LAST UPDATE | 27 May

MORE STAFF NEED to be recruited to work in the critical care unit of the National Children’s Hospital in order to “safely” maintain the current number of beds, and to achieve the planned increase in beds, a watchdog report has warned. 

The Journal understands that Children’s Health Ireland have carried out recruitment trips outside of Europe in locations including India and Dubai in order to find staff to work at the new hospital when it finally opens. 

The National Office of Clinical Audit (NOCA) publishes its Irish Paediatric Clinical Care report today, which stresses that real workforce planning needs to take place so the new hospital will be able to open in 2025 as planned, with a fully operational 42-bed critical care unit. 

The report found a 14% increase in children’s critical care admissions in 2021 and 2022 compared with 2018, with occupancy rates at Children’s Health Ireland (CHI) at Crumlin regularly exceeding 95% – which is far above the recommended standard of 85%.

The report said that for ten extra critical care beds to be added (there are currently 32 operational beds), a multi-disciplinary staffing plan will be needed. 

Otherwise, the quality of care provided to critically ill children could be compromised. 

The Journal understands that CHI carried out overseas recruitment trips in November 2022 and then again in 2023 aimed at recruiting more staff for the opening of the new hospital – which has been delayed several times, with construction still underway. 

“This trip was aimed across Southern India (Kerala) and the UAE (Dubai).  Three senior nursing staff and one recruitment officer went to interview panellists” CHI said in response to an FOI request. 

The trip was managed and organised by a recruitment agency that CHI engaged, which also sourced candidates in these countries. It’s understood that despite several of these trips having been carried out alongside domestic recruitment, CHI is still facing a serious staffing deficit.

Associate Professor Martina Healy, the clinical lead for the audit, said that there is an urgent need for a recruitment and retention staffing plan in paediatric critical care, as consultants, nursing staff and trainees need to be brought on board. 

Commenting on the report, Ciara Swan, the mother of a young child who was admitted to critical care units in Ireland, said that ensuring these units are fully staffed is not just about numbers, “It’s about saving lives and providing the best possible care for our children in their most vulnerable moments”. 

Ciara’s daughter Sophie had initial treatments at CHI Tallaght and Temple Street from December 2022 onwards, but then required an emergency ECMO transfer to Sweden for specialised care. 

(Extracorporeal Membrane Oxygenation (ECMO) is a machine that takes over heart and lung function when a patient’s organs don’t work on their own). 

“Sophie’s successful treatment in Sweden highlights the need for an ECMO service in Ireland,” Ciara said. 

The report found that neonates (newborns that have a corrected age at admission of less than 29 days old) accounted for 28% of critical care admissions in Crumlin and 25% in Temple Street in 2022. 

There was a rise in respiratory issues leading to admission, as respiratory cases accounted for 30% and 39% of admissions at CHI Crumlin and Tallaght respectively in 2022, compared to 18% and 24% respectively in 2020. 

The audit also found significant workforce shortages at CHI Temple Street, as staffing levels fell below the recommended 5.5 whole-time equivalents, averaging instead at 4.84 in 2022. 

There was also an increase in unplanned emergency admissions in Crumlin and Temple Street in 2022, as this category of admissions was up 60% from 2021 in the case of Crumlin Hospital. 

Mortality rates, which relate to the number of children and babies who die in CHI hospitals, remained steady at 4% annually, the report found. 

It also highlighted that in the year 2021-2022, 11 infants and children from 2 days old to 15 years of age donated organs and/or tissue. 

“Dedicated hospital organ donation personnel should be appointed to increase awareness of organ donation and to ensure opportunities are not missed,” the audit stated. 

It also said that there is a strong need for regional high dependency units to be developed in the HSE, to alleviate the pressure on the central critical care units. 

“Most admissions to CHI Temple Street are transfers from other hospitals,” the audit said.