BREAKING: HIQA highlights need for 'immediate action' to improve emergency care in the Mid-West

A REVIEW into urgent and emergency healthcare in the Mid-West has been published this afternoon, putting forward three options to improve overcrowding in University Hospital Limerick (UHL) and across the region. 

The options presented to the Minister for Health include; expanding capacity at UHL, extending the UHL campus to include another associated hospital site in close proximity to UHL to support the services of the hospital and the third option put forth is to develop another Model 3 in the Mid-West, which would include a second emergency department (ED). 

Dr Máirín Ryan, Director of Health Technology Assessment and Deputy CEO at HIQA said: “HIQA found that the core issue impacting urgent and emergency healthcare delivery in HSE Mid-West is the significant inpatient bed capacity deficit relative to demand from patients presenting with more serious or complex care needs. 

“This is intensified by an ever-growing demand for services, which will continue into the future as highlighted by the ESRI projections for the period up to 2040. The current situation caused by the demand-capacity gap at University Hospital Limerick (UHL) and across HSE Mid-West, presents a risk to patient safety.”

HIQA believes that the first two options - expanding capacity or adding on a nearby hospital site, would have the most immediate impact on inpatient capacity in the Mid-West, and the report says this would be “addressing the immediate risk of patient safety.” 

The final option of a second Model 3 hospital would “have the potential to meet longer-term bed requirements, but would be least capable of addressing immediate capacity deficits, while being associated with the longest lead times.” 

HIQA have recommended the development of a comprehensive strategic plan, to focus on addressing safety concerns, while also considering future needs and demographics. 

“Ongoing communication and engagement with the people of the Mid-West will also be crucial to its delivery,” HIQA’s Director of Healthcare Regulation, Sean Egan said. 

In the lead up to the release of the review, there has been widespread speculation about whether or not HIQA would recommend another emergency department (ED) for the Mid-West or another Model 3 hospital. 

The closure of the ED’s in Ennis, Nenagh and St John’s Hospital have come under fire, with many politicians citing this, along with staffing issues, as the reasons for the severe and consistent overcrowding at University Hospital Limerick.

This review was called for this time last year in late September 2024, by the then Minister for Health, Stephen Donnelly, following a report by former Chief Justice Frank Clarke in the aftermath of the death of 16-year-old Aoife Johnston from Shannon. 

Aoife died on December 19, 2022 and a four-day inquest at Limerick Coroner’s Court in Kilmallock, heard that the teen was a victim of “systemic failures” according to Limerick Coroner John McNamara. 

The Clare teenager was not treated in time for sepsis due to Meningitis B and waited more than 13 hours for antibiotics, which if given within 15 minutes of her presenting to the emergency department, could have saved the young girl’s life. 

At the time of the inquest, in April 2024, when a verdict of medical misadventure was delivered, Aoife Johnston’s parents Carol and James called for another emergency department in the Mid-West, saying they never want another family to go through what they experienced. 

Read more on Aoife Johnston's inquest here.

The ED’s in Ennis, Nenagh and St John’s Hospitals, all closed in 2009, as part of a HSE reconfiguration plan - they closed the year that Aoife Johnston was born. 

Mr Frank Clarke’s report detailed how understaffed the ED was and how the overcrowding at UHL was more “severe” than it should have been. 

UHL has the highest number of people waiting on trolleys, according to the Irish Nurses and Midwives Organisation (INMO), on an almost daily basis. 

This week, the overcrowding hit 147 admitted patients waiting for a bed - just three less than the highest number ever recorded, when there were 150 patients without beds on February 7, 2024. 

Today (September 30, 2025), there were 133 people waiting for beds at the Dooradoyle hospital - more than three times the amount waiting at the next overcrowded hospital today, which had 40 patients on trolleys in Letterkenny University Hospital. 

General Secretary of the INMO, Phil Ní Sheaghda said: “Unless we see a hospital-by-hospital plan to tackle overcrowding, we are in for a very bleak winter in Irish hospitals which will see nurses and patients in extremely unsafe circumstances.”

The review was conducted jointly by the Healthcare Regulation and Health Technology Assessment Directorates within HIQA.

HIQA also worked with the Economic and Social Research Institute (ESRI) to understand projected changes in the demand for urgent and emergency care and inpatient capacity in the region up to 2040.

Explainer of the different hospital models: 

• Model 2 hospitals provide the majority of hospital activity including extended day surgery, selected acute medicine, local injury units, a large range of diagnostic services (including endoscopy, laboratory medicine, point-of-care testing, and radiology (CT, US and plain film X Ray)), specialist rehabilitation medicine and palliative care.
• Model 3 hospitals provide 24/7 acute surgery, acute medicine, and critical care.
• Model 4 hospitals are similar to model 3 hospitals, but additionally provide tertiary care and, in certain locations, supra-regional care.

More on this report to follow.