There are huge manpower shortages at Our Lady of Lourdes Hospital which, critics say, are posing a threat to patient safety, writes Eithne Donnellan, Health Correspondent
Next month An Bord Altranais, the nursing board, will consider whether the number of student midwives being trained at Our Lady of Lourdes Hospital in Drogheda should be reduced.
Its concerns stem from a visit to the hospital's maternity unit last October when it found staffing levels to be well short of recommended levels. This, it says, raises "serious concerns" about the capacity of staff in the unit to support, teach and supervise midwifery students. It calls for the problem to be dealt with "as a matter of urgency".
Its report, seen by The Irish Times, is the latest to draw attention to the shortage of midwives in a hospital where births have increased dramatically in recent years.
It says there has been a 104 per cent increase in births at the hospital over the 10 years to 2005 due to the closure of maternity services at the Louth County Hospital in Dundalk and at Monaghan General Hospital, as well as an increase in the population of the area the hospital serves, an area extending to north Dublin.
Despite the increase in births, there has been no increase in beds and few extra midwives have been employed.
Others have also drawn attention to the staffing shortages. It emerged just over a week ago that Patrick Kinder, chairman of the maternity services task force for the northeast, wrote to the HSE's national hospitals office in October pointing to an "urgent need to review staffing and accommodation requirements" in the hospital's maternity unit.
His letter noted that the high birth rates and low staffing levels "show the extent of the serious risk which currently obtains in the maternity unit in Our Lady of Lourdes Hospital".
But the HSE was well aware of concerns about staffing levels in the unit even before Kinder's correspondence. It was made aware of them by the most senior nursing staff in the unit and would also have learnt of them from several reports commissioned over the past few years, including internal adverse incident reports and external risk management reports.
A workload analysis prepared in 2002 by UK consultants said there was a requirement for 85.5 midwifes for 3,200 births in the unit at the time. But it still has only about 66.8 midwives and this year it is expected to have to accommodate about 4,500 births.
The HSE has said it will soon recruit 22 additional midwives but Tony Fitzpatrick, the industrial relations officer with the Irish Nurses Organisation in the northeast, says this is grossly inadequate and would only match the requirements of a few years ago.
"Currently, they are desperately short staffed," he says. "It just adds up to an intolerable situation for the midwives where they are just by the skin of their teeth protecting the mothers and the babies that are born there," he says.
Some are wondering why it is the HSE is prepared to approve over 300 midwifery posts to deal with up to 8,000 births a year at a new maternity hospital in Cork when it will approve only 80
plus posts (that's after the extra 22 are factored in) for the Drogheda hospital to deal with over 4,000 births a year.
The midwife-to-deliveries ratio in Drogheda is about 1:58 compared with 1:35 in some of the Dublin hospitals. It would be even less in Cork and there seems to be no explanation for this inequity.
Chris Lyons, manager of the HSE's hospital network in the northeast, doesn't want to be drawn on why the ratios vary so much across the country. "Certainly it would not be for me to make comments or comparisons with other hospitals. My concern is to ensure that we work on increasing the resources into the Lourdes [ hospital]," he says, while Fitzpatrick argues the HSE should have standard staffing levels for every hospital.
But it's not just a shortage of midwives which is troubling the Drogheda hospital at present. It also has a shortage of doctors as well as too few laboratory and clerical staff. Only last week it emerged some women attending the hospital have to wait until the start of their fifth month of pregnancy before seeing an obstetrician due to manpower shortages. And a letter from the hospital's medical board to the HSE in February said patients were currently exposed to a high level of risk across all departments due to "common deficiencies in infrastructure and medical/nursing numbers that are far short of national norms".
The correspondence referred to midwife numbers being "far short of national norms", to low staffing levels in A&E, a shortage of anaesthetists, staffing shortages in the departments of medicine and paediatrics and to the fact that investigations in the diagnostic imaging department had increased from 55,000 in the year 2000 to 99,000 in 2006 without any increase in clerical staff.
