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News Update No. 23 : 16th April 2016
Workplace Relations Commission (WRC) held its second review

Report Of Second Review By The Workplace Relations Commission (WRC) Of The ED Agreement


Friday, 15th April 2016


Dear Colleagues

I write to confirm that the Workplace Relations Commission (WRC) held its second review, of the ED Agreement, between the INMO/HSE/Department of Health earlier today.

The purpose of this review is to allow the WRC receive reports, from both management and the INMO, into the implementation of all aspects of the agreement and to deal, where necessary, with difficulties/obstacles.

In that regard, arising from the discussions today, the following is a summary of matters discussed:


1.    Taskforce on Nurse Staffing in Emergency Departments

As you know a critical part of the overall agreement is the establishment of a Taskforce, on Nurse Staffing in Emergency Departments, to review and recommend standard staffing levels for all of the country’s Emergency Departments.

In recent days, ahead of this second review, the INMO had made it plain, to the management side and, in particular, the Department of Health, that the failure to progress this part of the agreement was a major breach and completely unacceptable.

Arising from this a proposal has now been made providing for a process, to report within three months, which will examine previous staffing reviews undertaken, in Ireland, together with a consideration of international research in this area.  Further discussions on this proposal will take place, within the next two/three days, and it is expected that the work will commence very shortly.

2.    Current Staffing Issues

It was reaffirmed, at today’s review, that all vacant posts, in Emergency Departments (currently 140 approx.) will be filled.

  • The HSE/Department of Health acknowledge that, despite the tightened financial controls now in place, the commitment to fill all of these vacant ED nursing posts, is absolutely steadfast and all local employers are being advised of same.
  • This issue will obviously have to be monitored via the weekly Group/Hospital level meetings, established under the agreement, between INMO and management.

3.    Additional Staff - Admitted Patients

The INMO, at today’s review, also reaffirmed our demand, which was acknowledged, for the need for additional nursing staff to look after the increased volume of attendances, to ED, and, in addition, the admitted patients.  This issue will also be raised at the Emergency Department Taskforce meeting, scheduled for Monday 18th April 2016, to which the Acting Minister for Health is expected to attend.

4.    Additional Posts/Regradings

The management side confirmed, as per my previous note, that the circular, giving sanction to the additional posts provided for in the agreement, has now issued. This circular provides for the following:

  • Assistant Director of Nursing posts, in all 26 Emergency Departments, with sole focus upon patient flow;
  • Clinical Nurse Manager 2 posts, in 15 hospitals, to look after admitted patients; and
  • Clinical Nurse Manager 1 posts (conversion) - seven such posts to be established, via internal competition, in all Emergency Departments, excluding St. James’s which already has these seven CNM1 posts.

Arising from discussions, at today’s review, management will issue the required clarification to ensure that the ADON post, for patient flow, is solely focused on this priority issue.  This post is completely separate from existing nurse management posts which hold hospital wide responsibilities.

5.    Miscellaneous Matters

At today’s review the INMO raised a number of issues, creating obstacles/ difficulties, at local level in a number of locations following feedback from members in recent days.

Issues raised included:

  • the requirement that some hospital managements are reminded there is one national Escalation Policy which is not subject to review/amendments/ additions in any way, shape or form by local management;
  • the need for the HSE to identify, at Hospital Group meetings, the senior clinical decision makers who will be available, outside of core hours, to assist with patient flow and admissions/discharge decisions;
  • the need for hospital managements to show greater flexibility with regard to requests, from nursing staff, for flexible working opportunities; 
  • the need to engage, with the National Ambulance Service, together with Group CEOs leading to the provision of ambulance protection, to an individual hospital, which is enduring particular high volumes of overcrowding; and 
  • swifter action in relation to the introduction of the No Faults Compensation Scheme, the Hygiene and Health and Safety Audits, in full conjunction with the INMO, as provided for under the agreement.

In regard to this overall issue it was acknowledged, at the review, that the level of ED overcrowding, and the number of admitted patients on trolleys continues at record high levels.  This fact requires the system wide measures to be applied with even greater priority.

6.    Special Delivery Unit (SDU) Reports

We have now been advised that the SDU has issued its first 12 reports to the Hospitals/Groups involved.

It is understood that these reports are to be discussed at the next round of Hospital/Group meetings provided for under the ED Agreement. 

These reports show that all 12 hospitals have been in breach, on a significant number of occasions, of the Directive, issued by the Minister/HSE, with regard to the nine hour target and other measures.  These hospitals have now been given a defined period, to demonstrate improvements under stated headings, before fines are levied.

During this four/five week period we also understand each of the 12 hospitals will be subject to ongoing, unannounced, visits from the SDU to measure the implementation of the improvement measures required.

7.    Next Steps

(i)    At today’s review it was agreed that there would be further, direct, engagement, between the management side and the INMO, on next Monday, 18th April 2016, with regard to the ongoing implementation of some strands of the agreement.

(ii)    It was also agreed that the Workplace Relations Commission would convene the parties, for third review of the implementation of the agreement, at 10.30 a.m. on Monday, 23rd May 2016.

Summary

It is quite apparent, both from local feedback and today’s review, that a number of Emergency Departments continue to be under unsustainable pressure with some sections of management still not engaging on revised working arrangements provided for within the Escalation Policy.  

In these situations, and in the absence of positive actions by management, it is possible that members, locally, may decide they have to take steps to ensure a safe environment for patients and manageable workloads for themselves.

However it is also fair to acknowledge that other managements are very engaged on this matter and continue to strive to respond to the levels of overcrowding through every means at their disposable.  In such situations we will continue to work the agreement in the interests of patients and our members.

Thank you for your attention to this note.  Please watch out for ongoing feedback, from your own Hospital/Group meetings, on an ongoing basis.  Further updates will issue in due course.

Yours sincerely


LIAM DORAN
General Secretary 

    

 
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