The Health Information and Quality Authority (HIQA) has published its independent Review to inform decision-making on the design and delivery of urgent and emergency healthcare services in HSE Mid West. 

Commenting on the publication of the Review, HIQA’s Director of Healthcare Regulation, Sean Egan, said: “This Review was prompted by significant concerns for patient safety in HSE Mid West, which have remained the utmost priority informing the advice provided to the Minister for Health. This Review was delivered with the support of a number of organisations and individuals, including patients and their families, whom HIQA wishes to thank for their contributions.” 

Dr Máirín Ryan, Director of Health Technology Assessment and Deputy CEO at HIQA said: “HIQA also wishes to acknowledge the significant work undertaken by the Economic and Social Research Institute (ESRI) at the request of the Department of Health in relation to future bed requirements for the Mid West, which informed HIQA’s advice.”

Dr Ryan continued: “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’s advice highlighted an immediate need for action and investment to address current risks to patient safety in the shortest timeframe and safest way possible. The solution must also have regard for the ESRI projected capacity requirements to 2040. 

HIQA has presented the Minister for Health with three options for how this might be achieved. These include the expansion of capacity at UHL on the Dooradoyle site (Option A); the extension of the UHL hospital campus to include a second site in close proximity under a shared governance and resourcing model (Option B); and the development of a Model 3 hospital in HSE Mid West, providing a second emergency department (ED) for the region (Option C).

HIQA is of the view that Options A or B will likely yield the required inpatient capacity in the Mid West within a shorter timeframe, thereby addressing the immediate risk to patient safety. Option C may 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. Given that the ESRI projections span a wide range in terms of additional beds required, it will be important to ensure that decisions made around the future design and delivery of urgent and emergency healthcare services enable flexibility in how services are planned and developed. It is essential that there is ongoing monitoring of actual demand for services relative to the ESRI capacity projections, to support timely decision-making.

HIQA’s Director of Healthcare Regulation, Sean Egan, continued: “In working to progress any of these options, HIQA recommends the development of a comprehensive strategic plan. This should remain focused on addressing the safety concerns which prompted this Review, while having regard to the future demographic and policy considerations. Ongoing communication and engagement with the people of the Mid West will also be crucial to its delivery.”

The advice document can be found at the link at the top of the page.

Ends

Further information:
Marty Whelan, Head of Communications & Stakeholder Engagement
085 805 5202, mwhelan@hiqa.ie

Notes to Editor:

• In mid-2024, the Minister for Health asked HIQA to conduct an independent Review to inform decision-making around the design and delivery of urgent and emergency healthcare services in HSE Mid West. As part of this request, HIQA was asked to consider the case for a second emergency department (ED) in the region.
• The Review was conducted jointly by the Healthcare Regulation and Health Technology Assessment Directorates within HIQA.
• To progress this work, HIQA took a programmatic approach spanning a number of different areas to inform the overall advice that has been provided to the Minister for Health. These included:
  • international evidence reviews to identify measures to alleviate ED overcrowding and the requirements for the provision of an ED service
  • a review of policy developments between 2000 and 2024 that have impacted current service configuration, design and delivery in the Mid West
  • regulatory inspection of the healthcare services in the Mid West, building on the ongoing programme of monitoring of services in the region against the National Standards for Safer Better Healthcare
  • a review of data relating to capacity and service activity performance to understand the situation in the Mid West and how it compares with other health regions
  • a stakeholder engagement exercise, including a public consultation, to seek the view of both people in the Mid West and other interested parties regionally and nationally. This stakeholder engagement exercise involved 1,121 submissions via an online survey and 17 in-person meetings.
• 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. HIQA used the ESRI’s regional projections to inform its advice on potential options for the necessary expansion of urgent and emergency healthcare services and inpatient capacity in the Mid West, to meet an expected increase in demand.
• All of the work conducted by HIQA was supported by an Expert Advisory Group convened to provide input and advice through this review process. Furthermore, through HIQA’s regulatory inspections, this Review has also considered the findings and recommendations of the Report of the Investigation of UHL by Chief Justice Frank Clarke.
• 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.