The Royal College of Physicians of Ireland, after it inspected the hospital's department of medicine last October, also found an insufficient number of doctors in the department to ensure patients were not put at risk.
And a report presented to the HSE in December by the joint department of medicine for the Louth hospitals, which include Our Lady of Lourdes Hospital as well as Louth County Hospital, pointed to the fact that a quarter of all medical admissions were having to spend their entire hospital stay in A&E where they were fed sandwiches the entire time.
It said there were insufficient numbers of adequately trained nurses to look after them and an inadequate number of doctors overseeing their care.
Of course, those in authority who need to address the serious staffing shortages at Our Lady of Lourdes Hospital will have many other hospitals also knocking on their door seeking extra manpower, but there is a sense that the Drogheda hospital has a better case than many, particularly after the Neary inquiry. Yet it is finding it extremely difficult to have the shortages tackled, leaving staff frustrated and demoralised.
The An Bord Altranais report noted that in the two months prior to its visit last October, 29 full-time and part-time midwives and nurses had left the maternity and paediatric services in the hospital. "Many have cited deficits in staffing levels and staff skills as reasons for leaving" and it was reported to the site visit team that "the process whereby replacement of staff who have left the services is sanctioned by the HSE is very lengthy and slow, with the most significant delay occurring in the National Hospitals Office".
Chris Lyons accepts the hospital is under significant pressure. "It's under pressure because of the huge explosion in the population along the eastern seaboard and also in terms of it having been the largest hospital within the northeast for many years, that there was at times a drift or shift, maybe not always deliberately planned, of the most acute and problematic cases within the region to the hospital site."
It was asked to take on extra paediatric and obstetric work as well as surgery and trauma in recent years which had been carried out at other hospitals in the region but got no extra resources to do so.
Lyons says ultimately there has to be a new regional hospital built, as recommended by Teamwork consultants after a review of acute hospital services in the northeast last year, but that could take years. In the interim the plan is, he says, to develop Cavan General and the Lourdes hospital "both in terms of staffing and infrastructure over the next four or five years to allow us the time and the space to develop the new regional hospital".
Some immediate steps are also being taken, he adds, including the development of a new 25-bay emergency department - due to open early next year - and there will be two floors above it to cope with extra patients. The hospital is recruiting 22 extra midwives and, it seems likely, an additional five consultant anaesthetists too.
Asked if the embargo on recruitment was affecting the speed at which staff could be recruited, he says: "It is in the sense that obviously we have to basically make the case like everywhere else in the country for additional staff . . . it's good practice to do that. You know we can't run a multi-million euro system without making very clear decisions about how we utilise additional staff and that's what we will continue to do."
While funding may be limited for Our Lady of Lourdes Hospital, the way the money that is there is used has also come in for criticism. For example, the hospital is spending €2.4 million this year on sending patients' specimens to a private laboratory in the UK for analysis because of a shortage of staff in its own laboratory. Many argue staffing the hospital lab would cost less, and would ensure test results were back quicker.
Lyons says he now accepts this himself, having had an analysis of the costs carried out recently. He hopes more lab staff can therefore be recruited.
Dr David Vaughan, chairman of the hospital's medical board, says the hospital is in close consultation with the HSE at the highest levels in an attempt to address the current deficits. "I think everyone recognises that there are deficits across the board not just in the hospital, but within the region," he says.
Lyons seeks to reassure the public about services at the hospital in the face of all the concerns raised about manpower shortages there. "I want to reassure them [ the public] that the quality of care is of a very high standard in the Lourdes [ hospital], albeitthey are coming into an environment which nobody can pretend is perfect."
He also says a claim in the An Bord Altranais report that the HSE has provided no specific funding to implement it is inaccurate, stating more than €2 million was recently signed off to implement a number of its recommendations. This money will be used for the extra midwifes and an audit co-ordinator.
He also makes it clear no more services from other hospitals in the region will be transferred over to Our Lady of Lourdes for the moment after a suggestion it would have to take on Navan hospital's emergency surgery workload.