Castleisland native, Joe Browne, chairman and founder of the Build4Life Cystic Fibrosis Charity has called on the Minister for Health to launch an investigation into how the management at Cork University Hospital (CUH) allowed over €2.3 million of the charity’s funds to be invested in the development of a desperately-needed new isolated Cystic Fibrosis inpatient rooms (Ward 5B) knowing that they wouldn’t have the staff to facilitate it and that it would be left idle.
*This is a matter which has been raised in Dáil Éireann in the Topical Issue Debate of Wednesday 1st July 2015. Three Kerry TDs: Deputy Tom Fleming, Independent; Deputy Martin Ferris, Sinn Féin and Deputy Michael Healy Rae, Independent raised the issue and you can read their contributions below with those of Fianna Fáil health spokesman and Cork TD Deputy Billy Kelleher and responses from the Minister of State at the Department of Health – Deputy Kathleen Lynch.
The project team for this new build was put in place over four years ago when all objectives and timelines were agreed. At no point were staffing levels a problem and it was agreed that the new CF inpatients room (Ward 5B) would open and be serviced by the existing CUH staff in March 2015.
Joe Browne recalls, “When the plans for this new ward were on the table the hospital advised us that the patients and staff would be relocated to the new ward as soon as it opened in March 2015. It was made clear that the existing staff in CUH would service the ward and that no new staff would be needed. The first mention of staffing problems was communicated to me in an email on 10th June 2015, outlining that new staff would need to be recruited for the hospital before the new CF unit could be opened and that the hospital could not give me a timeline as to when this would happen. I am raising the question as to how can money raised by a charity like Build4Life can be taken and used to build a state-of-the-art unit knowing that the hospital wouldn’t have the capability to open it. It now lies idle while patients with CF, who so desperately need the new isolation rooms, are without and their families and friends who fundraised so tirelessly are frustrated, angry and disbelieving of such an illogical situation.”
Build4Life, a parent run charity that raises money for improved facilities for patients with Cystic Fibrosis at the CUH, was originally set up in 2007 with the specific goal of raising the €2,300,000 needed to build and open the much-needed isolation rooms.
The development of isolated inpatient and outpatient facilities is clinically proven to prevent cross infection and allow CF patients to enter the hospital environment without fear of becoming more ill than before. These facilities will allow people with Cystic Fibrosis to live longer and enjoy healthier lives.
Joe Browne is looking for answers from CUH and is calling for someone to be held accountable. “These plans were in place for over four years and someone needs to be held accountable for the decisions that were made. The hospital will not tell us how many new staff are required overall to open the new ward and will not give us a date for opening. It’s a disgrace. I am calling on the Minister for Health Leo Varadkar to launch an investigation into how this situation involving such a substantial investment and now an empty and idle multi-million medical unit, was allowed to happen.”
*Dáil Topical Issue Debate 1st July 2015 Cystic Fibrosis @ C.U.H. Hospital Facilities
Deputy Martin Ferris: I am raising the issue of the respiratory unit for cystic fibrosis patients in Cork University Hospital for several reasons, not least of which is the current crisis. I knew personally several people who passed away as a consequence of that terrible illness, including Billy Burke who passed away a number of years ago, Mary Hand from Dingle and Kieran Treacy who was a great friend of mine. I am concerned that the proposed 20 bed adult respiratory ward in Cork University Hospital has not yet been activated. Mr. Joe Browne, a Kerryman whose 14 year old son Pádraig has cystic fibrosis, started a fantastic campaign, Build4Life, which raised €2.3 million to fund a ten bed ward at the hospital. Construction of the ward commenced in January 2014 and was completed by January this year, but I am told the ward has not been opened owing to staff shortages. I am sure the Minister of State at the Department of Health, Deputy Kathleen Lynch, has visited cystic fibrosis patients. I am a regular visitor to cystic fibrosis patients in the Mater hospital. Given their vulnerability to infection, the importance of a specialised ward cannot be overstated. When will sufficient staff be made available to open the unit? I hope the Minister of State can give this matter her immediate attention.
