'High-rated' recruitment risks force Laois hospital to depend on consultant living in England

Recruitment problems at Portlaoise hospital mean its Emergency Department (ED/A&E) has a small number of doctors relative to other hospitals while a UK-based consultant works remotely from England to prevent the spread of infection.

It is also reported that recruitment restrictions means the hospital’s dedicated patient complaints post is vacant. HIQA also revealed that there is no full pharmacy service in place with nearly a third of pharmacy department posts unfilled.

High risks related to staffing are also recorded on management's prioritised log of recognised threats to operations.

These are some of the findings in a newly published Health Information and Quality Authority (HIQA) inspection report on the Midland Regional Hospital Portlaoise.

While no non-compliance with standards was found in the Laois hospital, the watchdog’s report has identified some key issues to be addressed in the interest of patient safety.

While many clinical and nursing posts were found to be filled, HIQA reported that staffing is a constant concern for management.

“A number of high-rated risks related to staffing were recorded on the hospital’s corporate risk register. Workforce management was a standing agenda item at the monthly performance meeting with the Dublin Midland Hospital Group,” it said.

The inspection report is based on a visit to the hospital in May 2024. There were three consultant posts in emergency medicine two of whom were locum on the day of inspection. They covered a 24/7 on-call rota for the emergency department. The report indicated that this represents understaffing relative patient numbers.

“The emergency department had a small number of consultants relative to the number of attendances (42,616 in 2023),” said the report.

HIQA said this level of staffing contrasts the HSE’s 2024 Urgent and Emergency Care report data 2024 for hospitals in Sligo, Tullamore, Kerry and Mullingar.

Another risk highlighted was a continued dependency on an English-based consultant.

“The consultant microbiologist’s position was filled on a locum basis and the microbiologist was consulting remotely from the UK. This arrangement had been risk assessed and remained on the hospital’s risk register,” it said.

Microbiologists can diagnose, treat and prevent the spread of infection, making a major contribution to hospital clinical infection management.

Pharmacy services were also short-staffed with a medication safety pharmacist post among the vacancies.

“Pharmacy was carrying a deficit of 30% of pharmacist grade staff, which affected the hospital’s ability to provide a full clinical pharmacy service across the hospital including antimicrobial stewardship,” HIQA reported.

The report said the risks associated with these unfilled posts were escalated to the hospital’s corporate risk register and to the DMHG,” it said.

“HIQA also found that there were were vacant posts in the quality and patient safety department such as the quality patient safety manager grade-eight, the consumer affairs manager and the clinical risk officer (maternity services).

“Recruitment of replacement posts was impacted by the HSE recruitment embargo of late 2023,” said the report. MORE BELOW PICTURE.

Staff from several trade unions protested at the Midland Regional Hospital Portlaoise in November 2024 over staffing in Laois and other hospitals.

HIQA also highlighted issues about space and capacity.

While it was noted that construction work due to complete to expand the Emergency Department on 2025, the report found that A&E staff depend on the Acute Medical and Surgical Assessment Unit (AMSAU) when patient numbers surge. Staff had to use surge capacity on nearly 90% of days from January to the end of May 2024. HIQA says the usefulness of the AMSAU diminishes when it is used to cope with patient surges.

Issues with the main Dunamaise Ward were highlighted which the hospital identifies as an ongoing risk.

“Most patients on Dunamaise ward were accommodated in six bedded multiple-occupancy rooms. These rooms were small and patients complained that this affected their comfort.  Privacy curtains were used to promote the privacy, dignity and confidentiality of patients receiving care in multi-occupancy rooms,” it said.

The report acknowledges the existence of plans to improve the situation.

“Some elements of capital plans to improve the campus were at an advanced stage while others were still at the planning stage. This continuing scheme of works will be essential in providing a physical environment that supports the delivery of high quality, safe, reliable care,” said HIQA.

The Inspection report also highlighted a Governance issue regarding patient safety which led to previous big problems for the hospital. MORE BELOW PICTURE.

Pictured: Midland Regional Hospital Portlaoise.

Inspectors found that the hospital had formalised corporate and clinical governance arrangements in place but the hospital’s Quality and Safety Executive Committee (QSEC), with responsibility for governance and oversight of improving the quality and safety of healthcare services at the hospital, had only met once since the HIQA inspection in 2023. It had only met once since 2020.

The inspection team concluded that overall the hospital promoted a person-centred approach to care with staff observed to being kind and caring to patients. Hospital management and staff were found to be aware of the need to respect and promote the “dignity, privacy and autonomy” of patients.