Staff absence and overcrowding at heart of HIQA concerns at Letterkenny hospital

An inspection of Letterkenny University Hospital identified concerns around overcrowding, staff pressures and gaps in safety systems.

The inspection, carried out by the Health Information and Quality Authority (HIQA) on July 1 and 2, 2025, found the hospital only partially compliant in several key areas, including patient safety, workforce management and the physical environment.

The inspection centred on the emergency department, medical 6, medical 8 and surgical al 2 and focussed on four areas: infection prevention and control; medication safety; the deteriorating patient; and the transition of care.

HIQA said that there were some improvements noted compared to a 2023 inspection, but added that there were also “continuing or new gaps in compliance”.

The hospital’s reported absenteeism was 7%, which is above the target set by HSE of 4% or less, while staff from the HR department explained that the figure was at a high of 8.5% at the start of 2025.

Inspectors were informed that there is now an increased emphasis on one-to-one back-to-work interviews with staff. 

In the emergency department, for example, there was an approved nursing workforce of 85.6 whole time equivalents with 10 of them on various types of leave. 

Following the inspection, the hospital provided hospital-wide data on the percentage of staff who attended training in the past 24 months. 

The report said: “The data provided to HIQA reflected the need for considerable improvement in both the uptake, the recording of attendance and monitoring of compliance with attendance at mandatory training across the hospital.”

The report said that absenteeism levels remained high and that compliance with mandatory training “selected a deterioration from the levels noted in 2023” while inspectors found that, with the exception of medical 6, training words at ward and department levels were “difficult to obtain and were either inconsistent or not available”.

The report added: “Where they were produced for review by inspectors, they showed low levels of compliance with mandatory training across all staff groups.”

In the emergency department, inspectors observed multiple environmental concerns, including dirty wheelchairs, cluttered waiting areas, and non-HBN compliant sinks.

Cleaning sign-off sheets were out of date in several areas, and some toilets had not been serviced recently.

Some patients spoken to by inspectors commented on the poor cleanliness of toilet facilities in the ED while one patient described the waiting area as cold and uncomfortable.

“With the exception of the emergency department, the physical environment in the inspected wards largely supported the delivery of safe care,” the report said.,

“Quality improvement plans were in place to address audit findings, and a hospital- wide sink replacement programme had commenced. 

“Inspectors however, found evidence of suboptimal standards of cleanliness, and lack of evidence of compliance with cleaning schedules in the emergency department, and with regular environmental hygiene audits across the inspected areas. This is an area for improvement by the hospital.

Inspectors noted that while staff were consistently described by patients as “fantastic”, “very obliging”, “apologetic” and “doing their best”, the hospital was under considerable strain, particularly in its ED, where long waiting times were experienced.

HIQA inspectors also found that some patients were being treated on trolleys in corridors without access to call bells or adequate privacy, highlighting ongoing overcrowding pressures at the hospital.

The report found that Letterkenny University Hospital was operating at “black escalation” level - the highest level of overcrowding - with 33 patients medically fit for discharge but unable to leave due to a lack of community supports such as home care packages and nursing home beds.

HIQA noted the absence of a formal overarching quality and patient safety plan, while audit activity in areas such as medication safety and patient discharge processes was described as limited.

“Audit activity informed improvements in several areas,” the report said. “Limited evaluation of medication safety and transitions of care however, persisted as a gap. This issue was previously identified in the 2023 inspection.”

Despite these issues, the report acknowledged improvements in some areas since previous inspections, including better complaints handling and strong engagement from staff with patients.

Overall, the hospital was deemed compliant in just one of the assessed standards, with several others rated as partially compliant.

HIQA concluded that while there are established governance structures in place, further improvements are required to ensure consistent delivery of safe, high-quality care.

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The findings come as ongoing pressures on hospital capacity and delayed discharges continue to impact services.

The publication of the report comes just a week after the pressures being felt at LUH were brought into sharp focus at a Regional Health Forum West and North West meeting.

The meeting  heard that the total bed days lost due to delayed discharges for the last six months is a staggering 6,548 at LUH.

A total of 38 patients, who are medically fit to leave Letterkenny University Hospital, remain in beds this week.

A total of 226 day cases were cancelled in January or February of this year due to LUH being in escalation and these included 54 elective inpatient admission and 172 other day cases. In the whole of last year, there were a total of 295.

The same meeting heard that ambulance delays at LUH are going unmeasured - despite systems being in place to track them.