A HOSPITAL IN Co Meath currently has no non-locum/agency doctors working in its emergency department.
Our Lady’s Hospital Navan (OLHN) recently became a centre of controversy when it emerged that its emergency department was on the verge of closure due to staff shortages after agency medical staff declined to turn up for at least four days.
While at least three other hospitals were affected by the stoppages, Navan was particularly exposed due to its higher ratio of agency staff to HSE employees.
That situation, which first came to light a fortnight ago, lasted for most of a week with the department eventually bolstered by staff drafted from other areas of the hospital, until the HSE was finally able to replenish the hospital’s roster using alternate agency workers four days later.
Now new figures released to TheJournal.ie show that every doctor currently working in the hospital’s emergency department is a locum (a temporary replacement for a permanent worker, typically earning a far higher rate of pay).
A spokesperson for the HSE said that there are five agency doctors in the department who rotate shifts, and who have access to a consultant’s advice after hours (with that consultant typically being based at another hospital).
Work stoppage
The five doctors described above staff the hospital’s emergency department on a rotational basis. Each of them is an agency worker, retained at an hourly rate of €75.60 (more than double the pay of a staff registrar), or an annual cost of at least €766,000 (sources suggest this figure is in reality in excess of €900,000).
It’s understood that four of those five doctors failed to show up for work from Monday 4 September, while at least one of the missing has since returned to work at the hospital.
Those five doctors join roughly 23 nursing staff, an emergency department consultant, and an associate specialist (neither of whom are full-time) in forming the department’s total complement of staff.
The situation which sees all doctor positions within the department filled by locum staff has been in place since at least January 2016.
Work stoppages by agency staff ensued at Navan and at least three other hospitals two weeks ago in a row over pay, with the HSE attempting to slash the hourly rate of agency staff in an attempt to bring it more in line with that of in-house workers.
The HSE has struggled in recent times to fill permanent positions given the more attractive rates on offer to workers retained from outside the health authority (LocumExpress being one such agency for temporary medical workers utilised by OLHN).
Navan hospital has faced an uphill task in filling permanent positions in the emergency department for over a decade since a decision was taken to limit the number of consultancy sessions on offer for doctors each week to eight (which is not sufficient to qualify for training recognition by the Royal College of Surgeons in Ireland [RCSI]) in the early 2000s.
“The emergency department in Our Lady’s Hospital Navan has five agency registrars (doctors) who rotate shifts,” a spokesperson for the HSE said when contacted about the ratio of agency-to-HSE staff at Navan by TheJournal.ie.
The Ireland East Hospital Group has put in place a formalised arrangement where the locum emergency department registrars will have access to consultant’s advice after hours [it's understood that the consultant in question is based at the Lourdes hospital in Co Louth, situated 17 miles to the east].
It has long been suggested that a long-term plan with regard to Navan is to transfer the hospital’s emergency facilities to the Lourdes in Drogheda, in line with the closure of similar departments in Monaghan and Dundalk.
Campaign
A local campaign to save the provision of services at OLHN has been operational since 2010.
Chair of that campaign, Sinn Féin TD Peadar Tóibín, has decried the situation which has left the hospital’s emergency department staffed entirely by agency doctors, describing the “near collapse of service” as “scandalous”.
“The reason why Navan was so especially exposed to this strike is that our emergency department is scandalously staffed 100% by agency doctors,” he said.
What organisation in the world would staff an emergency facility with personnel that are far more expensive than full-time staff and are by definition far more transient?
It has come to light that two-thirds of the consultant surgeons within our hospital are to be let go this October. While these positions may yet be re-filled, the changes and lack of continuity are yet another blow to our hospital. Our emergency department was on a HIQA (Health Information and Quality Authority) list of nine emergency departments throughout the state that were to be closed. All of the others are gone. Navan is the last one standing.
“It is clear to me that because of the health authority’s staffing strategy and the attendant loss of services that the HSE see Our Lady’s Hospital emergency department as a temporary site. There are 200,000 people in the county. HSE chaos in surrounding hospitals means we don’t have alternatives,” he added.
It is not the first controversy to affect the hospital in recent times. In late June the HSE confirmed that OLHN had yet to establish a fully operational mental health day service, some nine months after the closure of the 24-hour psychiatric unit at the hospital.
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