Hospital overcrowding: INMO to consult members on industrial action over staffing levels

The Irish Nurses and Midwives Organisation has said it is to begin the process of consulting with its membership over the possibility of industrial action on staffing levels against the backdrop of the ongoing overcrowding being encountered in hospitals across the country.

The national executive of the union met on Friday, after which its General Secretary, Phil Ní Sheaghdha, said the 24-strong board, which includes many working nurses, had “taken the decision to begin a period of consultation on a campaign of industrial action in pursuance of safe staffing levels that are underpinned with legislation and clinical facilitation in all hospitals to ensure a safe skills mix”.

“What has transpired this week in our hospitals was totally avoidable,” she said. “For too long nurses and midwives have been warning that we were going to see an overcrowding blackspot in January unless serious and meaningful action was taken. While many will try to laud the fact that we have seen a decrease of patients on trolleys from 931 to 535, we won’t be part of attempts to justify this as an improvement.

“Nurses and midwives expect and deserve to work in a safe practice environment in which they can deliver the safe and excellent care they are trained to provide.”

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Speaking the The Irish Times on Friday evening, Ms Ní Sheaghdha said the process will be “what it says on the tin, a consultation” but that the fact nurses and midwives would be discussing the possibility of industrial action was a sign that ”all of the negotiations and our attempts to address the situation have failed”.

“We have been asking the Government since July to address the intolerable conditions being experienced by our members and by patients and we have been asking for a multi year plan since 2017, but we have still not received one and we know that if we are going to successfully address the huge challenges facing our healthcare system, you have to plan in advance.”

As it is, she said, “we have Government policy documents that set out targets for how many nurses and other healthcare professionals you need to safely run the system and they are not being met”.

The substantial growth in HSE staff numbers in recent years cited by Ministers, she said, had only been due to a dramatic growth in HSE services and not actually addressed the underlying and continuing problems being experienced with staffing levels.

INMO President Karen McGowan, who had earlier said it was currently “impossible” to deliver safe patient care in current emergency department environments, told the the meeting that “nurses and midwives are being asked to crisis manage a situation that is of our employers’ own making. We know that levels of burnout are at an all-time high”.

“We must now take whatever action is deemed necessary to ensure that we do not endure this level of danger in our workplaces in the coming months and years ahead on a continuous replay mode.”

She said the consultation process would take place over the coming month.

In response to the INMO announcement, a HSE spokesperson commented: “The HSE is very thankful to all our staff in hospitals and in community services for their commitment to working through this incredibly difficult time whilst also providing cover for staff who may be on sick leave.

“Emergency Departments continue to be extremely busy due to the unprecedented combination of very high levels of flu, Covid-19 and other respiratory illnesses in circulation.

“The HSE regrets that patients are experiencing long wait times in our hospitals and we are working as hard as we can to provide services to those patients and to support our staff.”

Earlier, the Minister for Finance said those involved in the HSE at an operational level need to “reflect and understand why some hospitals are doing far, far better than others” with regard to the current overcrowding crisis, given the levels of public money being put into the system.

Michael McGrath said the scenes currently being witnessed at hospitals around the country at present are “unacceptable” and acknowledged that capacity issues persist - but insisted the Government is doing what it could to address historic underinvestment.

“I don’t think we could be accused of that with €23.5 billion almost, it’s a record amount of investment.

“We are seeing a significant increase in capacity, that needs a lot more beds in our hospitals, 16,000 more staff over the last three years, a further 6,000 recruited this year - but that said, the scenes we’ve witnessed are not acceptable and should not be happening.

“We are adding to the number of beds so between acute beds and community beds, you’re looking at over 1,300 In the last three years,” the Minister said on RTÉ's News at One.

“We’re seeing some hospitals perform really well and have no patients on trolleys but I think at an operational level the HSE need to reflect and understand why some hospitals are doing far, far better than others,” said Mr McGrath.

“But there is an issue with capacity, we are addressing that as a government and we will be doing all that we can to accelerate that investment to build up that capacity.”

‘Perfect storm’

Minister for Health Stephen Donnelly said the current pressure on hospitals from the wave of Covid-19 infections and flu is a “perfect storm” that is hitting healthcare systems across Europe.

