weekdays (working up to 8pm and on-call after that), whereas in University Hospital Waterford, which has the lowest number of patients on trolleys, senior staff are on-site up to 11pm.”

Id like to see the evidence. It might be second lowest but by how many. Discharges are a function of community service, not always the hospital. If there’s no community service it can be hard to discharge. Still you’d expect a consultant cover that is comparable to other Model 4s.

“The midwest has the second lowest bed capacity in the country, a spokesman said.

The midwest also has the lowest private bed capacity of all regions, while 200 out of the current 530 beds in UHL are in multi-occupancy wards”

I had forgotten to mention how important private hospitals are to the public system. I don’t agree with them but they take a lot of pressure off especially day to day stuff. So the absence of private hospitals is not something UHL can lean on unlike all the other Model 4s, combine that with no Model 3!

HSE is rigid when it comes to contracts etc... I wittnessed on multiple occasions scenarios where nurses wanted to cut back on hours for various reasons and only the ultimate threat to resign resulted in a positive outcome for said Nurse.

On the topic of agency staff, what i experienced first hand is that agency staff is being assigned on the day what ward they are going to they present themselves to the person in charge of allocation and will be asigned accordingly, many agency staff are even working between community Hospitals and acute hospitals because it gives them a break of the madness in the acute setting. The majority of agency staff wants a certain flexibility which surprise surprise the HSE cannot provide. From the various settings i was in over the years I know 1 Nurse who is on the same ward all the time working Agency.

As for your comment of wards being over staffed or perfectly staffed, this shows you have no clue whatsover as to how things are on the wards. Do you have that opinion from personal experience on a ward or from a pdf file?

My original point was, the HSE doesn't follow up on outcomes. You said of course they do and listed a large number of publications that do. I took a look through one of them:

What this is, is a monthly data dump showing statistics. That's nice, but it's not followup. One can gather data till the cattle come home, if there's no plan driven by this data, it's a nice job for administrators is all.

Are they all this way? I skimmed another I can't find the link to now, and it was more of the same. This is just one monthly set of data, there are probably hundreds of these across all the hospitals and whatnot. Not particularly useful for the consumer per se, but should form

Can you point out such a plan, one with measurable targets? Like, we'll reduce the number of 70+ year olds contracting MRSA in our hospitals by taking this, that and the other action, by such and such date? Because otherwise it's just... data gathering and jumping to the media and politician's tunes.

Private hospitals don’t have models. Models were established by the Acute Medicine Programme (and Surgical Programme) over a decade ago.

Private hospitals help by taking procedures off the public list. Don’t get me wrong - the tax payer pays for it and pays well. I’m not convinced that all procedures are required. Remember - private hospitals make their money by procedures and investigations. But it’s another pressure release valve that UHL doesn’t have that every other Model 4 hospital has.

It should be pretty clear to everyone that I work in a hospital. I’ve been on the wards for 20 years. but as I mentioned in some of my first posts, this is part of the problem. Everyone sees it from their perspective and think that they know it all or have the answer. Even if I didn’t work on the wards for so long, it still doesn’t mean that I can’t form a view. I’ve never worked in community but that shouldn’t stop anyone having a position.

As mentioned earlier, as an employer the HSE has the right to organise itself so as to provide the best output for patients. It’s my view that the HSE is a particularly flexible organisation for nurses who get far more air time that all other professions put together.

And you will see that I said some wards are perfectly staffed. This is all available data on FoI. It shouldn’t be too unreasonable to say that not all wards require staff. You will also know that safe staffing is rolling out to hospitals first (model 4, then rest) then ED and then community.

and yet another avoidable death in UHL under investigation. Can anyone stand over this….. how anyone can defend UHL regardless of staffing and bed issues beggars belief? All of the deaths recently reported in UHL were down to mismanagement and patients not being checked up on or their symptoms being dismissed.

https://www.rte.ie/news/2024/0327/1440386-inquest-limerick-hospital-death/

Since the HSE polices itself, rather than a truly independent board (like the one brought in for the Savita case,) nothing will change. It's "regulatory capture" at its finest, no consequences. The HSE gets to decide what the "Best output" is that's mentioned above. Whether that actually means 'do good' or 'do no harm' is up to their decision makers.

it frightens me. I have a daughter with 3 little ones under 5 years old in a rural area close to Limerick, UHL is her hospital. The other day the 4 year old got sick suddenly , high temperature and a deep cough. Doctor gave steroids and antibiotics and said if no improvement in 6 hours to go to UHL A&E. I was petrified, all the recent bad press and deaths does no instill confidence. Thankfully the child responded to the medication.

Going forward if there is any emergency UHL is the place for her and her children to go ………..and take their health and sometimes their life in their hands by doing so.

I totally get you, I have a 3 year old and a 5 year old. My first port of call with them is the Laya centre over at ivans cross.

To be honest, theres people going to the A&E that shouldnt be, they need to see their doc first like you did. The proof of this was how empty the A&E was during covid.

GPs have a lot to answer for too, they are sending people to the A&E instead of seeing them also.

People did protest against it extensively to prevent the downgrading of Nenagh and Ennis during the FF government, there were massive Labour led protests at the time to prevent it from ever happening. We knew what would happen and the overcrowding it would lead to having everything concentrated in UHL so none of this is a surprise. What's happening now isn't shocking, it was entirely predictable and the reason for all the protests back then at a point when it could and should have been prevented.

Then Labour who led the protests got into power and implemented it anyway. There's a huge sense of betrayal and anger among the public but also a sense of futility when previous protests were ignored and politicians across parties backtracked on promises.

Take a look at this from 2009 for some nauseating hypocrisy:

https://www.alankelly.ie/blog/2009/02/21/nenagh-hospital-protest/

9-5 with breaks for lunch, lots of official holidays, nothing on the weekend… HSE controls who watches the HSE, so nothing will change.

thanks for that info, I will pass it on!

Because of regulatory capture. HSE is responsible for policing itself, and making itself look good, too. They're not neutral.

In other countries the two functions are independent. Not Ireland.

What I found amusing the other day was looking up HSE rankings. A few years ago (2018?) it was something like 80th. Now, much higher. So, the question I had, that I couldn't find an answer to, was what changed, and why Ireland had to have an 80th ranked health system for so long, presumably from the start of the HSE.

If it just took a couple years for such a rapid improvement, what prevented it from happening earlier? In my opinion, there was no will to do this because those that do the policing report to the same management as those that do the, hmmm, indiscretions.

Doesn't matter. HSE will just prevaricate about the impacts - they audit themselves. No chance at the truth.

FWIW, my plumber spent 4 days on a trolley with painful diverticulitis. 4 days. Youngish man. On a trolley. But, oh, US health care - where in my 50+ years living in the US I never knew anyone stuck on a trolley for days - is so bad and the HSE is just great. Yet, everyone I know here, has a trolley/inept surgical outcome story.

2 days is typical treatment for diverticulitis in the US. It almost never requires a hospital stay. Everything in Ireland seems to require a hospital stay.

There are many models of virtual ward. This is the one planned from end of last year.

https://www.gov.ie/en/press-release/211c0-minister-for-health-announces-acute-virtual-ward-programme-in-limerick-university-hospital-and-st-vincents-university-hospital/