EDITORIAL: New era for Ennis Hospital

A NEW era for health services in Clare dawned earlier in the week after the old emergency department in the Mid-Western Regional Hospital, Ennis, now known as Ennis Hospital, was split into a Local Injury Unit (LIU) and Medical Assessment Unit (MAU).
Consequently, patients will now only be able to get treatment for minor injuries and non-life threatening medical illnesses on their own doorstep at Ennis Hospital.

The conversion of the emergency department into two distinct units with different opening hours is the last piece in the jigsaw of a radical acute care shake-up in the hospital, which was first signalled 10 years ago in the Hanley Report.

The specifics of the Hanley Report provoked a storm of protest at the time, with the Ennis Hospital Development Committee viewing the controversial document as a blueprint to downgrade, rather than improve, facilities.

It was a very emotive topic and the public outcry manifested itself in the shape of a demonstration. People took to the streets in protest and as many as 15,000 brought traffic to a standstill as they marched through Ennis to vent their anger.

But to what avail? In the intervening years, most of the key recommendations in the report have now been introduced at Ennis Hospital.

The most significant change in hospital care was the reduction of 24-hour accident and emergency services to just 12 hours in April 2009.

This was quickly followed by the removal of surgical and some limited breast disease services after a damning Health Information Quality Authority (HIQA) report revealed major deficiencies in acute care.

The investigation at Ennis Hospital by the health and safety watchdog followed the much-publicised cancer misdiagnosis and subsequent deaths of Ennis woman Ann Moriarty and Edel Kelly, a young mother from Kilrush.

Interestingly, HIQA didn’t undertake any serious critical analysis of the investment, or hospital campaigners’ claim of a lack of significant investment in emergency services over the previous 10 years, which they believed were the main cause of gaps in the level of care.

It could be argued that this report signalled the death knell for 24-hour acute medical, surgical and some limited cancer care at the hospital, as it provided the Health Service Executive (HSE) with a strong case to move more services into the Mid-Western Regional Hospital, now known as University Hospital Limerick (UHL), in the interest of patient safety.

However, no alternative was examined, such as the proposal put forward by the local hospital development group of developing a certain level of acute care on a round-the-clock basis.

No one has suggested that Ennis Hospital should have the same level of services as the regional hospital in Limerick.

However, as more and more local patients with serious injuries and life-threatening injuries are transported into Limerick, the six million dollar question remains; will Limerick be able to cope with additional patients from the Banner County and indeed North Tipperary?

Based on the most recent evidence and reports of overcrowding in Limerick, the answer, in the short-term, is an emphatic no.

In fact, just three months ago, the HSE came under renewed pressure to restore 24-hour emergency services in Ennis and Nenagh Hospitals in an effort to address the overcrowding crisis at the emergency department in Limerick.

Clare County Councillors at the time expressed their frustration with the HSE’s appeal for Clare patients to stay away from the Limerick hospital, unless they have a genuine emergency. The stay-away warning was issued after claims that the emergency department was akin to a “cattle mart”.

The request to stay away was roundly criticised by Clare councillors at a HSE West Forum meeting in Galway, where they asked where were patients with acute illnesses supposed to go when the Limerick hospital couldn’t cope with its own admissions and Ennis didn’t have the resources to treat them.

Despite the use of every available bed in the Limerick hospital, the number of patients on trollies reached a high of 48 on Friday, March 21 last. Although it dropped to 38 the following Tuesday and Wednesday morning, this was still the highest figure in the country.

While the addition of the Critical Care and Cardiac Unit and employment of three new emergency care physicians in Limerick are some of the improvements introduced in recent times, the pace of change is far too slow.

In fact, one of the biggest mistakes by HSE management was the removal of 24-hour emergency services in Ennis and Nenagh in April 2009, before the new CCC unit and the proposed new emergency department in UHL, which could take another two years to construct, were built.

It will take a lot more improvements in Limerick before Clare trauma patients are fully convinced that spending hours waiting on trollies in Limerick is always worth the wait.