Deputy Tom Fleming: I am glad that the Minister of State, Deputy Kathleen Lynch, is responding to this issue because I do not think there is anyone better acquainted with the various obstacles and snags that affect health services. She has been very helpful at various stages in addressing the anomalies and issues that arise in dealing with this matter. There is an undue delay in opening the 20 bed adult respiratory ward 5B which includes ten designated single inpatient rooms for cystic fibrosis patients. Cork University Hospital was not in a position financially to provide a larger unit to replace the original ward 3A where for several years doctors and staff had been struggling to accommodate cystic fibrosis patients in 11 beds. Fortunately, Mr. Joe Browne and his fundraising group in County Kerry, Build4Life, stepped in to fund the unit. All members of the group were either adults with cystic fibrosis or parents of children with the illness which gave them first-hand experience of the inadequacies of the facilities at Cork University Hospital. Through its endeavours, the group raised more than €2.3 million as a catalyst to get the project off the ground. Following the initial discussions on the number of beds to be designated for cystic fibrosis patients, the Minister of State intervened to find a satisfactory solution. However, there has been a delay of four or five months since the unit was completed. It needs to be opened at the earliest opportunity because these patients need to be treated in isolation, given that exposure to infection can be fatal for them. It is shameful that the unit continues to lie idle. I am sure the Minister of State is willing to make one more strong endeavour to progress the matter. I also note that her senior colleague, the Minister for Health, has stepped in with national funding.
Deputy Michael Healy-Rae: I welcome the opportunity to join my colleagues in raising this important matter. I have close personal friends who are cystic fibrosis sufferers and their families have lived with this problem for many years. I commend Mr. Joe Browne and the other individuals who started Build4Life for their massive fundraising efforts for many years. They stepped in when Governments, past and present, let cystic fibrosis patients down. It is a shame that the beds and this much needed unit cannot be opened because of an insufficient number of staff. What are we saying to Mr. Browne and those who work with him? Are we to tell them that not only must they provide the money to develop and build the unit but they will also have to fundraise to hire nurses privately to staff it? Is that what the Government wants?
Deputy Kathleen Lynch: This is not an occasion on which to be critical.
Deputy Michael Healy-Rae: I am not criticising anyone; I am saying we want the unit to open. That is the bottom line. All we ask is that the unit receive the staff required to open it. That is what cystic fibrosis patients need and deserve. The facility was provided by people like Mr. Browne and those who supported the Build4Life charity. We will be forever in their debt for the work they have done for many years. I hope the Minister of State will have a positive response to our plea.
Deputy Billy Kelleher: It is extraordinary that we are still debating this issue six months after completion of the building project. Mr. Joe Browne and Build4Life went about organising a fundraising project. They lightened the obligation and burden on the State by developing an infrastructure that was required for cystic fibrosis patients. It is unacceptable that the HSE cannot bring itself to recruit the additional numbers required to staff the respiratory ward and ensure there would be complementary staff in the wards from which they would be taken. Is it beyond the wit of the HSE to do so? It knew for a number of years that this facility was going to be completed and opened at some stage. It is unacceptable, therefore, that it cannot provide a complement of staff to facilitate transition to the new ward. This is not the first time this has happened. The HSE seems to be incapable of anticipating staff requirements in the contexto f new builds and the completion of infrastructure. We have had the same issues across the country in many areas where emergency departments have been opened, yet the required staffing complements have not been put in place. In addition, there have been theatre and ward closures owing to the HSE’s inability to manage staff. In this situation, members of the public came together in a fundraising exercise to negate the State’s obligation to provide a service. All they asked for was a staffing complement, yet they now find six months after construction was completed that the requisite staff are not available. This fine facility has potential life-saving implications for cystic fibrosis patients. We all know the history of why Mr. Joe Browne and others became involved. It stemmed from the tragic outcomes for some people, including as a result of cross infections, because of which some died. We now find six months on that four Deputies have had to raise the matter. It is time for the HSE to get its act together and address the staffing issue immediately.
