BIG READ: HIQA report on Mid-West region met with mixed reactions from Tipperay’s politicians

Tuesday, September 30, saw the Health Information and Quality Authority (HIQA) publish their review of urgent and emergency healthcare services in the HSE Mid-West region.

HIQA, which was tasked with conducting the review in May 2024, concluded that urgent intervention is needed and outlined three long-term options to help alleviate the ongoing pressure and overcrowding at University Hospital Limerick.

A new hospital in the Mid-West with a second emergency department was one of three options presented to the Government, and perhaps the most predictable solution. HIQA also suggested expanding capacity at University Hospital Limerick in Dooradoyle, or extending the UHL campus with a new second site in close proximity.

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University Hospital Limerick finds itself consistently at the top of the list when it comes to patients being treated on hospital trolleys or in corridors on a national scale.

A reconfiguration of urgent and emergency healthcare services in the HSE Mid-West region was carried out in 2009. This saw the closure of three smaller scale emergency departments at Ennis, Nenagh and St John’s Hospitals, and ushered in the current centralisation of ED care at UHL.

HIQA’s found that the total volume of emergency care presentations in the Mid-West is similar to that in other regions on a per head of population basis, but the single ED configuration for the region is different.

Their data suggests that the pattern of urgent and emergency care service usage in HSE Mid-West differs from other health regions across Ireland, with a higher proportion of this care provided by local injury units. The overall severity of the illnesses presented by patients who attend the ED at UHL was found to be higher than for other EDs around the country.

A recent Government report titled ‘The Acute Hospital Inpatient Bed Capacity Expansion Plan’ was published in 2024. That report insisted that 382 hospital beds are required in the region by 2031.

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A separate report by Deloitte commissioned by UHL in 2022, found 302 extra inpatient beds and 63 day case beds were needed in the region to meet demand.

This new HIQA report concurred with these findings in recent years.

It said: “The core issue is that there are not enough inpatient beds in HSE Mid-West which are capable of treating the sickest patients who present for urgent or emergency care.

“We recommended immediate action and investment to address current risks to patient safety in the shortest timeframe and safest way possible.”

However Alan Kelly, a Labour TD for North Tipperary and Northwest Kilkenny, denounced the report stating he found it “borderline insulting.”

He said: “I mean I don’t believe in fairness to HIQA that they should have been asked to do this. But why it took 18 months or so for this to be done is beyond me.

“The obvious decision has to be made; we need a new Model 3 hospital in the Mid West. It has to have A&E capacity and ICU capacity. We can’t keep putting everyone through Limerick. It is insane, 147 people on trolleys in one day alone this week.”

“We need a Model 3 hospital in the Mid West, not a review to tell us,” he continued.

“I’m furious with the report. Why was it even needed? Another year and a half wasted! The decision by then Minister for Health Stephen Donnelly in May 2024 to ask HIQA to review hospital services in the Mid West was a political decision to get his then Government through the General Election.

“Today’s report is another insult to the people of the Mid West as it drags out decision making yet again and more years are lost. I’m sick and tired of how the Mid West and North Tipperary are being discriminated against.”

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Independent TD for Tipperary North Michael Lowry insisted that the report is a “belated and formal conclusion and acknowledgement” of what he and others have been saying for years; University Hospital Limerick “struggles year on year to cope with acutely ill patients or emergency bed requirements.

Deputy Lowry added that while the HIQA report gives options on how to address the capacity issues in the Mid West, the priority should be that the preferred option is selected and acted upon as a matter of urgency.

Ryan O’Meara, Fianna Fáil TD for North Tipperary and Northwest Kilkenny, welcomed the publication of HIQA’s review. “I welcome that this report has finally been published,” he said after a briefing with HIQA and Health Minister Jennifer Carroll MacNeill.

“In the short term, I will be calling for increased and rapid investment to deliver the beds that we need on top of the new 96 bed block that is due to be opened in UHL this year,” said Deputy O’Meara. Longer term, he argued, “option C; the development of a Model 3 hospital is the best option for meeting that demand.”

Independent Councillor John O’Heney insists that lives are “at risk” and that the Irish Government must act swiftly and “deliver real solutions” for both staff and patients in the HSE Mid-West region.

Cllr O’Heney welcomed the report, saying that it confirms the “serious and dangerous” shortage of hospital beds in the region.

However, like many others, he found that HIQA’s 18-month assessment of the region discovered nothing that of note that was not already widely known.

“This report proves what staff and patients have been saying for years. The Mid West is under-resourced, and lives are at risk.

The Government must now choose a solution and deliver it without delay,” he said.

The local Sinn Féin response to the report was more positive, with Sinn Féin activists in Tipperary North, Dan Harty and Damien O’Donoghue saying the report is “and important piece of work” that provides a clinical underpinning to the obvious solutions neeed in the area.

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HIQA, for its part, insisted that it was not in a position to offer a single definitive solution. Sean Egan, its director of healthcare regulation, stressed the trade-offs inherent in each approach:

“We weren’t in a position to actually make that call and the reason for that is each one of these has benefits and also potential challenges. And look ultimately this is a policy decision and this is advice to the Minister to make a Ministerial call in relation to exactly how services would be provided going forwards,” he said.

“There is no perfect solution here, each of them has its own challenges but at the same time we believe that there is a requirement for urgent intervention now to provide extra capacity in the short term.”

Meanwhile, the HSE says that the opening of a newly built 96-bed block at UHL is ‘imminent’. The first of three proposed 96-single-bed hospital blocks sits just yards away from the regularly overcrowded emergency department at the hospital.

However HIQA’s new 56-page report also suggested that any one of the three options chosen from their list of solutions could bring about planning delays that could push a second block of 96 beds back until 2029.

Monday, September 29, saw 147 patients on trolleys at UHL according to (INMO), just three patients shy of the record 150 patients recorded on trolleys there on Wednesday, February 7 2024.

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