Staff crisis hits Clare Mental Health Service

THE proposed closure of some community psychiatric facilities and the transfer of public patients to a private nursing home are being considered, following claims of a staffing crisis in Clare Mental Health Service.
A comprehensive review of Clare Mental Health Services has been initiated by the Health Service Executive (HSE) against a background of a 21.3% decline in the number of nurses working in the service over the last 22 months, a national moratorium on recruitment and the need to respond to the complex requirements of specialised services to patients in accordance with best practice in modern health care.
The HSE has acknowledged that the reduction of nurses from 202.38 whole time equivalents in January 2008 to 159.22 last September presents “challenges in maintaining the quality and safety of our services”.
Although the HSE has not disclosed details of the radical plan, The Clare Champion understands that it involves the proposed closure of the Orchard, Kilrush and the transfer of up to 14 psychiatric patients, who are deemed suitable, to a private nursing home run by Mowlam Healthcare in the town.
It is also proposed to close Gort Glas in Ennis and move about 16 patients into Cappahard Lodge, while there are plans to transfer between 12 and 14 high-dependency dementia patients from Cappahard Lodge to a unit in St Joseph’s.
Last February, over 20 geriatric patients were moved from Unit Six in St Joseph’s to a private nursing home in Ennis, run by Mowlam Healthcare.
Psychiatric Nurses Association (PNA) spokesman, Denis Meehan claimed that the service is suffering from a staffing crisis with up to 37 vacancies for psychiatric nurses, which had led to difficulties in providing adequate cover at times in the Acute Psychiatric Unit at Ennis hospital and Cappahard Lodge, Ennis.
Mr Meehan alleged that the service is extremely short staffed and operating below agreed staffing levels in a number of units.
He blamed the national recruitment ban for preventing the service from obtaining the required number of nurses. While the PNA and SIPTU attended the Labour Relations Commission with the HSE recently to deal with staffing problems, he stated that the only solution being put forward is the continuation of overtime, which is unsustainable and not cost effective.
He claimed that some student psychiatric nurses who had completed their placements in the Clare Mental Health Service couldn’t be hired and instead they moved to Limerick, where they were hired through an agency to work for the HSE in the local mental health service.
When the HSE was questioned about this, he claimed that officials were told that the Limerick service could do this because they had hired staff through an agency before January 1 last.
“People are browned off from doing overtime. The service is effectively being run on overtime at present. It is far more costly to hire someone on overtime rather than paying a newly qualified nurse at the lower end of the scale.
“This is not happening in other parts of the country. Any retired staff who left after January 1 last are not allowed to work on a part-time basis but we have about eight retired members who fulfil this criteria because they retired last year.”
He said that Clare cannot recruit new staff but there seem to be fewer problems hiring staff through agencies in other counties, such as Limerick.
“The whole thing is unbelievable. We had two stoppages in units recently because there weren’t enough staff to take up duty. Night duty staff had to stay on after their shift until a nurse was borrowed from another unit.
“This could happen in any unit at any time. If we have any bout of sickness, the service would be in serious trouble. The service seems to be run on a day-to day basis when we hope to have enough staff and, if not, we are in trouble. It looks as if the HSE are hiding behind the embargo, which doesn’t exist in other parts of the health service.”
He said that 30 psychiatric nurses retired in 2009, 10 in 2008 and five are retiring this month.
“I don’t know how we can run a service with so many people leaving. I would be concerned about the provision of services to patients if any units are closed within the service. I would be concerned if public patients are sent to private nursing homes, which are profit-making establishments,” he said.
His concerns were echoed by SIPTU spokesman Tony Kenny. He stated that staff were becomingly increasingly concerned about the non-replacement of members who had retired and the ban preventing newly qualified students from working in the service.
Mr Kenny said he hoped that unions and the HSE could make some progress towards resolving these issues at the next LRC meeting in three weeks’ time.
HSE Forum West member, Councillor Tom McNamara, claimed that there is a lack of leadership in the service because neither the director of nursing Denis Creedon, who retired last May, or clinical director, Mary McInerney, who retired last September, were replaced.
“It is wrong to hire retired people to work as psychiatric nurses when there are newly qualified nurses drawing the dole because of a Government or HSE directive on recruitment. People have been interviewed for vacancies at senior level but haven’t been appointed either. I would be concerned about the level of patient care and staff safety if adequate staff are not in place,” he said.
HSE Forum West member, Councillor Brian Meaney stated that the recruitment embargo in the HSE, combined with the haemorrhaging of experienced valuable frontline staff with a lifetime of knowledge was causing management across all sections in the HSE to reduce bed numbers.
He pointed out that a fear among staff that pay and pension entitlements will be affected by the upcoming Budget was “driving experienced staff from the HSE”.
“The Government has to give an immediate and clear statement as to the effect the Budget will have on nursing staff income to halt this situation.
“The Incentivised Scheme of Early Retirement introduced by the Minister for Finance in the budget of April 2009 has the possibility to wreak further havoc in the health services unless it is dropped as an option,” he warned.
Local health office manager, Dr Fergal Flynn, stressed that no final decision has been made on any proposed changes to the existing configuration of the mental health residential services in Clare, which doesn’t envisage moving services or residents outside of the county.
He said that the HSE wanted to do its best for its patients and respond to their changing needs, work to incorporate national policies into how it delivers services and respond in a timely and safe manner to the available financial constraints.
“Although public attention will likely focus on the budgetary and staffing aspects of these discussions, it is important to recognise that while these factors are bringing an acute spotlight on the need for change, the major driver is to meet the changing needs of individual patients and improve the quality of their care.
“More efficient practices not only improve the quality of care provided, they also often contribute to a more effective use of resources. HSE proposals are based on clinical advice regarding the best and most appropriate care for these individuals and the fact that the implementation of this clinically driven policy will enable us to deploy extra resources in other settings for more specialised cases requiring more intensive treatment is an added bonus,” he said.