The UHL is no longer short of funds. Why is it still so far from satisfactory performance? – The Irish Times

Following harrowing evidence from last week’s inquest into the death of 16-year-old Aoife Johnston at University Hospital Limerick (UHL), the state’s health watchdog issued a third inspection report on Thursday which highlights the poor performance of our most overcrowded hospital.

Inspectors from the Health Information and Quality Authority (Hiqa) found some improvements at UHL, but there was little in their report to encourage optimism about an early solution to its many problems.

These problems should be divided into different categories. The first relates to the way health services were reconfigured in the Midwest more than a decade ago. Locals claim UHL never received the funds it needed to meet demand. The hospital is the only large (model four) hospital for a catchment area of ​​400,000 people and, unusually, there are no model three hospitals in the region.

Hiqa’s latest report speaks of a “gap” between the number of people attending the hospital’s emergency department (the second highest in the country) and the hospital’s capacity of 536 beds, one of the lowest among hospitals in the country. model four.

Although the hospital was initially underfunded, this is no longer the case. Hospital spending is up 75 percent since 2016, a recent report showed — the highest in the country.

Staffing has increased by more than 1,000 people since the end of 2019, an increase of 40 percent. The hospital’s budget has increased by 45 percent. UHL has benefited from more new developments than any other hospital, including one 96-bed block under construction and another in planning.

According to various assessments, the hospital is still several hundred beds short of what it needs. These cannot be provided overnight, so the second problem, that of chronic overcrowding, still needs to be addressed.

Other hospitals have managed to overcome the tram crisis, but Limerick has gone in the opposite direction, repeatedly setting new records for overcrowding. The number of carts has decreased at many hospitals this year, but at UHL it has increased by 50 percent. This cannot be explained by claims of historical underfunding.

The source of some of UHL’s problems lies outside the hospital. More than half of patients arriving at the emergency department are self-referred, indicating difficulty in accessing GP services. The hospital lacks downsizing options, but plans to use a new 50-bed community care facility in Nenagh for convalescent care are meeting resistance.

Arguably the worst thing about Aoife Johnston’s death was that it was eminently predictable. Critics had been warning about the dangers of Limerick erectile dysfunction for years. His was not the only unnecessary death that occurred; she is just the youngest victim. Just nine months earlier, Hiqa had published a damning report highlighting the hospital’s problems, which highlighted the need to implement escalation protocols when overcrowding occurs.

However, at the weekend the teenager died in hospital, only one of the 11 emergency department consultants was on call throughout the weekend and none were physically present.

Escalation protocols, despite up to 55 patients waiting for a bed, were not followed, nor were clinical guidelines on the treatment of sepsis, which Ms Johnston had developed.

Last week’s investigation found evidence that the most senior manager on duty the night she was taken to hospital, described as an “executive on call”, did not actually have executive powers.

This manager, Fiona Steed, said she contacted the clinical director but received no response that night. She did not have the power to force the consultants to come, she concluded.

Ms Steed wanted staff to transfer up to 40 patients to wards and other facilities with emergency capacity, taking pressure off the overcrowded A&E. She assumed they had followed her advice, but they had not, for reasons that were not clear at the end of the investigation.

Hopefully former judge Frank Clarke’s upcoming report, which covers both Ms Johnston’s death and governance issues, will shed light on who really runs the hospital. And why, despite a plethora of reports, interventions and unnecessary deaths, so little has changed.