A NEW 352-BED Model Four Hospital with an Emergency Department (ED) on a green field site in Ennis is necessary to deal with the county’s long-term growing health care needs.
That is one of the key recommendations of a new independent study of acute hospital services, which has been completed by Ennis, University of Limerick Phd student, Sinéad Madden, and is one the first of its kind analysing acute care in the region.
Constructing a 352-bed Model 4 hospital with ED in Ennis would address the county’s long-term needs, according to the report. This is comparable to UHL’s capacity in 2014, which operated as a Model 4.
Considering the ageing population, this new facility could operate as a centre of excellence and a teaching facility for social and geriatric care considering the ageing population in Clare.
It noted cancer care and complex acute emergency cases could still be treated at UHL.
Clare needs an extra 302 unplanned acute beds in addition to the 48 beds that are planned in the HSE Capital Programme.
With a projected 8% increase in the population of Clare to 138,172 by 2031, the study recommends the provision of a new 352-bed Model Four Hospital with an ED on a green field site in Ennis to deal with the county’s long-term needs.
It argues Clare increasing population justifies the provision of a new Model Four Hospital, which would substantially reduce congestion and overcrowding at UHL.
In the short-term, the study proposes a new ED could operate in Ennis Hospital if operating theatres were provided and the number of acute beds increased to 84. This could deal with the casualty patients in Clare that currently have to be treated at UHL.
Projections based on national standards of 2.91 acute beds for every 1,000 people, which remain significantly below EU averages of 5.16 acute beds for every 1,000, indicate that by 2031, County Limerick will require 613 beds, County Clare 402 beds, and North Tipperary 221 beds.
The current acute bed ratio per 1,000 population for Limerick is 3.18, Clare is a paltry 0.39%, North Tipperary is almost double this figure on 0.81 and the Mid-West ratio is 1.86 well below the national average of 2.91.
By 2031, the region is expected to face a 128-bed deficit, with an additional 199 outdated Nightingale ward beds needing replacement, totalling 327 beds not addressed in the current Acute Hospital Inpatient Bed Capacity Expansion Plan 2031.
Since 2020, 85% of new bed allocations have been assigned to County Limerick, leaving only 9.6% for County Clare and 4.8% for North Tipperary; as of October 2024, only 23% of these beds have been delivered mainly at UHL.
Ennis, with demand three times higher than Nenagh, is identified as a critical site for healthcare expansion. The report highlights remote areas like Kilrush and Kilkee may require a Model 2 type health care facility to reduce future pressure on Ennis and UHL.
Established in 2020 by Ennis native Sinéad Madden, the Hybrid Simulation Modelling Laboratory specialises in advanced simulation techniques, including system dynamics, agent-based modelling, spatial analysis, and traditional methods, to develop practical, data-driven solutions for complex systems.
Ms Madden is prepared to develop this study further adopting a systems modelling approach to her work.
This newly published Hybrid Simulation Modelling Lab study reveals urgent and pressing needs for expanded hospital capacity and resource redistribution within the Mid-West.
Entitled “A Preliminary Quantitative Analysis and Strategic Approach to Emergency Department Overcrowding at University Hospital Limerick,” the study responds to Minister of Health Stephen Donnelly’s (FF) request for an independent Health Information and Quality Authority (HIQA) review, presents timely, actionable insights to alleviate severe overcrowding and bed shortages at University Hospital Limerick (UHL).
With the HIQA report not due until the summer of 2025, this timely and independent study highlights critical interim actions to redistribute more than 37,000 Clare and Tipperary ED attendees from UHL to regional hospitals in Ennis and Nenagh, aligning with a decentralised approach for equitable healthcare delivery under Slaintécare.
By redistributing over 37,000 patients from UHL to Ennis and Nenagh, immediate pressures on UHL would ease significantly.
A survey and stakeholder engagement employing system science approaches such as participatory modelling workshops is recommended to integrate input from patients, healthcare professionals, and key decision-makers in crafting actionable solutions.
“The findings of this study are a stark reminder of the challenges facing the healthcare system in the Mid-West region,” said Sinéad Madden
“We can act in the short term by redistributing pre-allocated resources and expanding capacity with 327 newly allocated beds in the long term, ensuring patients across the region can access the care they need.”
She expressed her optimism following a brief meeting recently with the CEO of the HSE, Mr Bernard Gloster, at the Health Management Institute (HMI) Ireland annual conference recently.
“Mr Gloster’s receptiveness to the study and requests to share it with him and the Mid-West Regional Officer (RO), Sandra Brodrick, underscores the commitment to collaborative action,” she said.
The study provides a foundation for decision-makers to prioritise regional healthcare investment and adopt a decentralised model for effective, equitable service. The proposed solutions tackle current overcrowding and set a foundation for a sustainable and equitable healthcare system for the future, aligning with the Slaintécare framework.
Participation will remain anonymous and is voluntary. A person must be over 18 years of age and there is one response per user. The survey is open from Friday, November 1 to Friday, November 15. For more visit hybridsimulationmodelling.com.
East Clare correspondent, Dan Danaher is a journalism graduate of Rathmines and UL. He has won numerous awards for special investigations on health, justice, environment, and reports on news, agriculture, disability, mental health and community.