FRIENDS OF ENNIS Hospital have refuted the clinical advice of the HSE’s Chief Clinical Officer not to reopen 24 hour emergency departments in Ennis, Nenagh and St John’s.
In correspondence obtained by The Clare Echo, the HSE’s Chief Clinical Officer, Dr Colm Henry advised the Minister for Health, Stephen Donnelly (FF) at the beginning of December not to reopen 24-hour emergency departments in Ennis, Nenagh and St John’s.
Time critical intervention for unclear serious emergency conditions cannot be provided at model two hospitals, Dr Henry stated. He said there was “accumulating evidence” to better outcomes in time critical conditions where the clinicians delivering that care treat high volumes of such patients.
A hospital providing a 24 hour emergency department service must have supporting services such as an intensive care unit on site, access to emergency surgery and timely access to diagnostic modalities such as point-of-care ultrasound and CT scanning, he flagged.
Dr Henry referenced HIQA’s report on Ennis Hospital in 2009, “the report remains as valid today when increasing numbers of patients experiencing multiple complex conditions are surviving for longer in the community and the range of emergency treatment options has also increased”.
This report flagged that “acute, complex and specialist services are not sustainable” in Ennis, it said Ennis had an insufficient volumes of patients attending out of hours to justify an ED on a 24-hour basis.
Capacity issues in the Mid-West need to be addressed, Dr Henry acknowledged. “Having consulted with the Clinical Lead for the EMP, I am informed that the ease of transfer of differentiated patients who are clinically stable, with clear care plans in place, from UHL to the JENS hospitals (St John’s, Ennis and Nenagh), including direct transfer from the ED, is at least as good as anywhere else in the country, if not better”.
He concluded, “the position from clinical experts and programmes, in line with policy development, is against the reopening 24-hour Emergency Departments in Ennis, Nenagh and Saint John’s hospitals in the Midwest”.
In a statement to The Clare Echo, Friends of Ennis Hospital said the Chief Clinical Officer was “relying on out of date data”. The group’s members include Paul Coghlan, Angela Coll, Deirdre Culligan, Marian McMahon Jones, Cllr. Cillian Murphy (FF) and Marion O’Reilly Forsith.
Pressures of the staff at University Hospital Limerick is leading to worse outcomes in time critical conditions, they argued. “While there may be accumulating evidence in relation to better outcomes in time critical conditions where the clinicians delivering that care treat high volumes of such patients, unfortunately, in the only ED serving the Midwest region the volume of patients is so high that the converse is true, medical personnel in UHL are under such enormous pressure that they cannot safely provide the level of service that their patients require and the outcomes have been fatal in several well publicised cases in recent years where young people have died in the ED in UHL from preventable causes (DVT/Sepsis etc) which was not caught by medical personnel due to the pressures they are working under”.
Upgrading Ennis to a model three hospital can see it better equipped with supporting services, the lobby group stressed.
Numbers of patients dying before an ambulance arrives has increased by 70 percent in eight years, Friends of Ennis Hospital stated. “For 1,108 callouts last year attended by the National Ambulance Service, the person was deceased by the time of arrival. This is up 100 on the 2022 figure, which was 1,008. In 2016, when data on such response times first became available, there were only 657 deaths at the time of ambulance arrival”.
80,000 patients attended UHL’s ED last year, of this Friends of Ennis Hospital calculate that 35 percent “at a minimum” are from Co Clare. “Using the conservative figure of 35% that would be 28,000 patients we could divert to Ennis to ensure a safe service in Ennis and a safer service in Limerick which should be the goal for all stakeholders here. Critically, if we look at travel times to the ED in Limerick, thousands of patients are being left well outside the ‘golden hour’ for treatment”.
Capacity issues will not be addressed by pouring more money into UHL, the group stated while pointing out population increases have been ignored by the HSE in their arguments. “Dr Henry fails to take into consideration that in the MidWest region our out of hours GP Service (Shannondoc) has experienced chronic staffing shortages over a number of years and seems to be extremely reliant on locums to provide a service and it is commonly accepted that Locum practitioners are more inclined to refer patients to the ED compared to community based GPs thus contributing to the pressures in UHL”.
From our perspective the solution is obvious. Yes, it will be expensive, but throwing money at UHL over the last ten plus years has not made the slightest dent in trolley numbers and we must consider alternative pathways to providing adequate, safe care for the growing population in the Mid-West. In our view that means the upgrading of Ennis to a Model 3 with all that that will entails,” the statement concluded.
