June 14: Limerick must learn lessons of HIQA report

That a detailed HIQA report on region’s acute hospitals has found its only emergency department “unfit for purpose” won’t come as a surprise to the 60,000 patients who have the misfortune to be treated there every year.

That a detailed HIQA report on region’s acute hospitals has found its only emergency department “unfit for purpose” won’t come as a surprise to the 60,000 patients who have the misfortune to be treated there every year.

Nor is it news to those running the hospital. Its chief executive, Ann Doherty, used the exact same phrase in describing the department upon her appointment two years ago.

She has in the meantime been leading the process of reform across the region’s six hospitals and while the focus has been on A&E, it is the overall group that is the subject of the HIQA review.

That the report is so critical can hardly be laid at the door of Ms Doherty or others getting on with the job of implementing government policy. Yes, there is much to ponder for the management but the problems at the hospitals go much deeper than that.

The word crisis loses all meaning when crisis is an everyday fact of life. And in the emergency department at least, that is what staff and management have been dealing with for years.

HIQA believes the reorganisation of the workload of the hospitals is moving in the right direction. And where weaknesses in corporate and clinical governance in Limerick are identified, it is more often than not a veiled criticism of the government.

James Reilly came into office promising to slay the HSE behemoth. But the narrative that he was the man who would whip it into shape no longer holds water. His special delivery unit has been in the hospital since 2012 – and things have hardly improved since.

That UL Hospitals Group has not assumed full control over St John’s Hospital, for example, or that the group board doesn’t have proper oversight of its managers and clinicians is simply down to the fact that there is no statutory basis for them to so do. The minister appears happy to let management drive on with its transformation into an autonomous trust without giving them the necessary legal authority – and at the same time cutting hospital budgets and curbing recruitment.

But there are lessons for more than just managers and politicians.

It is clear that some senior clinicians in Limerick have not bought into the idea that Dooradoyle, Croom, the Maternity, St John’s, Ennis and Nenagh have now all come under the one roof. HIQA also refers to doctors’ failure to co-operate with new rosters.

The report concerns patients above all – and maybe the patients themselves can be part of the solution. While the ED in Dooradoyle is “persistently overcrowded”, the local injury clinics in St John’s, Ennis and Nenagh are underutilised.

The report suggests that these clinics should look after less urgent cases not only from their own communities but also from Limerick city and county.

It would be difficult for a triage nurse in Dooradoyle to tell the parents of a child from Kilmallock with a broken hand that he has to go to St John’s or further. But if those parents fully understand it means somebody who has suffered a heart attack or is being rushed from a major accident will be seen quicker, it might just work. Any option to alleviate the pressure on A&E is welcome. It is a paradigm shift that will require leadership from administrators, doctors and politicians across the region.