University Hospital Limerick is the worst-hit hospital in the country in relation to overcrowding.
The region’s main hospital has accounted for 15% of the total number of patients left on trolleys so far this year.
University Hospital Limerick has topped the poll for the most overcrowded facility in the country this year.
The latest analysis by the Irish Nurses and Midwives Organisation shows that to date, 15,322 people have been left waiting on trolleys at the Dooradoyle facility.
This accounts for 15% of the more than 100,000 patients who’ve been left without a bed in hospitals across the country.
UHL’s overcrowding figures are more than 40% higher than the next busiest facility – Cork University Hospital.
The nurses union is now calling for urgent action to address what its described as an ‘unsafe’ situation.
The INMO wants all non-urgent elective care in public hospitals to be cancelled, accommodation to be provided for essential workers, legislation to underpin the implementation of safe staffing levels and for funding to be prioritised for delivery of long-term care in the community.
The union expect the crisis to last until the end of March at the earliest and is calling for private hospitals to provide elective activity until this point.
The five worst-hit hospitals so far this year are:
- University Hospital Limerick 15,322
- Cork University Hospital 10,107
- Sligo University Hospital 6,919
- St Vincent’s University Hospital 6,359
- Letterkenny University Hospital 5,366
INMO General Secretary Phil Ní Sheaghdha said:
“This is the earliest in any given year that trolley figures have reached this unacceptable level. It is not good enough that nurses and the patients they are trying to provide safe care to are expected to accept this as normal.
“Senior figures in the health service have warned the Irish public that waiting over 24 hours to be admitted to hospital is the new normal. In no other country would this level of indignity be accepted.
“Behind our trolley figures that we publish everyday are vulnerable patients trapped in undignified and unsafe conditions. Our members are working incredibly hard, it is clear that our public health service can no longer provide both emergency care and elective care. To that end we are calling for all non-urgent elective care in public hospitals to be curtailed. Private hospitals must be now brought on the pitch to provide elective care until the end of March 2023 at the very least.
“We know that many nurses and midwives are signaling their intention to leave the profession or go abroad to work in safer conditions. Directors of Nursing and Midwifery in hospitals are telling us how incredibly difficult it is to recruit but also retain staff, particularly in large hospitals. We are now calling on the Government to deal with this unsafe, unacceptable and inhumane situation.
“While it is welcome that safe staffing is prioritised in the winter plan, we know that in many hospitals that safe staffing is not being met, a number of hospitals around the country have insufficient rosters and inappropriate skill mix to provide safe care.
“We do not need more pronouncements of increasing bed capacity, which is a meaningless endeavour if you do not have the staff to ensure that these beds can be opened safely. The Department of Health and the Health Service Executive cannot afford to be passive. Between overcrowding and retention of nurses, the situation is worsening every day. Every possible measure that can be taken in the coming days and weeks must be taken.”
UHL Statement:
Along with the long-standing challenges arising from the shortage of acute hospital beds in the Midwest region, UL Hospitals Group has for some time been managing—and continues to experience—extraordinarily high volumes of attendances at its Emergency Department (ED) in University Hospital Limerick (UHL).
Emergency attendances at UHL reached 76,473 in 2021. This figure, the hospital’s busiest year on record for emergency care, is projected to increase by 4% by the end of 2022. In the two weeks to Tuesday morning at 8am, daily attendances averaged at approximately 230; significantly higher than the 210 average daily attendances recorded in 2021.
At this time, we’re currently caring for high volumes of frail, elderly patients and other patients with complex care needs. People with less urgent care needs can expect long delays in the ED at this time. We’re working to ensure that care is prioritised for the sickest patients. As part of our escalation plan, additional ward rounds, accelerated discharges, and identification of patients for transfer to Ennis, Nenagh and St John’s hospitals are all underway.
Elective activity is reduced every January, in order to better manage admissions surges, and we will be doing the same again in 2023.
We continue to advise patients who are seriously ill or injured, or worried that their life is in danger, to attend the ED where they will be treated as a priority. Less acutely unwell patients are asked to first consider our Injury Units, GPs, out-of-hours GP services and pharmacists before attending ED. Opening hours for Ennis and Nenagh Injury Units are 8am -8pm and St John’s Injury Unit 8am-7pm. Full contacts for these units, and details of the services available there, are available at: https://www2.hse.ie/services/injury-units/
We apologise to every patient who has been experiencing long waits for admission at UHL, and for the inconvenience and frustration this also causes for their loved ones. This is not the standard of healthcare we wish to provide for the people of the Midwest.
