Union highlights difficulties with patient transfers

THE Psychiatric Nurses Association (PNA) has claimed the transfer of psychiatric patients from North Tipperary to the acute psychiatric unit at the Mid-Western Regional Hospital, Ennis was not entirely seamless.

 

Commenting on an extensive interview with Mid-West continuing and community care manager, Bernard Gloster, which was published in last week’s Clare Champion, the nursing union acknowledged the praise of nurses for the commitment and efficiency given since the admissions of patients from North Tipperary to the unit in Ennis.

However, it claimed the transfer was and is not as seamless as described in the interview and noted the five extra nursing posts were used to fill vacancies in the Clare Mental Health Service and were not put in the acute unit, where the North Tipperary patients were accommodated.

Mr Gloster acknowledged the five extra nursing posts were not used to fill existing vacancies in the Clare Mental Health Service. He said they were used and deployed in the overall community services, which are one of the main means by which the throughput of the acute inpatient unit is managed more effectively.

“The HSE never sought to create the impression that the five extra posts were deployed to the acute unit. Furthermore, it should be noted that the deployment of these posts was entirely a matter for nurse management and clinical management within the Clare services and was not dictated by executive management at the time,” he explained.

PNA representative, Denis Meehan pointed out no new resources were put into the acute unit at the time of the transfer of acute inpatient admissions in relation to the people of North Tipperary.

While Mr Gloster acknowledged this fact, he pointed out no additional beds were created in the acute unit in Ennis.

“It is through the more efficient management of the patient flow through the existing inpatient beds that the North Tipperary dependencies were accommodated. Therefore, there was not a need for specific additional resources as additional beds in themselves were not opening within the unit complement. There was additional consultant psychiatrist input to ensure that the patients from North Tipperary were dealt with by a consultant connected to their own services in North Tipperary,” he said.

Mr Meehan expressed concern that the acute unit is almost always short of the agreed levels of nurses on a daily basis, even with more than 100% occupancy of patients.

Mr Gloster stated the pressures of the recruitment moratorium and other cost-management measures were acknowledged in the course of the interview. However, he noted that the PNA had failed to acknowledge 6,256 agency hours were used from May 8 at the time of the interview up to October 15 last by the Clare Mental Health Services. There were also a substantial amount of extra hours provided by additional staff, which were paid for.

Mr Meehan stated the change is also not ideal for the population of North Tipperary because of the distances required to travel by patients and families.

He claimed people with a mental illness who are in a crisis are regularly required to travel more than 70 miles simply to be assessed by mental health staff out of hours.

Mr Gloster outlined the distance from population centres to acute inpatient beds for mental health services is increasing as the number of acute beds indicated in the national policy, Vision for Change, is less than what was used heretofore. This is because there is a preference for the use of alternative means of intervening with and supporting patients other than repeated dependency on acute beds.

Mr Meehan expressed concern about the long distances for the multi-disciplinary team to travel from day facilities in Thurles and Nenagh.

Mr Gloster noted the staff of the Mid-West Mental Health Services, previously Limerick, Clare and North Tipperary, now all operate as one mental health service crossing a geographic area, which is referred to as a supercatchment area, consistent with national policy.

Commenting on Vision for Change, Mr Meehan stressed the vision of fewer admissions to hospital cannot be realised until an adequate community service is resourced by extra staff. “The situation at present is that the community is now operating at less than half nurse staffing than was in place in 2009,” he said.

Mr Gloster said the point acknowledged in respect of the use of community services is noted and explains why the additional five posts referred to were deployed into the community and not the acute unit.

Lack of funding stalled temporary posts
THE Mid-West Health Service Executive (HSE) has acknowledged that 10 temporary posts sanctioned to provide relief for maternity leave weren’t filled due to a lack of funding.

Following a number of statements made by Mid-West continuing and community care manager, Bernard Gloster, about the restrictions imposed by the national recruitment embargo, the Psychiatric Nurses Association (PNA) representative Denis Meehan pointed out the 10 temporary posts sanctioned for the relief for maternity leave were selected but less than one week before commencement date, they were stalled and have not been put in place.

Mr Gloster acknowledged that at the time the interview was conducted last May, those 10 posts for replacement of maternity leave had been approved. However, due to national financial circumstances within the health service, these posts were further deferred in the new recruitment pause introduced.

“It is equally important, however, to note the extensive amount of agency hours which have continued to be supplied to the Clare Mental Health Service partly as a result of this. It is not fair to simply say that because the 10 temporary posts did not proceed, that the service was left with that deficit,” he said.

The PNA agrees with Mr Gloster that the embargo is an undesirable instrument and has decimated front-line nurses in Clare Mental Health Services and welcomed its plan is to convert agency and replacement nurses to full-time nurses.

Mr Meehan pointed out the use of agency is unacceptable because of the lack of continuity for clients. These nurses cannot carry out some duties, such as work as preceptors to students and so cannot advise or support the student nurses in their training.

Mr Gloster acknowledged the union’s concern in relation to the use of agency in the context of student nurses. “The management of student nursing is a task directly carried out by nurse management and again it is noted that the PNA failed to comment on the fact that the most recent group of student psychiatric nurses completing their training were kept on as employees of the service, including a number of former attendants who have now converted to nurse grades.

“It is disappointing the PNA would fail to acknowledge these very significant interventions,” he said.
Of the 20 extra staff that were approved for community mental health teams this year, Mr Meehan expressed concern not one nurse in adult psychiatry was included.

Mr Gloster explained the new posts for mental health and primary care were delayed due to the national finances.

As recently as last Wednesday, Mr Gloster confirmed with the national HSE system that there is every intention to ensure that approved mental health development posts will proceed and a number of these are with the national recruitment service for processing.

Mr Gloster reiterated that the interview was conducted in May of this year and published in October and it is important to reflect that.

“However, it is equally important that the time between conducting the interview and its publication has not substantially altered the picture portrayed at the time.

“In the context of dealing with staffing numbers, which is the main thrust of the PNA commentary, it is also important for balanced public opinion to note that the Clare Mental Health Service continues to have challenges in respect of absenteeism. For example, the most recent figures for nursing in the Clare Mental Health Service would show an absent rate of 6.57%. That August figure is an increase from the rate in July of 4.95%.

“I attempted in the course of the interview to acknowledge the significant flexibility and positive disposition of staff in the Clare Mental Health services and I believe the journalist reflected this very well. It would be extremely important when talking about staffing numbers that we inform public confidence with the proper context.

“Public service numbers in terms of adequacy requires that we not only focus on the numbers who have left or the numbers on the ground but also the important issues of absenteeism, agency and overtime,” Mr Gloster explained.