THREE OPTIONS to improve emergency healthcare in the Mid-West have been presented to the Minister for Health by HIQA including the construction of a new model-three hospital in the region.
On Tuesday, the Health Information and Quality Authority (HIQA) published its long-awaited report which it was tasked with completing by previous Minister, Stephen Donnelly (FF) in May 2024.
Minister for Health, Jennifer Carrol MacNeill (FG) will now be tasked with deciding what to do based on the information put forward in the review.
Construction of a new hospital in the Mid-West with a second emergency department has been the targeted outcome of health advocacy groups in Co Clare. This is listed as Option C by HIQA, the other options include expanding capacity at University Hospital Limerick (UHL) which is Option A or extending the UHL campus with a new second site in close proximity under a shared governance and resourcing model (Option B).
Extending capacity at UHL or adding a new second site on the campus “will likely yield the required inpatient bed capacity in the Mid-West within a shorter timeframe, to address the immediate risk to patient safety,” the review outlined. The UHL based options “may be more appropriate near-term” decisions that building a new hospital.
No consideration was given by HIQA on the county to build the new hospital. HIQA did warn, “there would be a long lead time to develop a Model 3 hospital in terms of planning, designing, building and commissioning. The associated costs would also be very significant, as evidenced by recent experiences in building the National Children’s Hospital and projected costs for the new National Maternity Hospital”. The report did acknowledge how Clare County Council informed the report it would support efforts to provide a new hospital or expand services into Co Clare.
A Model 3 hospital provides acute and emergency surgery and medicine, and critical care 24/7. It has an on-site emergency department and high-dependency unit, and strong links with the local Model 4 (tertiary referral) hospital to enable the transfer of patients requiring critical care.
Within Option C, HIQA does not believe that there would be justification for a second Model 4 hospital in the Mid West. Based on the projected bed numbers, the likely demand for many services would still not be sufficient to justify two tertiary services (Model 4 hospitals) in the Mid West. “Furthermore, the development of a new Model 4 hospital may have an adverse impact on service sustainability from a staffing and skill mix perspective in both the pre-existing Model 4 and the new hospital”.
Of the three options on the table, HIQA cautioned that building a new hospital “is likely the most expensive of the options” and “would require substantial investment to ensure the infrastructure, operational structures and processes are in place to support the delivery of a range of medical specialties and the efficient and effective functioning of a Model 3 hospital. The feasibility of this option needs to be carefully considered by the Minister for Health, with particular focus on key determining factors which will impact the viability of this option, including the significant capital cost, time to deliver and workforce considerations associated with it”.
Titled, ‘Advice to the Minister for Health to inform decision-making around the
design and delivery of urgent and emergency healthcare services in the HSE Mid West region of Ireland’, the 56 page report was published on Tuesday morning. Regional projections from the ESRI were used by HIQA to inform its advice on potential options for the necessary expansion of urgent and emergency healthcare services and inpatient capacity in the Mid-West.
A significant inpatient bed capacity deficit has been flagged as the core issue “impacting urgent and emergency healthcare delivery” in the Mid-West.
Current ongoing investment at UHL is due to provide an additional 128 inpatient
beds by the end of 2025, with a further 96 beds in planning. Immediate delivery of all 224 of these beds would be expected to bring UHL up to parity with current bed numbers in other Model 4 hospitals, relative to demand. However, the timeline for 96 of these beds is now estimated to be 2029, by which time demand for acute capacity will have increased further in line with demographic change.
Recent investments, further developments to grow capacity at UHL “are welcome and should be expedited where possible. These interventions however will not fully address current deficits in inpatient beds and further action is now required to provide additional inpatient bed capacity in the Mid West. Given this, the decisions arising from this review should aim to deliver the necessary inpatient bed capacity within the shortest possible timeframe to mitigate potential patient safety risks arising from the demand-capacity mismatch,” HIQA’s review stated.
Members of the public who participated in public onsultation perceived the current issues at UHL as an urgent and emergency care problem. In contrast, staffing groups and other interested parties predominantly cited overall inpatient bed capacity issues in the Mid-West as the key cause of overcrowding and the need for this issue to be addressed in the first instance.
Data analysis showed as a “key finding” that “the number of inpatient beds at UHL remains significantly lower than other Model 4 hospitals nationally when compared to the number of ED presentations. While there has been investment in bed capacity at UHL in recent years, demand for healthcare services in the region has also grown in line with demographic changes. HIQA’s data analysis indicates 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.
“However, the single ED configuration for the region is different. It is noted that the pattern of urgent and emergency care service usage in HSE Mid West differs from other health regions with a higher proportion of this care provided by local injury units. The overall acuity of patients who attend the ED at UHL was found to be higher than for other EDs around the country, likely due to these service usage differences,” the report added.