In addition to the Escalation Plan, UL Hospitals Group continues to work on a range of measures on Patient Flow & Admissions Avoidance; and Integrated Care Pathways in collaboration with our colleagues in HSE Mid West Community Healthcare. These and other measures, including our work with the HSE National Support Team, are set out in detail below.
Patient Flow & Admissions Avoidance
We maintain a constant focus on patient flow and admissions avoidance, through a range of measures and initiatives that include:
– An increase of 19% in attendances at our Medical Assessment Units in Ennis and Nenagh between 2019 and 2021. In the first eight months of 2022 they have seen a further annual increase of 34% combined.
– OPTIMEND involves review of elderly patients in ED by a team of health and social care professionals. International evidence demonstrates that health and social care professional teams can play role in the ED in terms of improving patient and process outcomes, particularly for older patients. In 2021, the OPTIMEND team assessed 801 older adults with a 68.3% (547/801) incidence of discharge post ED attendance. 10.3% of the total cohort experience a 30-day unscheduled ED revisit.
– Frailty at the Front Door service, as part of the Integrated Care Programme for Older Persons (ICPOP), commenced in the ED in UHL in November 2021. This service commenced with a 0.5 WTE Registrar in Geriatric Medicine and also includes the input of the OPTIMEND team. The overall aim of the frailty at the front door team is to improve the quality of care provided to frail older adults who present to UHL ED.
More recent hospital avoidance measures include the Geriatric Emergency Medicine (GEM) unit for the over 75s. This initiative, including the additional staff required to run it, has been supported by the HSE National Support Team, and aims to improve the patient experienced and reduce wait times for less acutely unwell older patients. Of the 76,500 (approx.) patients who attended the Emergency Department at UHL in 2021, more than one in four were aged 65 and over and more than one in seven were aged 75 and over.
The Pathfinder programme has also been launched in Limerick, with the aim of providing a safe alternative care pathway for vulnerable older people who have phoned emergency services, safely keeping them in their own homes, rather than transporting them to the ED for assessment. In the Midwest, Pathfinder is a collaboration between the National Ambulance Service and the occupational therapy and physiotherapy departments at UL Hospitals Group. The programme has been evaluated and found to be a safe alternative to ED conveyance for older people.
Integrated Care Pathways
We also continue to work with colleagues in HSE Mid West Community Healthcare on integrated care pathways and hospital avoidance, including initiatives focused on older people living with frailty. These include:
– Integrated Care Programme for Older Persons (ICPOP) is a community-based specialist service that provides rapid access to a multidisciplinary-delivered comprehensive geriatric assessment (CGA) for older adults living with frailty or at risk of developing frailty. To date this year, ICPOP teams in Clare, Limerick and North Tipperary have received over 600 referrals. There is currently no waiting list for this service, and service users are typically seen within seven days of a referral.
– Almost 10,000 radiology tests have been completed up to the end of August 2022 under the direct GP access Community Diagnostics Programme.
– Community Intervention Teams (CIT) based in Clare, Limerick and North Tipperary focus on hospital avoidance and early supported discharge to the person’s home. Across Clare, Limerick and North Tipperary, these teams are currently supporting an average of approximately 760 people each month.
HSE National Support Team
Since July we have been working with the HSE National Support Team and community colleagues on additional patient flow initiatives. These have been supported with additional staffing resources. We have been approved for 10 additional patient flow co-ordinators, a number of whom are already in post. A new interim head of operations for the UHL site is also in post.
The work being done with the HSE National Support Team builds on existing work and we have seen some improvement in the numbers of admitted patients waiting for a bed in recent weeks. However, the fundamental mismatch in our capacity to meet existing and future demand – in terms of beds and staffing resources – must be addressed if we want to end overcrowding in UHL. The commencement of construction on our 96-Bed Block this week will address some of that shortfall. It will be at least two years before these beds open and in the interim we will continue to focus on internal processes, admissions avoidance and integrated care pathways.
