Tipperary University Hospital beds will close unless more nurses hired, union warns

A trade union has warned of bed closures at Tipperary University Hospital in the new year with serious implications for patient care if urgent action isn’t taken to fill more than 50 vacant nursing posts to bring staffing levels up to a “safe” standard.

The Irish Nurses & Midwives Organisation (INMO) that represents over 500 nurses at the Clonmel hospital, has bluntly stated that critical areas of the Clonmel hospital are “understaffed and unsafe, falling significantly short of the standards outlined in the Government’s own Safe Staffing Framework”.

And it fears the continued “suppression” of frontline nursing posts at the hospital is placing patients and staff at “increased risk”.

The union’s warning was issued as more than 250 healthcare workers staged a lunchtime protest last Thursday over the impact of staff shortages on Tipperary’s health services.

The protest, organised by the INMO, Fórsa and SIPTU unions, highlighted their members’ anger and frustration at the stress and “burn out” the failure to fill vacant posts is causing health care staff across a range of disciplines and the negative impact on patients.

It was one of a series of protests organised around the country in recent weeks as INMO and Fórsa members are balloted on industrial action over the Government's foot dragging on filling vacancies despite the lifting of the health services recruitment embargo imposed in October 2023.

At the picket line last Thursday, INMO Industrial Relations Officer Liam Conway said the filling of more than 50 nursing and midwifery vacancies at Tipperary UH was required to bring staff numbers up to the required “safe level”.

He said it was “completely unacceptable” that this number of nursing and midwifery posts were being left unfilled at the hospital due to budget caps the HSE has put on recruitment.

Mr Conway claimed that despite its public utterances, the Government was continuing its recruitment embargo in all but name.

He said there were significant vacancies in all the hospital’s wards and in the Emergency Department.

Mr Conway highlighted that nursing posts in stroke care, COPD, neurology and colorectal specialisms are being left vacant along with shift leader posts in the paediatric unit, midwifery and women's health development posts in the maternity unit.

The union official said research based on the Government’s Safe Staffing Framework demonstrates that inadequate nurse staffing leads to “poorer patient outcomes, longer hospital stays, and a heightened risk of mortality”.

He said the reality is that if staff numbers aren’t increased, the hospital’s management will have to close beds in the new year.

Mr Conway pointed out that despite the opening of the modular 33-bed Slievenamon wing last year there is still an overcrowding problem at the hospital with patients on trolleys being placed in already full wards.

He explained that demand for Tipperary University Hospital’s services continues to grow and significant investment in staffing and bed capacity is needed to keep up with this demand.

“Our members are extremely angry, not at local management but national HSE and Department of Health management. They feel extremely let down.

“I am from Tipperary Town and the people of Tipperary deserve a lot better in terms of services.

“A lot of nurses and midwives feel they are being let down by those in the Government,” he declared.

He said the frontline health workers also deserve better and urged the Government and HSE to urgently reverse their current pay and staffing policies.

Fórsa represents a wide range of Tipperary HSE workers ranging from physiotherapists, occupational therapists, language therapists and dieticians to cardiac technicians, care assistants and administrative staff.

Fórsa’s Tipperary South Health & Community Branch Chairperson Colette O'Connell said the continuing employment restrictions are putting patient services under enormous strain and are happening against a backdrop of higher health demands from an ageing population with more complex needs.

She said the HSE was under-resourced and this protest was their members’ way of “taking a stand” to protect health services.

Ms O’Connell spoke of the stress healthcare workers are under covering for unfilled vacant posts and people on sick leave with worrying levels of burn out.

“I hear of members having their lunches at their computer and some can’t be here to protest today because they don’t want to let the public down.”

She said Fórsa union members working on the frontline in the health services are facing the public’s anger because the services can’t meet their needs due to the staffing shortages. “They want to provide a top level of service but can’t to that.”

Ms O’Connell said very experienced staff with over 30 years service are saying they have enough and are walking with the loss of years of experience and relationships with patients and their families.

Deirdre Whelan, a cardiac physiologist at Tipperary UH and Fórsa member highlighted how staffing shortages in her section are negatively impacting patients.

She said the waiting list for out-patient cardiac diagnostic tests has increased due to staffing shortages resulting in people ending up in the Emergency Department and admitted as in-patients because their cardiac problems weren’t diagnosed soon enough.

She said extra posts created during the Covid-19 pandemic were now being suppressed. When a staff member left, they were not being replaced.

