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# Healthcare crisis
Health watchdog finds staff shortages and 'gross overcrowding' in latest hospital inspections
The latest Hiqa inspection reports come amid ongoing staffing struggles in the health sector.
INSPECTIONS OF HOSPITALS in Cork, Kerry and Tallaght found significant staffing shortages and “gross overcrowding”, the health quality watchdog has revealed.
The Health Information and Quality Authority (Hiqa) inspected University Hospital Kerry, Cork University Maternity Hospital and Tallaght University Hospital in September and October 2022.
All three hospitals were found to be struggling with staffing levels, while both Kerry and Tallaght were experiencing overcrowding.
The latest Hiqa inspection reports come amid ongoing staffing struggles in the healthcare sector that have been exacerbated in recent months.
The Irish Nurses and Midwives Organisation (INMO) is calling for more unannounced inspections to be carried out, citing the “very real human impact” of unsafe staffing levels.
In Kerry, Hiqa found that the hospital was “substantially” behind other similar-sized hospitals in terms of its efforts to comply with national standards, though it acknowledged that the hospital management team was in transition at the time of inspection.
The inspection identified that there were significant deficits in governance and management arrangements in the hospital that affected its ability to quickly and effectively manage any increase in demand for its services.
In particular, Hiqa found “gross overcrowding” of the emergency department and significant patient flow issues, outlining that the department had a significant shortage of medical and nursing staff.
There were no formalised arrangements to ensure 24/7 consultant oversight in the emergency department at the time of the inspection and the department had a significant shortfall on the rostered complement of nursing staff.
The Cork inspection found “good overall levels” of compliance with national standards.
However, it identified shortages of medical, midwifery and nursing staff, though it noted that hospital management were aware of the problem and trying to resolve it by reassigning existing staff.
Finally, in Tallaght, the inspection found that emergency department staff were “striving” provide safe quality care to its high number of patients but was challenged by capacity issues, insufficient isolation facilities, and limited options for transferring patient care to community facilities.
Hiqa discerned that the practice of admitted patients awaiting inpatient beds on trolleys in the emergency department contributed to overcrowding and that the environment where care was provided to patients on the day of inspection did not promote dignity, privacy or confidentiality.
The hospital had made progress in recruiting medical staff for the emergency department, Hiqa said, but unfilled nursing and healthcare assistant roles were impacting the department’s ability to be fully functional.
In a statement, INMO General Secretary Phil Ní Sheaghdha said that Hiqa’s reports into University Hospital Kerry and Tallaght University Hospital “paint a bleak picture of the realities of unsafe nurse staffing”.
In the case of both hospitals, unsafe nursing staff levels meant that medical assessment units had to close or operate at a reduced capacity.
She said the situation in University Hospital Kerry is “of a particular concern” to the union. It has sought urgent meetings with hospital management on how to achieve safe staffing.
“HIQA’s report into Cork University Maternity Hospital highlights the crisis in midwifery staffing that exists in many maternity units right across the country,” Ní Sheaghdha said, adding that it is “not acceptable to our members that they are not in a position to provide one-to-one support for women in labour”.
“Of the ten HIQA reports carried out in hospitals in the last eleven months, not one hospital has been found fully compliant when it comes to staffing. This is totally unacceptable but not a surprise to our union,” she said.
“The INMO has been long sounding the alarm on the very real human impact that unsafe staffing has on both nurses and the patients they are trying to provide care for.
“The HSE and Department of Health have been provided with substantial independent information from HIQA when it comes to the level of non and partial compliance on the ability of hospitals to organise and manage their workforce to achieve safe and reliable healthcare.
“These are not reports that should just sit on a shelf or in an inbox. They must be the catalyst for change when it comes to making safe staffing a reality.”
