Expect plenty of new ideas from the UHL inquiry... but we’ll be left waiting for action
THE circumstances of the death of Aoife Johnston in University Hospital Limerick (UHL) were appalling, every parent’s nightmare. Her death was avoidable, had she received the appropriate treatment urgently. That she didn’t is a scandal.
In a week in which Taoiseach Simon Harris apologised profusely for the State’s treatment of the 48 people who died unlawfully in the Stardust fire of 1981, the finding of an inquest that finished the previous week, the Health Minister Stephen Donnelly issued a very carefully worded statement in addressing Aoife Johnston’s inquest finding.
Other than expressing condolences to the family and thanks to the coroner, Mr Donnelly made no commitments to addressing the issues of overcrowding and understaffing so dramatically outlined in the evidence to the court.
Damning
‘The coroner’s recommendations will be fully considered,’ he stated, ‘along with the work of retired chief justice Frank Clarke, who is due to conclude his independent investigation in the coming weeks.’
Much of what was heard at the inquest was known previously to Mr Donnelly, albeit the reports of the witnesses were deeply distressing and personal in a way that a clinically written report could not necessarily express. But it’s clear that he and the Government don’t want to offer hostages to fortune by making promises that this type of outrage will never happen again. Mr Donnelly previously wrote to the chair of the HSE about the ‘clear failures in clinical and wider governance at the hospital’ and expressed his ‘deep concern’ about staffing levels in the emergency department on the night Aoife presented there. He also appointed Mr Clarke following a ‘systems analysis review’ conducted by the chief clinical director of UHL.
That ‘systems analysis review’ made its own series of damning findings, including that overcrowding is ‘endemic’ in the hospital’s emergency department, and that there was ‘little apparent understanding of the risks and inefficiencies caused to patient care by a crowded environment’, a ‘misuse of the resuscitation area’, ‘insufficient ED nursing staff to provide adequate monitoring and care to the patients’, and ‘insufficient emergency medicine doctors to care for the numbers and acuity of patients presenting in the timescale expected by the triage system, the hospital and the community’. It noted a ‘high turnover’ of nursing and nonconsultant doctors ‘which leads to low experience levels and low situational awareness’. There was much more.
It will be interesting to see what more Mr Clarke will write. He has been told to ‘make any recommendations as he sees fit’ and was asked to ‘report on any other factors and/or causes which can be identified for the purposes of improving current and future service delivery.’
Demand
Here’s what he might include: while the idea of centres of excellence in emergency department delivery is good, the 24-hour services at the EDs at Ennis and Nenagh were closed before UHL was upgraded to cope with the additional demand. It can’t serve 400,000 people in the mid-west with 530 beds, as the total of 424 patients on trolleys on Thursday emphasises. The new 96-bed block under construction (not ready until 2025) and the other samesized block proposed won’t be enough, and even then the fear must be that there won’t be enough doctors and nurses on call to satisfy demand.
Mr Clarke’s report will be met with thanks, and ‘consideration’ will be promised about the proposals put forward. There’ll be a delay and then promises will be made, albeit conditional.
And then, most likely, we’ll wait... and more people will either die unnecessarily or suffer miserably in waiting for the help due to them, through no fault of the frontline workers trying to deliver it.