Minister of State at the Department of Health – Deputy Kathleen Lynch:
I thank the Deputies for raising this issue. Deputy Tom Fleming, in particular, has always had an interest in it and this is not the only forum in which we have discussed it. Cystic fibrosis is the most common life-threatening inherited disease in Ireland. I am acutely aware of the challenges facing people with cystic fibrosis and their families in managing their condition. I fully acknowledge the need for dedicated accommodation for appropriate isolation and better infection control. Where inpatient treatment is required for people with cystic fibrosis, it should be in single en suite rooms, as these patients need to avoid possible sources of infection. At the same time, however, we must aim to minimise hospital admissions and instead treat patients on a day-care basis as close to home as possible. There has been significant investment in treatment and services in the past few years. It includes the €29 million unit at St. Vincent’s University Hospital, a new outpatient unit at Beaumont hospital, a paediatric outpatient unit in Galway and a paediatric day unit in County Mayo. In addition, we have developed newborn screening services and provide the cystic fibrosis drug ivacaftor, Kalydeco.
The Government welcomes the completion of the new 20 bed cystic fibrosis and respiratory unit at Cork University Hospital. This unit, with single bedrooms and state-of-the-art infection controls, will be a great boost for cystic fibrosis patients and their families in the region. I commend Build4Life and Mr. Joe Browne for raising €2.3 million for the project. It is a tremendous achievement and I am pleased that the Department of Health was able to support it through the provision of national lottery funding of €300,000.
I also welcome the start of construction of new paediatric cystic fibrosis facilities at Cork University Hospital. I understand the current unit moved temporarily in June to allow work to begin. I am, of course, aware of concerns about delays in opening the new inpatient unit at the hospital. I am advised that while it has been completed and fitted out, there are difficulties in staffing the unit. Recruitment of nurses is an issue not just for Cork University Hospital but also nationally and internationally. I have been assured that Cork University Hospital is actively recruiting nursing staff and will open the unit as soon as it can be safely and effectively staffed. The National Recruitment Service has been asked to prioritise the issue.
Unfortunately, it is not possible simply to move staff from other areas of the hospital. Cystic fibrosis units have a higher nursing requirement and require dedicated staff. Consequently, to open the new unit in Cork University Hospital would require staff reductions in other areas and this would necessitate bed closures. I am sure none of the Deputies would like this to happen, as it would affect patient flow and access and would have a serious impact on the emergency department.
I fully recognise the disappointment of Build4Life, as this is a personal and heartfelt project for it. The Government fully acknowledges the work it has put in and its frustration at the delay in opening the unit. Nobody wants the opening of this upgraded service to be delayed. However, the House must accept that patient safety cannot be compromised and, therefore, the unit cannot open until it is safe to do so. I have asked the CEO of the South/South-West Hospital Group to keep me informed of progress in the opening of the unit and have urged that the issue be resolved as a priority.
As Deputy Tom Fleming and others will know, I have taken a personal interest in this issue. When there was an impasse, we managed with cool heads and dedication to ensure the project would proceed. We managed to have the ward reconfigured. Its state-of-the-art status is incredible. I have been told that there are approximately 40 nursing vacancies in Cork University Hospital. If any nurse was to walk in the door of the hospital today, he or she would be offered a contract and a job. It is not an issue of financial resources but of an inability to recruit. The difficult is not ours alone; it is also an issue across a range of areas. I am hopeful, however, that the unit will be opened as soon as possible. It is a priority not just for me but also for those charged with recruiting nurses to ensure it this will happen.
Deputy Tom Fleming: There is no doubting the Minister of State’s commitment to the project from the very start, but the HSE’s ad hoc arrangements are unfortunate. It appears that a staff member within the hospital was seconded to oversee the issue of staffing levels. It is mindboggling that, at this late stage, they have fallen down disastrously in failing to put the necessary team together. I understand there have been some statements on the multi-disciplinary aspect, including the specialist consultant side. At this stage, however, it is not a reasonable or justifiable answer to come up with. Efforts should be redoubled immediately. Perhaps the Minister of State might revert to hospital management to see if we can come to a resolution as quickly as possible.
