19 May 2022

‘Staff are just phenomenal’ - Kilkenny's Grace Rothwell, general manager of busy Waterford hospital

'There is just no let-up in the acute system'


Grace Rothwell, general manager of University Hospital Waterford

A Kilkenny woman has one of the busiest jobs going these days, as the general manager of University Hospital Waterford and
Kilcreene Regional Orthopaedic Hospital.

Grace Rothwell is from outside Castlecomer, where she still lives today. She has worked in health services since 1994 in a variety of roles and places, including the Coombe, St James’ Hospital, nationally with the HSE and South Tipperary.

She took up her most recent post in Waterford in January 2019. Of course, things changed in a very real way last March when the pandemic announced itself.

“It has been a very unusual set of circumstances where we expected the worst and did a lot of prep in March 2020,” says Ms Rothwell.

“But realistically, it has been January 2021 that has really overwhelmed us. The third wave has proved to be much more considerable in the South-east than ever the first and second were.

“So a totally different way of working, very fluid, very dynamic. Seven days, 24/7 - huge teamwork and hospital staff are just phenomenal.”

The highs of January 2021 have now abated, but there are still new cases each day in the Waterford and South-east area. The hospital still sees a daily share of new cases.

On top of that, there are still a lot of people that remain unwell —Covid or otherwises — and require considerable resources allocated. Ms Rothwell says that the demand is such that even as things are in less demand for Covid-related issues, they must immediately look to other areas. That is the nature of a modern health service.

“The minute people have a perception outside the hospital that you only have ‘x number’ of positives — why aren’t you doing this, why aren’t you doing that? The big challenge for me now is that there are people here now owed considerable leave that they didn’t get to take last year,” she says.

“People need a break. And there is just no let-up in the acute system. There just isn’t — people are being diagnosed with cancer, people require treatment, surgery. Outpatients need to be seen. People didn’t present when they could, or presented in fewer numbers. So the minute things go one way, you will see a bounce on the other side. There is no let-up.”

As well as the Emergency Department which is 24/7, Waterford has one of the busiest orthopaedic units in the country.

“Whether there is Covid or not Covid, people inevitably break bones, or have accidents,” says Ms Rothwell.

“We are a trauma referral centre. We take all the regional referrals from the hospitals in the South-east.

“So give or take, everyday, we probably try and have 50 admissions. In order to facilitate 50 admissions, we need 50 discharges. It is as simple as that, and it’s simple in words only. You are reliant all the time on all the cogs in the system to turn over everyday.”

There is a web of liaising with community services to step people down and discharge them. Waterford’s Trolleywatch figures are excellent — they have shown consistently a count of zero in the INMO’s daily count since last March.

“That’s not only due to Covid, it’s due to good overall active management of patient flow,” she says.

“So that means, what you need to get in, you need to get the equivalent out. That needs to move seven days. You’d hear sometimes people giving out — ‘oh, they discharged my mother on a Sunday’. We have to discharge seven days because people come in seven days!”

Her diary is full pretty much every day from 7am morning through to the evening. She must also account for the performance of the hospital to the South/Southwest Hospital Group, in terms of how resources are used, people waiting to be seen.

“We have 47,000 people on an outpatient waiting list. You can imagine what needs to happen to do that,” she says.

It is clear from the demands on the system and the nature of the work that it is a 24/7, with little break or downtime.

“Healthcare is very evolving,” she says. “Demand is ever-increasing. We have an ageing population, waiting lists are growing. It is never going to ease and there is not one magic ingredient, but it is a bit of a balancing act — more juggling than balancing — to make sure you keep all of the services going along.”

So, is the job frustrating? Is it rewarding —and is it enjoyable? 

“I love it, absolutely love it. It makes me like a lunatic at the best of times, but I love it,” she says.

Thousands of people come through University Hospital Waterford each week, and all have to be looked after. Most of them have a good outcome and are very happy, but of course there will always be those who do not. That’s the case in any service.

“Someone will go in and say they had a great experience, somebody will say they didn’t,” says Ms Rothwell

“Some people aren’t happy they have to wait, other people are delighted to be seen. People are different.”

There are also the details around finance and budgets and managing people, quality of care. There’s the non-clinical side — patients have to be fed, the hospital has to be cleaned, sheets washed. That falls under her remit, and ensuring everyone is valued for their contribution. She says the goodwill and effort of the staff is a consistent asset.

“I know that staff here every single day get up and set out to do good. And they do good,” she says.

“Thousands of people are looked after here every week to the best of people’s ability. So that’s the reward. You will always have a critic, but you do your best. But no one can run a hospital 9-5, Monday to Friday.”

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