Telling the sick to avoid an A&E is truly bizarre concept

Concerns have been raised about patient safety and overcrowding at University Hospital Limerick. Photo: Niall Carson/PA


The horrifying report on conditions in University Hospital Limerick’s (UHL) emergency department will come as little surprise to those who live in the region. The overcrowding at the A&E in the Dooradoyle hospital occasionally makes national headlines when patients are reportedly being urged not to attend due to pressures on bed capacity. However, locally, the travails at the hospital are well known.

For some time now, there has been anecdotal evidence of GPs advising patients not to attend A&E, even during the worst of Covid-19, as they would be stuck on a trolley for days.

A hospital where patients are better off not going for treatment is a surreal concept, but the facts behind the theory are borne out by the health watchdog.

The Health Information and Quality Authority (Hiqa) found patients at risk of harm. Cases where some have waited up to five days for a bed amid acute staff shortages paint a bleak picture of the health service in 2022. The report followed an unannounced inspection in mid-March, but merely confirms suspicions about the hospital.

One patient was waiting for 116 hours, another for 85 hours and a third for 71 hours for a bed. The number of patients in the resuscitation area was twice its capacity. One patient waited 45 hours for an angiogram.

The report is staggering. The usual apologies, excuses and promises of improvement were issued. However, it is amazing that the health watchdog took so long to expose the conditions in one of the country’s largest hospitals. It is hardly the first time UHL has come on the radar for all the wrong reasons.

The Hiqa report found demand for services exceeded the emergency department’s capacity. There was ineffective patient flow, and decreased in-patient bed capacity significantly contributed to overcrowding. Nurse staffing levels were also insufficient.

The argument from the Government is that major hospitals and centralisation of acute services is the future of healthcare here.

Smaller hospitals do not have the expertise and capacity to provide the best outcomes for patients who need acute care from multi-disciplinary teams in major hospitals.

These arguments are playing out in Navan, where experts are saying Our Lady’s Hospital emergency department is not safe.

UHL is the only hospital in the Midwest offering a 24-7 emergency care and critical care service for those with more complex requirements. The theory is a patient will get the best care there. The practice is somewhat different.

Such reports do little to reassure patients about progress in health reform or encourage buy-in for changes in service delivery.