A new hospital in the Mid-West region with a second emergency department is among three proposals presented to the Government by HIQA following a review of urgent and emergency healthcare services in the area, reports RTE.
Other options include increasing capacity at University Hospital Limerick (UHL) in Dooradoyle or expanding the existing UHL campus by developing a nearby second site.
The Health Information and Quality Authority, tasked with reviewing the services in May 2024, stated that either increasing existing capacity or extending the current campus would be the most effective way to add more hospital beds in the shortest possible time — a key step toward mitigating risks to patient safety, reports RTE.
UHL regularly tops the national list for the number of patients treated on trolleys or in corridors.
According to the Irish Nurses and Midwives Organisation, 133 patients are currently waiting for beds at UHL.
A new 96-bed facility, expected to open “imminently,” will still fall short of the overall need for capacity at the hospital, reports RTE.
A Government report published last year — The Acute Hospital Inpatient Bed Capacity Expansion Plan — projected that 382 additional beds will be needed in the region by 2031.
Similarly, a 2022 Deloitte report commissioned by UHL concluded that 302 inpatient beds and 63 day-case beds are necessary to meet demand, reports RTE.
HIQA’s report, released today, reaffirms these findings.
“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,” it stated, reports RTE.
“We recommended immediate action and investment to address current risks to patient safety in the shortest timeframe and safest way possible,” reports RTE.
In 2009, urgent and emergency healthcare in the Mid-West was restructured, leading to the closure of emergency departments in Ennis, Nenagh and St John’s hospitals and the centralisation of ED services at UHL.
While bed capacity at UHL has been expanded in recent years, HIQA notes that population growth and demographic shifts have led to increased healthcare demand in the region.
Their data show that emergency care usage in the Mid-West is comparable with other regions on a per capita basis, though the single-ED setup is unique, reports RTE.
The Mid-West also sees higher reliance on local injury units, with UHL’s ED handling more critical cases than other EDs, possibly due to this model of service delivery.
The report noted ongoing reliance on overflow capacity, with many patients still being treated on trolleys in both ED and inpatient wards.
“Within this context, patient safety risks will persist until the demand-capacity gap is resolved,” the report stated, reports RTE.
Census data show that Limerick and the wider Mid-West have a greater proportion of older residents compared to eastern regions, increasing pressure on hospital services.
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Limerick also sees higher rates of chronic illness, disability, and social deprivation — all factors contributing to higher demand for hospital beds, reports RTE.
The report outlines three solutions to the crisis.
Option A proposes expanding UHL’s current site in Dooradoyle.
HIQA believes this is feasible but notes the planning process might slow progress. This option would expand the emergency department and other services, maintaining UHL as the region’s sole 24/7 ED, supported by Medical Assessment Units in Ennis and Nenagh, reports RTE.
This is considered the least expensive approach and would support staff recruitment efforts and clinical capacity at the current location.
Option B involves building a second hospital close to the existing UHL site, reports RTE.
A two-campus model would help meet projected bed needs from the ESRI, allow for the future development of services, and offer more operational flexibility.
Under this option, the ED and complex surgeries would remain at UHL, while other services would be relocated to the new facility.
HIQA noted this would need major investment to ensure seamless integration of services across the two sites, resulting in higher capital costs, reports RTE.
Option C offers a more radical alternative — creating a new Model 3 hospital with a second 24/7 ED at a different location.
HIQA did not identify where this new hospital would be built.
It ruled out the need for another Model 4 hospital in the region but said a second ED would ease pressure on UHL and offer improved access for some residents, reports RTE.
Any decision would involve weighing whether to renovate an existing facility or build a new one from scratch.
This option would represent the most significant departure from the current system and would come with the highest costs.
Option C is considered a long-term solution only, as it wouldn’t deliver immediate relief to the hospital’s capacity issues. It would also require new governance structures and healthcare processes within HSE Mid-West, reports RTE.
Staffing could become an issue as well. HIQA warned that attracting healthcare workers to less urban areas may prove difficult, affecting the success of recruitment.
This scenario would also demand more resources than either of the other two options, reports RTE.
HIQA clarified that its report “was not conclusive” in terms of recommending one option to the Health Minister over the others.
However, the Authority said that Options A and B are likely to increase bed capacity more quickly, reports RTE.
It stressed that careful decision-making and “proactive engagement” with the public will be critical to building trust and improving healthcare delivery. The HSE, it added, must demonstrate alignment with government policy, deliver a detailed plan, and measure short-term improvements in service availability.
HIQA also urged improvements in leadership, governance and operational management at UHL, reports RTE.
It recommended stronger pre-hospital emergency care services to reduce pressure on the ED.
Additional steps include expanding community care, improving GP access across the region, increasing workforce investment, and refurbishing existing healthcare services in the Mid-West, reports RTE.
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