Dáil Éireann díospóireacht -
Wednesday, 16 May 2001

Vol. 536 No. 3

Adjournment Debate. - On-Call Hospital Cover.

Ms McManus

I raise public concern about the deteriorating industrial relations situation at St. Columcille's Hospital, Loughlinstown. On 14 March 2001 the hospital management was informed by the INO that theatre nurses would no longer provide excessive on-call cover for out-of-hours service. These nurses are paid £13.30 for being on-call for a night. Most of them are job-sharing and yet they do the equivalent on-call duty a full-time nurse does. The contribution of these nurses is such that it is clear that the withdrawal of their services would create a significant risk to emergency patient care. Only by the hospital authorities fully addressing the issues raised by the nurses could patient care be safeguarded. Regrettably, this has not happened.

I have no intention of getting into the area of industrial relations. I know meetings were held between management and the INO and that the Labour Relations Commission was involved and that action was suspended for a while. Despite any efforts that have been made, there has not been a resolution of the ongoing dispute and this is causing grave concern among the public and professionals working in the hospital, particularly now we are facing a deterioration in services.

Last weekend there was no on-call cover available and this Tuesday there was no on-call cover either. The hospital arrangements for emergencies during those times is to have an ambulance available to transfer patients to other hospitals like St. Vincent's. This is totally unsatisfactory. The patient may not be able to sustain the journey to another hospital and even when the patient can, there is no guarantee that a hospital as busy as St. Vincent's will be able to attend to that patient on arrival. We all know the horror stories of patients lying on trolleys for days in accident and emergency departments.

The failure to deal with this issue increases the pressure on other hospitals as well as heightening the level of danger should a major emergency occur in Wicklow. This dispute is not only affecting the capability of the hospital to respond to out-of-hours emergencies but creates problems for operations during the day. Admittance to the accident and emergency department can similarly be curtailed. This situation is so serious that I understand there have been reported requests from medical professionals to close down the accident and emergency department altogether as a safety precaution rather than put the public at risk.

From this Friday, if the dispute is not resolved, it is expected that there will be no out-of-hours cover for the following ten consecutive days. We are entering a new and worrying phase during which the risks for people in County Wicklow and south County Dublin are increasing rather than lessening. It is vital that everything is done to resolve this dispute quickly. The Labour Court usually takes four to six weeks before hearing a case but we cannot wait that long. I ask the Minister for Health and Children with the senior management of the Eastern Health Board to co-operate with the INO in reaching a settlement in the interest of patients and the professionals who care for them.

Dr. Moffatt

I thank Deputy McManus for giving me the opportunity, on behalf of my colleague, Deputy Martin, to clarify the position regarding out-of-hours theatre cover by nursing staff at St. Columcille's Hospital, Loughlinstown. The Minister has been informed by the East Coast Area Health Board that on 14 March 2001 the Irish Nurses Organisation advised that job-sharing theatre nurses who were "currently providing double the rate of on call cover that their full-time colleagues were providing" would refrain from doing so with immediate effect. Following telephone discussion with the INO it was agreed that this action would be deferred until a meeting had been arranged to discuss this issue.

At a meeting on 4 April it became apparent that the issue was not "excessive on-call duties" but rather the rate of remuneration for on-call. The INO tabled a demand seeking substantial increases over the existing national rates payable to theatre nurses for on-call work and for telephone rental refunds for nurses providing on-call cover.

Local management advised that there was no difficulty with the concession of telephone rental refunds but that increases in nationally agreed rates could not be negotiated locally. Local hospital management requested that nursing staff continue to provide on-call cover pending discussions with the industrial relations section of the East Coast Area Health Board. The INO refused to co-operate in this.

On 6 April 2001 the employee relations officer of the East Coast Area Health Board, together with hospital management, met the INO and sought agreement to the restoration of on-call cover by job – sharers pending the outcome of more detailed discussions and negotiations. Again the INO refused to co-operate.

At the request of the East Coast Area Health Board, the Labour Relations Commission invited both parties to a conciliation conference which took place on 11 April 2001. The Labour Relations Commission representative offered to fast track the INO's proposal to a hearing of the Labour Court provided the previous level of on-call cover was restored in the interim. Once again, the INO refused to co-operate.

A further conciliation conference was held on 27 April in the offices of the Labour Relations Commission. At this conference the INO gave an undertaking "to come off action and to stay off action for the duration of proceedings". Both parties agreed to explore settlement options and another conciliation conference was scheduled for Friday 4 May. Unfortunately, the parties failed to reach agreement at conciliation on 4 May and the Commission agreed to refer the matter to the Labour Court and to request an early hearing. The health board representatives left the talks under the clear impression that the INO commitment to stay off action was still in place and that all parties were committed to resolving their difficulties through the normal industrial relations machinery. Management was thus surprised and disappointed when the INO served notice of their intention to resume their action later that evening. The industrial action began on Friday 11 May at 4.30 p.m.

The lack of on-call cover in theatre has led to restrictions in the provision of accident and emergency services at St. Columcille's Hospital. On-call cover is normally provided from 4:30 p.m. each day. On days when no on-call cover is available, the accident and emergency department is only in a position to accept medical patients. On these days arrangements are in place to divert patients requiring surgical intervention to other hospitals in the area. An ambulance is also on stand-by at all times to ensure the rapid transfer of any patient in the hospital developing a need for surgical intervention.

St. Columcille's Hospital and the East Coast Area Health Board are very aware of the additional pressures this dispute places on hospital services in south east Dublin and east Wicklow and have been anxious to engage in meaningful discussions with the INO in order to reach agreement and a restoration of full on-call cover to the operating theatres at the hospital.

The Minister understands that a meeting with the INO has been scheduled for Monday next, 21 May. The health board hopes progress can be made at this meeting and that the INO will agree to call off its industrial action and allow the Labour Court proceed with a hearing on the substantive issues. The Minister encourages all parties to seek a flexible and effective solution to this dispute through the Labour Court's objective arbitration. On behalf of the Minister I call on the INO to call off its industrial action pending the outcome of the Labour Court hearing.