Midlands regional hospital faces staffing concerns

A HIQA inspection of the Regional Hospital Mullingar (RHM) has noted improvements in some areas but found 'further work is required to address management and staffing vacancies'.

And the shortfall in staffing combined with deficits in the senior executive management out-of-hours cover arrangements was said to represent a 'significant risk'.

The health watchdog conducted an unannounced inspection on October 9 and 10, 2024 and found the hospital compliant or substantially compliant with seven national standards, partially compliant with three national standards and non- compliant with one national standard assessed.

There were 40 patients registered in the ED on the day of inspection, with 10 of these patients admitted and waiting for an inpatient bed.

As such, while the dignity, privacy and autonomy of patients was promoted and respected in inpatient areas, patients’ privacy and dignity in the ED required significant improvement.

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The facility was found to be non compliant in the 'Workforce' category and under the 'Service Providers Plan'.

At the time of inspection, the hospital’s governance and management arrangements were said to be 'in a state of transition'.

The report summary noted that staff attendance and the monitoring of uptake of staff training had improved since HIQA’s last inspection in 2022.

However, at the time of the October 2024 assessment there was a significant difference in the funded and actual number of staff in managerial, nursing and midwifery positions.

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Additionally, there were vacancies in nursing, midwifery and healthcare assistant staff to support the health service delivered.

The report stated the "13% shortfall in nursing staff, 20% shortfall in midwifery staff and 13% in healthcare assistant staff was managed in the short-term through staff redeployment and the use of agency staff, but this was not a reliable and sustainable way to manage the issue".

Inspectors found that four of the nine executive management positions were unfilled which had the potential to affect the future governance and efficient delivery of healthcare services.

The hospital was found to be 'substantially compliant' in terms of having 'systematic monitoring arrangements' and having 'effective management arrangements' under the 'Leadership, Governance and Management' section as well.

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The Regional Hospital Mullingar was also recorded as being 'substantially compliant' for effectively identifying, managing and responding to and reporting to patient-safety incidents.

The facility was found to compliant in terms of 'promoting a culture of kindness, consideration and respect'.

The hospital was ruled to be partially compliant in formalising governance arrangements for assuring the delivery of high quality, safe and reliable healthcare and of respecting and promoting service users' dignity, privacy and autonomy'.

The Regional Hospital Mullingar was also found to be partially compliant in terms of 'protecting service users from the risk of harm associated with the design and delivery of healthcare services'.

The report summary noted the significant risk posed by the shortfall in staffing combined with deficits in the senior executive management out-of-hours cover arrangements represented.

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"Notwithstanding interim assurances received from the IHA (Integrated Healthcare Area) manager to address the issue, adequate staffing, contingency and continuity arrangements need to be addressed in the medium to long-term to manage the staffing gaps on the days of inspection."

A HSE spokeswoman said the RHM has demonstrated improved compliance in six of the 11 National Standards for 'Safer' and 'Better' Healthcare assessed compared to results of the 2022 HIQA inspection carried out at the hospital.

HIQA highlighted in particular one area of non-compliance in respect of Theme 6: Workforce. They asked us for assurance on the further development of a robust management team at RHM and the hospital leadership have been working with the Dublin Midlands Health Regional team to implement a recruitment plan for a number of senior posts in Clinical, Leadership and Management positions at the Hospital. We are in the process of recruiting to these over the next six to eight weeks.

The HSE said HIQA anoted the challenges in respect of demand and capacity within the Emergency Department (ED) and they are working hard to resolve these through relocating the Acute Medical Assessment Unit, allocating dedicated clinical space to the Mullingar Frailty Intervention Team (MFIT) to improve the patient experience and quality of care for patients aged 65 years and olderand they now have a dedicated Phlebotomy Service for the ED to ensure that patients have their blood tests taken promptly along with a Telemetry Hub provide additional monitoring for patients.