High costs and planning delays adding to UHL overcrowding crisis

A NUMBER of issues with how University Hospital Limerick (UHL) is currently being run, along with staffing issues and infrastructural shortcomings, were all highlighted in the review into urgent and emergency care in the Mid-West, published by HIQA on Tuesday (September 30, 2025). 

The review suggested three options; A - to expand UHL, B - to add onto UHL with another hospital building close to the current Dooradoyle campus or C to build a Model 3 hospital, which would include another emergency department (ED). 

The review stated that options A and B would provide short term relief to issues like bed capacity and the ED being overcrowded, but Option C was cited as being the better long-term solution, while it could fall victim to planning delays and would cost the most, in terms of capital. 

The review projected an increase in patients attending for urgent and emergency care of between 16 and 23% between now and 2040. 

The review states that “unless inpatient bed capacity at UHL increases in parallel with this rise in ED attendances, overcrowding at UHL will continue. 

“Data available to HIQA shows that demand for urgent and emergency healthcare services and inpatient care continues to outpace available bed capacity at UHL. 

“As a result, it is imperative that the risk to patient safety continues to be managed to support the delivery of high-quality safe healthcare services, while the additional bed capacity is being developed and commissioned at UHL. 

“This should include the mitigation of any actual and potential harm and safety risks to people using services, especially those who require admission and inpatient care.”

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In terms of Option C, the review outlines that “at the time of writing, the second 96-bedded block currently planned for construction on the UHL site at Dooradoyle remains subject to an appeal placed with An Coimisiún Pleanála. 

“Therefore, each of the three options presented in this advice document should be considered in the context of potential delays associated with planning decisions, as the potential for delay has already been demonstrated. 

“A risk analysis of whether all potential capacity outlined in this document would be fully available for use over the next 15 to 20 years up to 2040 and beyond should inform the decision-making process.”

The review also noted that “UHL has demonstrated its efficiency in the ability to roll out additional bed capacity at the Dooradoyle site, with over 100 beds delivered since 2021, and another 128 beds expected by the end of 2025.”

A report from an external architectural firm suggests that UHL in Dooradoyle could be developed on a four-phase basis over the course of twenty years to “add significant additional inpatient bed capacity,” and that the bed capacity would meet the targeted projections for 2040.

The review states: “Notwithstanding the significant level of disruption that might result from a twenty-year construction project at UHL on the Dooradoyle site, Option A results in continuity of to the current urgent and emergency healthcare service configuration, whereby emergency care for the Mid-West is provided in one ED (UHL) supported by MAUs and injury units. 

“The level of change, adjustment and service disruption associated with Option A, especially during the construction and operational phases, would need to be identified at the outset. 

“Measures would be required to manage and lessen the disruption to service and care delivery, and to support staff and people in the Mid-West to adjust to any change and disruption to service delivery.”

The cost analysis of options A, B and C is deemed in the review to fall outside of HIQA’s specific expertise, but the review does say that “Option A may represent the least costly of all of the options presented, whereas Option C would likely be most costly.”

Staffing levels, recruitment and retention were also identified as potential stumbling blocks to solving the trolley crisis. 

“Workforce planning and recruitment are crucial to ensuring that any additional beds at UHL on the Dooradoyle site are fully commissioned. 

“This will also strengthen services, such as critical care, laboratory and radiology to ensure the safe and effective delivery of the range of healthcare services. 

“Expanding UHL on the Dooradoyle site provides an opportunity to continue ongoing recruitment efforts at UHL, and increase employment opportunities at the site, which may support staff recruitment and retention,” according to the HIQA review.

Meanwhile, Option B would allow for the addition of between 299 and 593 beds, giving the total UHL campus up to 1,131 beds. 

This option could also lend itself to the maternity services being located at UHL, instead of at the Ennis Road, where they currently are. 

Like the first option, Option B brings the risk that while this plan is being developed and commissioned, that demand for inpatient care at UHL “will continue to outpace bed capacity.”

A suitable site near UHL would also need to be identified and “HIQA understands that, at present, no site has been identified or acquired in the region that might be deemed suitable for Option B.”

The review states that “any delay in identifying a site will need to be carefully weighed up against the need to keep pace with growing demand for urgent and emergency healthcare services and inpatient care in the Mid-West”.

Option B would also allow for some services to be segregated. 

“At University Hospital Galway (a Model 4 hospital which spans two sites) a range of healthcare services, including outpatient services, elective care, and specialised care are delivered on the extended hospital campus location at Merlin Park Hospital.”

The review does not explore where a Model 3 hospital could be located within the Mid-West or whether it would be the expansion of a current Model 2 hospital or building a new one.