Use of private hospitals for elective care
Acute hospitals are among the partners working with the National Treatment Purchase Fund (NTPF). Like all public acute hospitals, UL Hospitals Group works closely with the NTPF in the exercise of its functions in funding treatment for public patients on waiting lists.
The NTPF arranges for the provision of treatment in an agreed panel of the country’s private hospitals, for people on waiting lists for Inpatient/Daycase and Planned Procedures (IDPP), and for outpatient activity.
The key criteria of the NTPF is the prioritisation of the longest waiting patients first. The clinical suitability of the patient to avail of NTPF funded treatment is determined by the public hospital.
The NTPF works with public hospitals, as opposed to with patients directly, to offer and provide the funding for treatment to clinically suitable long waiting patients who are on an inpatient/day case waiting list for surgery, having been referred on to such a list following clinical assessment by a consultant/specialist at an outpatient clinic. The NTPF also supports Hospitals Groups in managing specific cases of longer than desired waits for treatment.
Patients on UL Hospitals Group waiting lists who meet the NTPF criteria will be contacted directly by the Group to acquire consent for treatment in the private sector. However, patients may not always be able to take up these offers of treatment, for a variety of reasons, including the need to travel to other parts of the country for treatment.
The 2022 Waiting List Action Plan sets out how the Department of Health, the Health Service Executive (HSE) and the National Treatment Purchase Fund (NTPF), will work to reduce waiting lists. The plan has a specific focus on 15 high-volume inpatient daycase procedures, so that every person waiting for over six months who is clinically ready will receive an offer of treatment for:
- cataracts
- cystoscopies
- hip replacements
- knee replacements
- skin lesions (general surgery and plastic surgery)
- varicose veins
- angiograms
- tonsillectomies
- laparoscopic cholecystectomy
- septoplasties
- dental
- hysteroscopy
- laparoscopy (gynaecology)
- total abdominal hysterectomy
- inguinal hernia repair
In UL Hospitals Group the NTPF initiative is on target to achieve more than 4,500 consultations across ten specialities by year-end. The NTPF is one of five initiatives in our Group designed to target both the longest waiters and urgent time-critical patients. The initiatives are a mix of virtual and face to face consultations, procedures and diagnostics and are supported by numerous specialities across our hospital sites. The other four initiatives include:
– The Advanced Clinical Prioritisation (ACP) initiative, which to date has delivered 8,047 virtual consultations and is expected to achieve 10,000 by year-end.
– The Scheduled Care Transformation Programme (SCTP), which was introduced this year as a once-off funding initiative providing out-of-hours consultations for additional activity within the Group. It is supported by twelve specialties. Since starting in April of this year, the initiative has delivered 4,048 consultations and procedures, and is forecast to achieve 6,000 by year-end.
– The Safety Net Agreement (SNA) initiative has delivered 6,802 consultations and procedures to date and has just recently come to an end.
– Access to Care was introduced in July of this year and will provide additional support to patients, including inpatient and day cases.
All these initiatives are making a significant difference in tackling our long waiting lists, particularly in inpatient and day case procedures and endoscopy. The number of patients waiting longer than one year for an inpatient or day case procedure or scope in UL Hospitals Group is 160 as of today’s date, down from 1,230 at the start of the year. We’re forecasting no patient waiting longer than 12 months by year-end, in line with Slaintecare targets on waiting lists.
Since the start of this year to today’s date, October 26, 2022, the number of patients on an outpatient waiting list has reduced by 11% across UL Hospitals Group, from 56,330 to 49,700.
In that timeframe, the number of patients waiting for inpatient or day case procedures has reduced by 6% in UHL; 47% in Ennis; 53% in Croom; and 46% in Nenagh.
And for endoscopy, the numbers waiting have reduced by 65% in UHL; 66% in Ennis; and 77% in Nenagh.
UL Hospitals Group continues to work on in-house initiatives and on facilitating care in the private sector. However, the current lack of private capacity in the Midwest, and difficulties for patients in travelling outside the region for consultation and procedures, mean that more sustainable solutions are necessary in the long-term.
For example, while numbers waiting for day case surgery have fallen, there has not been a corresponding decrease in numbers waiting for more complex inpatient surgeries that in this region must be carried out at UHL. This strengthens the case being made for an elective hospital in the Midwest.