“What we’re seeing this year doesn’t happen every year. So what we’re seeing this year was a combination of flu, Covid and RSV, we haven’t had that before,” Mr Donnelly said.

“The first two winters we had Covid if you like there wasn’t really a flu season, so the system was able to manage,” he said.

“Nobody wants to see this… it’s not acceptable to me or Government. And it’s not something that we should see. It’s not something anybody wants to see,” he said.

Speaking on Friday, Mr Donnelly said the last three days had seen a 50 per cent drop in the numbers waiting on trolleys, but noted the trend was that the start of the week was always busier.

The health service was focused on increasing the number of patients discharged over the weekends, to free up beds, he said.

The plan was to have more “senior decision-makers” working in hospitals over the weekend.

“They’ll be looking for access to things like radiology, critically they’ll also need access to community services so that we can discharge patients home,” he said.

Mr Donnelly said stories of elderly patients waiting for nearly 60 hours on chairs or trolleys in emergency departments was “not acceptable”.

Hospital staff were already working “above and beyond” and were dealing with “immense pressure” in recent weeks and years, he said.

However, the HSE felt there was an “opportunity” for some more senior staff to work during weekends where possible, he said.

“A lot of the consultants, a lot of the nursing staff, the radiology staff, a lot of them are coming in at the weekends anyway,” he said.

“Nobody wants to see what we’re seeing right now in the hospitals. I want to fully acknowledge the distress for patients, the distress for their families and the intense pressure that that puts on our healthcare workers,” he said.

The overcrowding in emergency departments was something that “should not been seen” in any healthcare system, he said.

On RTÉ's Six-One news, he said the HSE has been asked to discharge more patients from hospitals over this and the next few weekends than is normally the case.

“We don’t know as of yet what will happen over the weekend in terms of discharge[s] but we expect to see significantly more discharge[s] than would normally happen and therefore, not completely get rid of, but help manage this Monday, Tuesday spike.”

Trolley figures

The Health Service Executive put the trolley numbers at 8am on Friday morning at 398 with 94 patients said to have waited at least 24 hours.

The figure is 66 per cent up on the same date a year ago. While it’s down from 469 on Thursday, the HSE’s interim chief executive Stephen Mulvany had also said earlier that some reduction was to be expected in the normal course of events, with Monday and Tuesday usually the worst two days of the week and that a substantial effort had been made by staff across the service to move patients through the initial part of the system over the past couple of days.

[ ‘It’s unsafe and inhumane’: Letterkenny nurse tells of hospital overcrowding ]

In the HSE figures, the EDs at Letterkenny University Hospital, St James’s Hospital and Cork University Hospital were listed as the most overcrowded in the country on Friday, while University Hospital Waterford was reported not to have had any patients waiting on trolleys at 8am.

Asked how it had eliminated overcrowding in the ED, a Waterford hospital spokesman said management were “too busy” to explain.

Mr Mulvany visited University Hospital Limerick on Friday, meanwhile, to discuss overcrowding action plans with the UL Hospitals Group.

A Limerick hospital spokesman said emergency measures it had taken to decompress the ED since it declared a “major internal incident” on 2nd January would “remain in effect over the coming days”.

[ Hospitals told to implement seven-day working with ‘immediate effect’ to ease overcrowding ]

Surge capacity remains open across the UL Hospitals Group “to manage a wave of illnesses” and there will be reductions in day and elective surgery from Monday.

Outpatient clinics will resume on January 9th, however, a visiting ban remains in place “due to high levels of flu and Covid-19″.

“The numbers waiting for an inpatient bed across the hospital group are still too high [with] admitted patients on corridors within our ED and [non-urgent] patients continuing to face lengthy wait times to see a doctor,” the hospital’s spokesman said.

“We expect we will continue to see high numbers of attendances at our ED and high numbers of admitted patients waiting for beds to continue into the coming weeks,” he said.

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The knock-on impact on Ennis, Nenagh and St John’s Hospital of providing University Hospital Limerick surge beds has led to delays in resuming day surgery in the UL Hospitals Group’s Model 2 sites.

“There will also be reductions in elective surgery at Croom Orthopaedic Hospital from next week.”

“University Hospital Limerick, Ennis, Nenagh and St John’s Hospital are all operating at or above capacity as hospitals across the region manage a wave of illness largely driven by acute respiratory conditions.”