The Psychiatric Nurses' Association, representing nurses in the acute psychiatric unit of Kerry General Hospital, has had to resort to strike action to force management in the Southern Health Board to meet its reasonable demands. The PNA has been involved in negotiations with management for over 18 months regarding the unsuitability of the unit regarding its overall size, the lack of a proper reception area and the lack of secure facilities for high-risk patients.
Up to seven years ago those high-risk patients being admitted to the unit under Garda escort were being admitted under a loophole in the Mental Health Act, 1945. Arising from the death of a patient while being escorted to the unit, the Garda reverted to escorting patients to St. Finian's Hospital, Killarney, where proper secure facilities were available along with adequate staffing levels. This procedure was in place for seven years until two months ago, at which stage there was a change at the request of the Southern Health Board, I understand. Now patients under Garda escort are coming directly to the admissions unit for assessment.
The unit is totally unsuitable for high-risk patients. Plans to extend the unit to include an observation area are now very much on the long finger and there are concerns following the publication of the Estimates that it may not be provided in the foreseeable future. The health and safety of patients and staff are at risk when one considers the age profile of many patients. I am aware that the new psychiatric facility in Portlaoise, for example, would have an independent facility for psychiatry for later life.
The dispute revolves around the fact that there has been no investment made in the acute psychiatric admissions services either from a structural perspective, to improve the actual admissions unit, or from a staffing perspective in increasing nurse numbers. The Southern Health Board management may claim that staffing levels are comparable with other admission units but this is clearly not so. There are 50 beds in the unit and until this dispute the unit was often overcrowded with 53 beds, while staffing numbers are 11 by day and six by night, with no supervisory post at night. If one compares this with the roster at St. Michael's unit in the Mercy Hospital, Cork, one sees the latter has a staff complement of 15 by day, with nine on long shifts from 7 a.m. to 7 p.m. and the remainder covering activation and developing social skills in areas such as substance abuse and relaxation. These activities and responsibilities are covered by the 11 staff members in Tralee but from 6 p.m. the staff complement drops to six. These staffing levels need to be reviewed immediately.
In the past week a commitment was made that a personal alarm system will be put in place within two weeks, which is welcome. A risk assessment procedure has been put in place and two clinical nurse specialist posts are to be upgraded from the existing staff complement. I understand it has also been agreed that if there is overcrowding, management will provide an extra staff member on an overtime basis.
However, no financial commitment has been given regarding structural changes to the unit, nor has the board provided a timetable for the necessary training of staff in the handling and management of aggressive and violent behaviour, training the health board provides. At present approximately seven staff members out of 50 have taken the training courses.
The inadequate staffing provision must also be addressed so the best service can be provided for patients. It is also critical that patients under Garda escort are assessed first in St. Finian's Hospital, Killarney, until the unit is made safe from the health and safety perspective and staffing levels are dealt with.
This dispute must be dealt with immediately before it escalates into an all-out work stoppage which results in major hardship for patients and nurses alike.
