Louth Meath Hospital Group – contingency planning

HSE Statement

The Louth Meath Hospital Group has agreed a local contingency plan for the safe delivery of Paediatric services in the Louth Meath Hospital Group. 24/7 paediatric ED services will be maintained.

Many hospitals are experiencing significant challenges in recruiting Non-Consultant Hospital Doctors (NCHD’s). The HSE has been working closely with the Medical Council and the Colleges in order to resolve this issue. It is hoped that this engagement will provide a satisfactory resolution to the problem.

The Louth Meath Hospital Group has been working through these challenges and has been planning for the anticipated shortage. As a consequence of this we have been devising contingency plans in each of the clinical specialities.

Dr. Alan Finan, Clinical Director, Women & Children’s Services, HSE NE said ‘ A local contingency plan agreed by the Paediatric Service and the Senior Management Team for the safe delivery of Paediatric services in the Louth Meath Hospital Group has been devised. In developing this contingency plan we have prioritised care based on clinical need and acute presentations, particularly to the Emergency Department. These contingencies are necessary to free up sufficient Paediatric Consultants’ time and to allow the Consultants to provide essential front-line ward based care during the working week.’

These contingencies initiated on the 27th of June include the following measures:

· Paediatric Out Patient Department Services (OPD)
All new and follow-up Paediatric OPD appointments will be assessed and prioritised according to their urgency and clinical need. However, there will be a reduction in the number of overall OPD clinics and an increase in waiting times for routine OPD appointments from approximately 16 weeks to 32 weeks. Current routine wait for Paediatric OPD clinics in Cavan is approx 12 weeks.

·Suspension of the Shared Care facility for Crumlin Oncology patients.
There are currently 16 children with cancer attending Our Lady of Lourdes under the ‘shared care’ service with Crumlin Oncology service. On average there would be between 1 and 2 of these patients on the paediatric ward in Our Lady of Lourdes at any one time and their length of stay would usually be 5-10 days. Therefore from the 27th of June 2011, any of these children presenting to Our Lady of Lourdes will not be admitted but will be transferred to Crumlin and arrangements with Crumlin have been put in place.

·Babies under 32 weeks gestation
Currently babies under 30 weeks are transferred to the Rotunda as part of an agreed programme of care. However we have agreed that babies delivered under 32 weeks gestation will now be transferred to the Rotunda Hospital for ongoing care. Based on our most up to date collected figures, the number of babies delivering in OLOLH < 32 weeks is approx 60 per year (with 25-30 of those <30 weeks – already being transferred to the Rotunda). Therefore at maximum this contingency measure will mean that an additional 30-35 of our excess 4,000 births per year will be transferred to the Rotunda which is an average of perhaps 3 per month. We would also note that some babies between 30 and 32 weeks are healthy and some can be very sick and it is only this cohort of sicker babies that we will be transferring. Our intention here is to reduce significantly the amount of acute activity in the NICU. Therefore from the 27th of June 2011, any sick babies born under 32 weeks will be transferred to the Rotunda and arrangements with Rotunda have been put in place.

· Suspension of the Paediatric Assessment Unit service.
Paediatric patients will need to be referred to our emergency department however we anticipate that there will be delays and longer waiting times in the Emergency Department. The current average wait time in the Paediatric Emergency Department is approx 1 to 2 hours but can vary from 10 minutes to 3 hours, depending on time of day, business etc. However we would emphasise that all acute Paediatric presentations, particularly to the emergency department will be prioritised.

GPs in the region have been notified of the contingency plan and where Out Patient appointments have to be postponed, parents/guardians have been advised.

An ongoing review of the situation will be carried out by the Paediatric Clinicians and the Senior Management Team. These measures will be reversed as soon as the NCHD staffing situation allows.

The HSE has taken a range of actions to address Non-Consultant Hospital Doctors (NCHD’s) vacancies over the past two years and to ensure that the shortage of NCHD’s and any resulting impact on services is minimized and to ensure patient safety is maintained. These include:

· A recruitment drive for a new intake of NCHD’s is currently underway. A range of initiatives are underway to address the situation and to ensure that
hospitals continue to offer a high level of care to all patients.
· In addition to a centralised recruitment process which commenced this year, the HSE has undertaken a significant overseas recruitment campaign in
India and Pakistan which has identified a significant number of junior doctors willing to take up posts in Irish hospitals.
· The HSE is working closely with the Irish Medical Council regarding the registration process for these individuals so that they can be placed within the
Irish hospital system as soon as possible.

The situation in relation to the other specialities in the Louth Meath Hospital Group will be reviewed as recruitment progresses. Offers of employment continue to be made to potential candidates. These contingency plans will stay under constant review in what is an evolving situation.