World of Irish Nursing & Midwifery May 2019


University Hospital Limerick needs to heed the lessons of Mid Staffordshire

lessons from Mid Staffordshire are applied at University Hos- pital Limerick. Florence Nightingale’s guid- ing principles stated that the first job of any healthcare professional is to ensure the patients are safe and well cared for. Limerick nurses are speak- ing out for patients to ensure they are well cared for and insisting the senior managers in the HSE and Department of Health address these concerns. The failure of management to appropriately manage the hos- pital and comply with national agreements makes it an impos- sible environment for nursing staff to ensure that patients are safe and well cared for. Furthermore, it is clear and INMO members have outlined that patients are trying to avoid attending UHL by instead presenting at South Tipperary General Hospital or Galway University Hospital. Practice nurses report that GPs and practice nurses have lengthy debates with patients when they indicate they wish to refer them to the acute facility. There must now be a review of the standards of govern- ance and performance within University Hospital Limerick. When patients and staff are articulating their concerns about the provision of care within this facility, then the political system as well as health service management must pay attention and take appropriate action. If they do not then they have not learned the lessons of Mid Staffordshire and patients’ lives and the health, safety and wellbeing of staff are at risk. The Minister for Heath and the director general of the HSE must take action now to address these matters. – Tony Fitzpatrick, INMO director of industrial relations

The INMO wrote to the Oire- achtas Committee on Health recently to outline grave con- cerns about a combination of issues at University Hospital Limerick. This followed the INMO highlighting concerns about industrial relations problems in the hospital at the National Joint Council in March and also raising the matters at the Health Service Oversight Body last month. The s e p rob l ems cen t re around the failure of hospital management to comply with the Protection of Employees (Information and Consulta- tion) Act 2006 and subsequent health service/trade union agreement around engage- ment and consultation. The hospital management is disre- garding the provisions of this agreement and also the terms of the Public Service Stability Agreement on such matters. The INMO has also high- lighted the significant clinical risk that exists within the hos- pital as a result of severe overcrowding. In recent weeks the number of patients on trol- leys in the hospital reached 81, which is a new record. This overcrowding ensures that the emergency depart- ment is packed full of admitted patients awaiting appropriate inpatient beds. Furthermore, the hospital places additional trolleys on inpatient hospital wards, creating a risk through- out the hospital. The nationally agreed Esca- lation Policy requires that when the Full Capacity Pro- tocol is utilised, ie. trolleys placed on a ward, the hospital must prioritise de-escalation immediately. However, the reality in Limerick is that hos- pital management is now using trolleys on wards as part of its normal bed capacity and the

Lessons from Mid Staffordshire

The Report of the Mid Staf- fordshire NHS Foundation Trust Public Inquiry 1 identified numerous warning signs which could and should have alerted the system to the serious fail- ings in healthcare that took place at the Trust. The report made many recommendations, with the essential aims to: •  Foster a common culture shared by all in the service of putting the patient first •  Develop a set of fundamental standards, easily understood and accepted by patients, the public and healthcare staff, the breach of which should not be tolerated •  P rov i de e v i den c e - ba s ed means of compliance with these fundamental standards which can be understood and adopted by the staff who have to provide the service •  Ensure openness, transpar- ency and candour throughout the system about matters of concern •  Make all those who provide care for patients – individuals and organisations – properly accountable for what they do and to ensure that the public is protected from those not fit to provide such a service •  Provide a proper degree of accountability for senior man- agers and leaders to place all with responsibility for protect- ing the interests of patients on a level playing field •  Enhance the recruitment, education, training and sup- port of all key contributors to the provision of healthcare, in particular those in nursing and leadership positions, to integrate the essential shared values of the common culture into everything they do.

Tony Fitzpatrick, INMOdirector of IR: “The practices at UHL are putting patients at risk as well as affecting the health, safety and wellbeing of nurses working there”

hospital has failed to de-es- calate in the past two years. This is putting patients at risk as well as affecting the health, safety and wellbeing of nurses working in those areas. In addition, as part of the Full Capacity Protocol, day service areas and the medi- cal assessment unit are also being used to accommodate admitted patients while, at the same time, expect- ing staff to continue to run operating lists. Again, this is creating significant risks and is not appropriate for the safe provision of care. The clinical director of the hospital astounded mem- bers of the INMO recently when he was reported in the media as stating that there was no clinical risk within the department as a result of this overcrowding. The INMO and its members met with public representatives for the area in Dáil Eireann last month to outline the need for action on Limerick University Hospital. An external industrial relations and clinical review of the hos- pital is needed. It is the clear view of the nursing staff that University Hospital Limerick is Ireland’s Mid Staffordshire waiting to happen, if action is not taken. The INMO is seeking that the

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