Report says it is ‘unclear’ who is in charge at UHL

It is unclear from an operational perspective as to who is in charge at the University of Limerick (UHL) site on any given day, according to a new report published by external medics.
The UHL Support Team Report 2024 acknowledges the focus and engagement by the various management teams in respect of patient flow and notes the participation of a significant number of senior staff in the on-call rota.
Notwithstanding the absence of a management team member, who was on leave during the review, the report stated that “it is unclear from an operational perspective as to who is in charge on the UHL site on any given day”.
Furthermore, the report said is not clear as to what ‘Handover Plan’ is shared at the day and night interfaces.
The external support team who analysed services at UHL included HSE’s National Director Grace Rothwell, director of nursing and integration at Waterford University Hospital Orla Kavanagh, and retired emergency medicine consultant Dr Fergal Hickey.
The report praised staff for their ongoing commitment to patient care, despite their levels of fatigue, the ongoing adverse publicity, and in the face of persistent overcrowding in UHL.
“Staff are engaged, working to the best of their ability and doing a good job with hundreds of patients receiving excellent care every day in UHL and right across the Mid-West,” the report stated.
“There was a level of acceptance in relation to the ‘intractable’ nature of the overcrowding problem in UHL and a corresponding belief that the overcrowding would only be resolved by capacity enhancement.”
The report recommended a Hospital CEO, Hospital Director of Nursing and Hospital Clinical Director are required to be on the ground in the hospital to lead and support the various teams in what is a large and very complex organisation. It stated that a full review of the medical and surgical resource is required to ensure that capacity and capability is enabled and optimised right across the Mid-West and that appropriate governance and structures are in place to oversee and support same.
The report says a full review of the nursing workforce is required to ensure that patient care is optimised. Recruitment and retention of front line nursing staff needs to be a priority.
The report suggested that consideration should be given to temporarily pausing the filling of promotional posts to ensure no further denuding of staff nurse and CNM posts. Each speciality should be reviewed by the respective Clinical Director and Directorate Nurse Manager to identify issues of concern that impact on its ability to proactively see and treat patients and positively impact on patient flow.
It said that directorates must work collaboratively to address identified concerns and ensure optimisation of resources and equity of access.
Following the recent cancellation of some surgical operations, the report warns significant engagement is required with all clinical and non-clinical stakeholders and their teams to develop short, medium and long term plans for all of the services in the region.
It says a full review of diagnostic demand and capacity is required across the Mid-West acute, community and private. There is no evidence to suggest that available capacity across the region is exhausted to support admission avoidance and safe and timely discharge.
All services across the MidWest need to be better integrated to ensure appropriate prioritisation of patients in line with available resource, the report stated.
There are pockets of excellence in both the acute and community settings and yet overcrowding is largely seen as an ED issue, the report states. All staff need to work collaboratively to prioritise, identify, implement and sustain solutions which enhance and support patient flow. In line with the current restrictions in place on recruitment in the HSE each site location needs to look at existing resources and ensure optimal usage of same.