The CEO of Cork University Hospital has written to the HSE expressing an “increasing concern” regarding patient safety risks.
In a letter sent to regional HSE management on Monday, CUH CEO Jennifer Kearney said immediate delays appointing just over 800 pre-approved and funded posts, on top of regular vacancies, has led to an unsustainable position as the hospital enters the winter period.
In her letter, the CEO pointed out significant issues across several key areas.
These included the cancellation of 30 appointments for paediatric neurology involving some of the most complex cases, stresses on interventional neuroradiology services, radiography shortages leading to the restriction of CT scanner capacity, delayed patient discharge and rehabilitation because of insufficient physiotherapy staffing, and a PFT laboratory, which examines lung capacity, that is currently being outsourced because the CEO said a funded post remains unapproved.
The subject line says ‘URGENT’ and references patient safety risk arising from employment approval processes.
Ms Kearney said in her letter: “I do not believe that the current position is sustainable, nor do I believe it is safe to enter the winter period with the level of staffing uncertainty that currently exists.”
The letter details the number of posts that are funded and clinically prioritised but remain unfilled at the moment.
Some of these have been delayed at regional level, the letter claimed and with rising demand on services, the CEO said she is “increasingly concerned” that we are “moving from a position of managing operational pressure to one where we are managing avoidable patient safety risk”.
To alleviate the pressures, a number of immediate actions are now being called for by CUH management.
These include having the current list of clinically prioritised funded vacancies reviewed as a matter of urgency.
The CUH CEO is also calling for a derogation from what she called the current employment restrictions for CUH, recognising the specific patient safety and winter resilience risks facing the hospital.
CEO calls for immediate approval of 172 priority posts for winter
She said there should be approval at a minimum of 172 priority posts to allow CUH to safely strengthen its workforce ahead of winter.
Ms Kearney said there comes a point where further restriction does not generate additional efficiency, that “it simply transfers the consequences into clinical risk, staff fatigue, delayed care and reduced resilience”.
She said she is “forecasting a material deterioration in the hospital’s ability to safely absorb winter demand if the current staffing position is not addressed urgently”.
“We should not wait for a patient safety incident to demonstrate that the current position is unsafe,” Ms Kearney added.
The most significant deterioration is in HSCP (health and social care) and Nursing, with funded vacancies increasing substantially over the period, she said.
In radiography, the combination of vacancies, maternity leave and sickness absence means that CUH is now having to restrict CT scanning capacity because of staffing constraints.
CUH said all of this means there is total staffing gap of 1053.07 posts (whole time equivalents) entering the winter months, and all this at a time when the hospital said demand will be highest and coming after their busiest July on record.
Among the areas of particular concern highlighted in the letter by the CEO is paediatric neurology, which includes the management and treatment of epilepsy and other conditions.
The service currently has one consultant, who is working on an agreed basis of 80% of full-time hours.
Clinicians said at a minimum the service needs two full-time consultants.
The CEO claimed an interim solution was put forward in this area, involving a consultant from outside the Republic of Ireland, who would see 30 of the most complex cases.
But despite extensive engagement, this plan was not approved in time, the CEO claimed, resulting in the appointments being cancelled.
Admission of patients aged over 75 is twice the national average
The letter stated that CUH is managing a sustained 12% increase in demand, with admissions among patients over 75 running at twice the national average.
In response to the warnings by the CUH CEO, the Irish Nurses and Midwives Organisation (INMO) said it is not surprised to learn that concerns about care and safety are being raised at this senior level.
“The unsafe conditions that our members have been highlighting in CUH have been allowed to worsen, with a current pause on replacement posts and a failure to recruit at the level needed to replace like-for-like vacancies.
“The safe staffing framework for medical and surgical wards has also yet to be implemented in CUH and other acute sites in the region,” the union said.
HSE South West said it is working proactively with the HSE nationally and the Department of Health to deliver the commitments set out in the HSE National Service Plan 2026 while remaining within approved budget allocations.
In a statement, HSE South West said it recognises the “increasing demand for services across all integrated healthcare services in the region and continues to prioritise patient safety through ongoing risk assessment and management”.
A spokesperson said that as of the end of last month, Cork University Hospital (CUH) was operating at 258.67 whole-time equivalent (WTE) staff above its approved workforce limit, including the medical and dental workforce, which is currently 13% above its approved limit.
“CUH has continued to increase its workforce during the most recent reporting period,” the HSE South West said.
“In contrast, other service areas have experienced workforce reductions while continuing to manage significant service pressures and associated risks.”
HSE South West said it is working closely with the HSE CEO’s office to implement newly introduced employment approval processes and to progress recruitment across all sites, including CUH.
‘We need to be putting patients first’
Sinn Féin Spokesperson on Health David Cullinane said the letter was “one of the strongest” he had seen from a chief executive of one of the major hospitals in the State.
Speaking on RTÉ’s Today with Sharon Tobin, the Waterford TD said the “warnings are very, very stark and very clear”.
He said it was shocking that a hospital manager was essentially asked to “suppress the number of posts which are needed because it would not look good nationally for the HSE”.
“We need to be putting patients first.”
“I find the letter quite shocking, quite profound, it tells us what we already know that hospitals are under pressure, but it also shows that the recruitment process is simply not working. It’s too bureaucratic, too centralised.
“And it’s putting real pressures now on hospitals as they approach the winter season.”
Mr Cullinane added that CUH should get the derogation it is requesting.