Cork University Hospital staff shortages a risk to patients, says hospital’s CEO

Radiology for cancer treatment and children’s neurology are among the services most affected by insufficient staffing at Cork University Hospital (CUH), the hospital’s CEO said in a letter to HSE management this week.

Jennifer Kearney noted in her letter that there were more than 1,050 whole-time-equivalent (WTE) staffing gaps.

A new process, requiring hospital management to “prioritise” posts internally before progressing them to national HSE level for approval, began in March; and there were further restrictions due to CUH being “above its WTE ceiling” of limits set by national HSE senior management.

In response, a HSE South West spokesperson told The Echo that CUH is nearly 260 WTE posts “above its approved workforce limit”, and that the workforce has continued increasing in CUH, though “other service areas” have seen reductions.

In her letter, sent last Monday, Ms Kearney said that CUH “complied fully with the process and repeatedly re-prioritised posts, as requested”, but between March and July, only 28 replacement posts and six new were approved, alongside 42 summer locums for cleaning and catering.

“Meetings were cancelled in July and August, further slowing down approvals,” she said.

Not look good nationally

Ms Kearney continued: “At a meeting in Caha House on 7 May, CUH was asked to significantly reduce its list of approximately 120 prioritised posts, with the rationale that the number would ‘not look good nationally’. When I raised concerns about the impact on safe service delivery, I was asked to consider which services could cease in order to suppress the number of posts.”

She described this as a fundamental issue, saying: “Reducing the number of posts presented for approval does not reduce the clinical need or the associated patient-safety risk.”

On August 17, she said she was asked again to prioritise posts, including posts already awaiting approval, and “the expectation was CUH prioritise around four to five posts only”. 

There are 348 fully funded vacancies: 131 health and social-care professionals, 88 nurses, 72 management and admin staff, 51 general support, and six medical and dental.

There are an additional 249 approved, but unfunded vacancies; 202 posts identified in National Service Plans and never filled; a further 166 WTE on maternity leave; and 88 on long-term sickness leave, for a cumulative 1,053 staffing gap.

Ms Kearney said that paediatric neurology “provides a particularly stark example of the consequences of an inflexible approval process”.

The service is operating with only 0.8 WTE, which Professor Colin Hawkes, a paediatric endocrinologist at Cork University Hospital, has “repeatedly advised is unsustainable, for both patients and the consultant”, Ms Kearney said.

Waiting lists continue to grow

As waiting lists continue to grow, Ms Kearney and Prof Hawkes worked to identify an interim solution.

A paediatric neurology consultant from Belfast was secured to review 30 of the most complex children, but, “despite repeated efforts”, the approval process took so long that all 30 appointments had to be cancelled.

“The Belfast consultant has understandably withdrawn from further engagement,” Ms Kearney said, adding that approval on a permanent post is still awaited.

“The children cannot wait for the process to catch up with the risk,” she said.

Radiography is also “particularly concerning”, the CEO told HSE management, saying that the combination of vacancies, maternity leave, and sickness absence means that CUH is now having to restrict CT scanning capacity because of staffing constraints.

A locum interventional radiologist has been secured to commence in October, but cannot receive a contract and requires three months’ notice.

The consequences are also being seen across multiple other services, including geriatric medicine, where a backfill position was not secured. That resulted in the hospital becoming unable to support postgraduate medical training and placement co-ordination.

Consultant backfills also remain unfilled in endocrinology, and approximately 800 patients’ appointments have already been cancelled.

Staffing shortages

In the PFT laboratory, which examines lung function, service is being outsourced because of staffing shortages.

A candidate has been recruited, but the funded post remains unapproved, even though “approval would remove the requirement for costly outsourcing”.

Ms Kearney concluded her letter by saying: “The approach now needs to shift from controlling the number of posts submitted to actively managing and mitigating the clinical risk created by the vacancies.”

She said that as well as dealing with the staff shortages, CUH is managing a sustained 12% increase in demand, with admissions among patients aged over 75 running at twice the national average.

Quoting Eleanor Roosevelt, she said: “We must know what we think, and speak out, even at the risk of unpopularity.”

Ms Kearney said that her role as chief executive is not simply to comply with a process, but to speak up when there is a foreseeable risk to patients and staff.

“I would rather raise that concern now, when there is still an opportunity to act, than remain silent and explain afterwards why we did not.”