FOR MUCH OF last 10 months, the HSE has defended claims it could soon be overstretched or overwhelmed. 

In October, CEO Paul Reid said the health service was “challenged but not overwhelmed” by the second wave of Covid-19. In the Dáil that same week, the Taoiseach said that the “HSE are very clear that it has the capacity to deal with the current situation”.

As we entered 2021, however, the message has become very grave, very quickly. 

On Tuesday, Reid said that “our health service is under real threat now”. 

“We’re heading to the peak of hospitalisations as in the 1st wave,” he said. “Primary and GP services are under relentless strain.”

That peak of 881 in the first wave was then eclipsed on Wednesday, with hospitalisations rising above 1,000 the following day. 

At the frontline dealing with this new peak of virus cases are healthcare workers.

Earlier this week, Reid had confirmed that 3,000 staff are currently out of work either due to being a confirmed Covid-19 case or a close contact of a confirmed case. It’s understood this figure is now at around 3,200.

In Cork University Hospital, alone, 100 nurses were unable to work due to Covid-19 reasons.

Irish Nurses and Midwives Organisation (INMO) general secretary Phil Ní Sheaghdha told TheJournal.ie that the situation for healthcare workers has deteriorated severely very rapidly.

“It’s a different landscape in the past two weeks,” she said. “It’s really severe. And it’s unsustainable.”

Ní Sheaghdha said that staff in a number of hospitals are being put under severe pressure at present given the high numbers of hospitalisations and low staff numbers.

“There’s issues we just keep raising, or members keep raising on the absolute pressure they’re being put under,” she said.

“They seriously believe things have been moving too slowly. Electives should’ve been cancelled earlier, and private hospitals should’ve already been on the pitch last month. It’s waiting for problems to arise and worsen before solutions are looked at.”

These sentiments were echoed by Kevin Figgis, health divisional organiser at Siptu.

He told TheJournal.ie: “I was speaking to a healthcare worker the other day who described it to me like this. 

They said the current crisis is like a fire that was lit back in March that has continually burned since then, but is now raging out of control. Healthcare workers have been fighting this every hour of every day. It’s never abated. Fatigue and exhaustion are massive factors here. 

According to figures from the Health Protection Surveillance Centre (HPSC), over 13,000 healthcare workers have been diagnosed with Covid-19 since the start of the pandemic. 

Over 400 of these have been hospitalised with the virus, while nine have died. The median age of healthcare workers who’ve been confirmed cases is 40. 

Since August, in almost 40% of all recorded cases of Covid-19 among healthcare workers, they caught the virus at work. 

Figgis said: “It’s not just the infected rate. If I’m working in a team and am diagnosed, other members on that team have to self-isolate. And that has an effect on everyone. I said fatigue – people might say wearing a mask for 20 minutes in a shop can be difficult, try doing it for a 12-hour shift.”

TheJournal.ie has spoken to multiple staff members in hospitals in Dublin and Cork. There was a shared sense of foreboding about what might happen in the coming weeks as hospitalisations continue.

Some described months of avoiding friends and family out of fear of potentially exposing them to Covid-19, while others spoke of their trepidation at going to work each and every day with worry at the situation they’ll find when they arrive. 

The INMO’s Ní Sheaghdha said the government’s decision to close schools this week would also have a huge effect on nurses and midwives. 

“You can’t divorce one from the other,” she said. “The knock on effect for a predominantly female workforce is huge in terms of the care their children will need when schools are off.”

Recruitment

One potential way to help alleviate pressures on staff during this period is to allocate more resources to the health service. And the government late last year promised significant funding in this regard. 

In Budget 2021, an extra €4 billion was announced to help the health service combat and cope with Covid-19. Included within that funding were plans for 2,600 beds and about 16,000 staff for the health service over levels promised in the previous Budget. 

Minister for Health Stephen Donnelly said the funding “will not just be about the response to Covid-19, it is also about building positive permanent change into our health service”. 

Three months on, Siptu’s Figgis said that his members are seeing little evidence on the ground that recruitment has been ramped up to help deal with the current crisis.

“Whatever plans they have in place, they need to be fast tracked now,” he said. “Staff are on their knees. They start shifts with everyone having their eyes on the ground. They need to see cavalry coming over the hill.”

According to figures released by the minister on 10 December, an additional 4,483 full-time equivalent staff were recruited in 2020. This included 1,404 staff under the category of nursing and midwifery. 

But, between absenteeism due to Covid-19 and other absenteeism, Figgis said that the pressure currently on healthcare workers is at a remarkable level. 

“There’s nobody suggesting that the 16,000 staff (pledged in Budget 2021) will arrive tomorrow,” he said. “But there’s no point saying that by mid-2021 it’ll ramp up.

This is January 2021, and we’re dealing with the worst of this crisis. Members across hospitals, community services, national ambulance services, mental health, they’re not seeing additional staff come on stream. They’re not seeing it. 

Ní Sheaghdha said the INMO had written to the HSE this week setting out a “clear ask” for evidence of the recruitment plan being put in place by the HSE. 

“We asked what extraordinary measures are they now implementing to recruit,” she said. “Contracts for nurses or for retired staff? All our questions remain unanswered. We need to have evidence of a clear recruitment plan. We need it now.”

Figgis was also critical of the HSE’s use of agency staff as a stopgap instead of recruiting full-time staff. 

He also said that the “red tape” blocking line managers from filling vacancies needed to be fully eased to allow speedy hiring of new staff. 

“We have to take the proverbial handcuffs off, and we have to do it now,” he said.

Ní Sheaghdha added that the need for further recruitment to relieve exhausted and under pressure health staff couldn’t be more urgent.

“All in all, it’s a very grim picture,” she said. “Our members would say they’re feeling taken for granted – not by the public. But that the actual strain and pressure is not understood. They’ll be going into wards tonight that are understaffed.

The ask on them to shoulder what they’ve shouldered… there comes a point where the ask is too great and the ask is beyond what we can give. 

In response to a query from TheJournal.ie, the HSE said its national service plan has provided an unprecedented level of investment to support 16,000 additional permanent staffing posts by the end of 2021. 

“The Resourcing and Recruitment Strategy required is of a scale that has been unparalleled and will require an ambitious suite of resourcing approaches with the collective aim to meet, to the greatest extent possible, both the resourcing requirements set out in NSP 2021, along with the retention of the current workforce,” the HSE said. 

It said 6,000 additional staff had been recruited by the end of November 2020, across all categories, and that a number of options are being considered for recruitment this year including building capacity internally or the use of external recruitment providers. 

The HSE added: “Local management are reviewing all rosters and absenteeism and will manage on an ongoing basis locally in terms of supporting and prioritising services in this regard.”