Deputy Michael Healy-Rae: I thank the Minister of State for her response. I take what she said as fact – that if a nurse was to walk into the hospital tomorrow morning, he or she would be given a job. However, she is saying nurses are not taking up the jobs available. Has she examined why our young nurses are going abroad and do not want to take up offers of employment here? We cherish and adore our young people and want them to stay in Ireland, if at all possible. If young, qualified nurses choose to go abroad rather than work in Ireland, is it because of the packages being offered? The Minister of State says money is not the issue; why, therefore, can we not recruit nurses? I understand what the Minister of State is saying and accept her bona fides, but we have the same issue in places such as Kenmare Hospital where the upstairs section is not fully open. In Dingle Hospital the HSE located offices where there should be beds to cater for patients. It is simply not good enough. The cystic fibrosis unit in Cork University Hospital did not suddenly fall out of the sky. Management and everybody else knew that it would have to be staffed and managed. I cannot get my head around the fact that we are in this situation so long after the building was completed. I compliment the manager of Cork University Hospital and the staff working there, as well as the staff in Kerry General Hospital. We really appreciate the work they do in tough conditions, be they surgical, nursing, catering or cleaning staff. We thank them for their efforts in dealing with sick people every day.
Deputy Martin Ferris: The HSE has been aware of this issue since 2011 and Joe Browne himself said there was no other project on the ground. He said that, since 2011, they knew they had to plan for staffing requirements and staffing has been on the agenda of the project group’s monthly meetings since January 2012. How can it be that the HSE was aware of it, the staffing project was aware of it and it was on the agenda since 2012 but they still have not started? It is either total incompetence or total neglect. Mr. Browne also says he may as well have had crayons and colouring books and that no staff numbers were even given. This is the man who was the driving force behind this project to save the State €2.3 million yet, from 2011 to 1 July 2015, the staff have not been available. The HSE has totally lost focus on what this is all about.
Deputy Billy Kelleher: I would reiterate everything previous Deputies have said. Catherine Shanahan’s article in the Irish Examiner, her correspondence with Joe Browne and Build4Life and the correspondence of Mr. Browne, Catherine Shanahan and the HSE all go to show that the HSE is footdragging at the very least, and that is being polite. At worst it is incompetent. Since 2012 it knew this building would be completed and it knew the staff complements it would require. There were difficulties in bed allocations, which we accept, though one could argue the HSE even handled that badly. Since the resolution of the designation of the beds and the completion of the project in January 2015 the HSE, six months on, has still not had the wit or the ability to staff the unit. I accept that the Minister is trying to explain it from the HSE’s point of view but the HSE is ultimately culpable here and is failing people who need the service.
Deputy Kathleen Lynch: This Government has only been in position for four years but, for the first time ever in this country, we are now developing workforce planning to look at what our staff needs will be in the future and what skill-mix we will need. This should have been done a number of years ago because one cannot plan for the future without knowing exactly what one’s requirements will be. I was centrally involved in the negotiations on the unit and it would have been impractical and unreasonable to say in 2012 that we were going to need a certain complement of staff for the unit but that it should be held in abeyance until the unit was opened. That would not have been a very good use of resources.
As Deputy Healy-Rae rightly pointed out, we have a difficulty in recruitment, not just in CUH but across a range of areas, and we are now targeting the very people about whom Deputy Healy-Rae spoke, namely, our young graduates who are ready to go. They will need a degree of supervision, as all new entrants to any profession do, but we are targeting the two groups coming out this year for recruitment. We sometimes forget, however, what it is like to be young. Young people like to travel and we cannot stop them doing that. They gain experience and worthwhile accreditation in other countries. They learn how to do things differently but they do come home and we are targeting that group. Not all of them will want to travel back but we are now targeting those who wish to work for us with a recruitment drive. We are now going to England to target our nurses and to try to bring them back home to work for us.
Deputies must remember that the economy did collapse in a crash. The cystic fibrosis unit we are now discussing should have been built when this country was experiencing a boom, something Deputy Fleming and I have discussed many times. It was not built then but it is there now with the help of Build4Life and we are determined that it will open. We are doing our very best to recruit staff and, on foot of this important debate, we hope that people will hear what we are saying. If they are available and wish to have a job as nurses, male or female, in our service we would love them to work for us. This is not something I dismiss. I have taken an active interest in developments and will continue to do so.