Fórsa Assistant General Sectretary Tosh Cowman stressed this protest wasn’t about the union’s members looking for more money. It was about staffing. They were genuinely concerned about the health services they are working in being undermined.

He complained that vacant posts weren’t being filled due to money concerns, yet huge amounts of money were being given to private agencies to fill certain staffing gaps in the health services.

This was a criticism echoed by Stephen Brady, a SIPTU Shop Steward at Tipperary University Hospital.

His union represents about 90 portering, catering, cleaning and surgical implements cleaning staff at the hospital.

He said there are 14 vacant posts in these areas of the hospital at the moment with annual leave being withheld in some cases due to staffing shortages.

Mr Brady complained the HSE was spending an “absolute fortune” bringing in temporary agency staff to fill gaps in staffing.
Agency staff were paid at a higher level than regular hospital staff and many were not adequately trained.

Mr Brady pointed out that untrained agency staff were adding to the already heavy work load and stress of existing staff who had to constantly train them up on top of their own duties.

“They (hospital staff) are saying to shop stewards, please help us, we want permanent staff to train.”

Mr Brady said SIPTU hasn’t balloted its members working in healthcare for industrial action yet.

But he indicated that if management don’t listen to their concerns after this protest, the next step will be for his union to ballot its members for industrial action.

Ireland East Hospital Group responds on behalf of Tipperary University Hospital management

The hospital group that includes Tipperary University Hospital says it is regrettable the INMO and Fórsa unions are balloting their members for industrial action in view of an extra €1.5bn funding for the health service this year.

The Ireland East Hospital Group, responding, on behalf of Tipperary UH management, noted the ballot was also taking place against the background of a planned €1.2bn increase in the health budget next year

The statement from the new hospital gropu didn’t address queries The Nationalist specifically put in relation to staffing shortages at Tipperary University Hospital, the resulting pressure and strain on existing staff and negative impacts on patient care including the threat of bed closures this winter.

Instead it focused on the national picture. The statement explained that in July, the HSE finalised its Pay and Numbers Strategy for 2024 following months of detailed discussion with the Departments of Health and Public Expenditure.

“There is now a new approved Maximum Whole Time Equivalent (WTE) staff figure for the HSE of 129,753.

”This excludes disability services provided by the HSE and its Section 38 organisations in that sector, pre-registration nursing and midwifery students, and 76 special assignment temporary posts.”

The statement explained the 2024 Pay & Numbers Strategy provided for the retention and funding for approximately 4,000 whole time staff, that were due to excess recruitment at the end of 2023 and the retention of once of funding provided for COVID-19 posts.

“This has enabled the retention of 4,000 posts across the publicly funded health system.

“This agreement has provided clarity on the funded workforce in the health service.

“Based on the agreement of December 31 2023 - all posts occupied and reporting WTE on the Health Service Personnel Census (HSPC) on this date are comprehended and considered as funded.

“The CEO of the HSE has welcomed this positive step, and the fact that there is now a two year line of sight of both the HSE budget and the size of the workforce to work within,” the statement continued.

“Each of the six HSE Health Regions and each national service has been provided with its own specified number of WTEs and can within that approved number, replace, recruit and prioritise. 

“This provides greater oversight when responding to the needs of the population and prioritising appropriately.

“There will be in the region of 3,000 new posts advertised for this year, and recruitment has started.

“Managers will have to control recruitment to stay in line with the approved maximum.

“This combined with the pay and numbers strategy, gives great clarity and stability to health service funding, and allows for a  period of confident planning and budgeting.”

In relation to hospital overcrowding, the Irish East Hospital Group reported a 11.5% drop nationally in the number of patients on trolleys at 8am waiting for hospital beds compared to last year.

“We are acutely aware that even one person on a trolley is too many and reducing trolley figures continues to be a particular focus.

“With the implementation of the Health Regions, the HSE has plans in place across its hospital and community services to support high attendances at its emergency departments. 

“Hospitals together with community teams work closely to enable patients move as safely and as efficiently as possible through the acute hospital system.

“All patients who present to our emergency departments will be seen and treated, with the sickest and most urgent patients being prioritised.

“We urge any patient requiring emergency hospital treatment not to delay and come to the ED, or dial 999 or 112 in an emergency,” the statement concluded.

Healthcare workers protesting over staffing shortages in Tipperary's health services at the Western Road entrance to Tipperary University Hospital last week