There will be only one ED in Mid-West – ULHG chief clinician

THE Chief Clinical Director of the UL Hospitals’ Group has poured cold water on the proposed return of 24-hour emergency cover to Ennis Hospital and other Model Two acute facilities, despite a petition from a local lobby group that is supported by 15,000 signatures.

The Mid-West Hospital Campaign has sent a petition calling for the restoration of round the clock casualty cover in Ennis, Nenagh and St John’s Hospitals to the Dáil’s Petitions’ Committee after this was controversially removed for safety reasons in April 2009.

In an extensive interview with the Clare Champion, Professor Brian Lenehan doesn’t support any move to have another ED in the Mid-West, despite the fact the group is the only one along the western seaboard that doesn’t have a Model Three Hospital.

“I fundamentally believe as part of the additional bed stock we need a scheduled care hospital.

“That could be a new development or the development of one of our existing hospitals, but I don’t believe we need to go back to where we had more than one ED in the Mid-West.

“Emergency care, critical care, care for heart attack patients, stroke and multiple trauma all need to be centralised in one hospital. We are strong advocates for the Local Injuries Unit and Medical Assessment Unit model.

“No matter how we develop outside of the Dooradoyle campus, I don’t believe there will be another hospital opened with an ED. If you open an ED, you need ICU, HDU, access to surgeons and anaesthetists and orthopaedic surgeons.

“You would dilute the service that is being currently delivered if you provide emergency care at that level on another site in the Mid-West. Focusing that in UHL is fundamentally the safest way to do it.

“However, I believe we need to develop a hospital whose focus is scheduled care and planned medical and surgical care,” he said.

Asked if he is describing an elective hospital, the Chief Clinical Director explained he is not proposing a scheduled care facility in the context of the Sláintecare plan.

Instead, he proposed there should be a facility for planned surgical, medical and diagnostics rather than an elective hospital where a patient goes for planned surgery.

Under this proposal, it would take more of the intermediate care out of UHL to allow it to focus on unscheduled high acuity care, cancer and trauma.

Patients who need an operation that requires two or three days in hospital or assessment as an in-patient could have this completed in a scheduled care hospital.

Asked if Ennis Hospital could be upgraded to become a schedule care hospital, he acknowledged any hospital could be upgraded but the question is this the appropriate thing to do because there is limited space to extend some of the smaller hospitals.

Having recently opened the new “fabulous” Ennis Local Injury Unit and are at the advanced stage of planning for the new operating theatres, he said Ennis has a very busy Medical Assessment Unit, LIU and day case surgery profile, with new theatres coming on stream that will increase the level of scheduled care that can be provided.

“Ennis Hospital is performing very well in the Small Hospitals’ Framework for what a Model Two Hospital is supposed to do. Occupancy levels and patient satisfaction levels are very high. The LIU and MAU are very effective.

“Building on these services is what I see if the focus for Ennis and Nenagh rather than trying to change the type of hospital it is. I wouldn’t see putting in an ED or having patients staying overnight after surgery because you would need a whole surgical team. You have to put in all the ancillary services with it,” he said.

If new two theatres are built in Ennis, he confirmed there is an adequate number of consultants who want to carry out surgery.

Professor Lenehan confirmed in the short term management would continue to work on patient flow and continue working on measures to ensure patients spend the least amount of time waiting to be seen in the Emergency Department.

The Chief Clinical Director said they wanted a scenario where patients can avail of a bed in the shortest possible time, reduce their length of stay in the ED, have a focus on their length of stay when they are an in-patient, get patients discharged when they are fit to leave and try to remove all the barriers and delays there.

He outlined UHL has secured funding to hire additional non-consultant hospital doctors and consultants in the ED.

However, he acknowledged it would take some time for these doctors to be recruited and start working in the ED.

“Key to the whole thing will be the implementation of the Safer Staffing Model for nurses in the ED, which will see up to 30 additional nurses being recruited to work in the ED.

“All of these measures taken together should improve patient care and patient flow, I would hope.

Asked about alleged delays in filling of permanent nursing and doctors’ positions, Professor Lenehan admitted it can be difficult to recruit medical personnel in a marketplace where there are shortages across all grades and disciplines.

Last year, UHL recruited 1,200 additional staff and 900 extra staff this year. Professor Lenehan said the key issue is to get approval for the nursing, non-consultant hospital doctor or allied professional posts they need.

Outlining due diligence has to be undertaken considering garda vetting and checking medical qualifications, Professor Lenehan confirmed two extra ED consultants were due to be interviewed in the near future.

Asked if there is a need for a dedicated unit within the HSE for medical recruitment, the orthopaedic surgeon acknowledged there needs to be a focus on recruitment.

“The UL Hospitals’ Group has its own dedicated unit for medical and nursing manpower that focuses on nursing and non-consultant hospital doctors. We work very hard on that. Recruitment is our issue, but it is also a national issue.

“We need to recruit our own staff, we can’t ask the national HSE to recruit our staff, we need to be involved in that recruitment process.”

There are 32 vacancies for non-consultant hospital doctors across the group. While this is far less than previous figures, Professor Lenehan acknowledged the group is 98 short of where in should be in terms of population health and the number of doctors per capita compared to other regions.

Asked if he was disappointed a group of medical doctors effectively went public to highlight safety concerns in UHL earlier this year, Professor Lenehan challenged the perception they went outside normal medical channels.

“The letter was issued to us as a hospital management team. We have done everything we can to address the issues they have raised. They spoke about the streaming patients from the ED to the Medical Assessment Unit as a Medical ED, which we forced to do for Covid-19 purposes.”

Professor Lenehan confirmed the MAU had returned to its former structure that predated Covid-19, which would address a lot of the concerns raised in this letter.