HIQA notes improvements, but highlights staffing concerns at Mullingar hospital

The most recent report by Health Information and Quality Authority (HIQA) indicated that there are significant staff shortfalls in the area of nursing, midwifery and healthcare assistants in the Midlands Regional Hospital Mullingar.

The unannounced inspection took place on October 9 and 10, 2024. The subsequent report notes that, compared to previous inspections in 2022, there were improvements in the compliance level with two of the four national standards assessed.

The report noted the hospital was ‘compliant’ or ‘substantially complainant’ in most areas of the inspection.

The hospital was found to be fully compliant in one of the 11 national standards assessed, substantially compliant in six, partially compliant in three, and non-compliant in one.

The report notes the hospital provides a range of healthcare, maternity and specialised services to the population of Westmeath, Longford and the broader population in counties Laois, Offaly, north Meath, Kildare and Roscommon and that 1,804 births occurred in the hospital’s co-located maternity unit in 2023.

At the time of the inspection, the Health Service Executive (HSE) was progressing with the establishment of six new regional health areas. As part of that process, the hospital will be integrated into the HSE Dublin and Midlands regional health area.

The inspection team visited four clinical areas: Emergency Department; Acute Medial Assessment Unit (AMAU); Surgical 1; and Medical 2 (the 28-bedded general medical ward).

During the inspection, the inspection team spoke with staff and patients at the hospital.

Patients commented on how staff were “excellent”, “supportive”, “kind” and “very good”.

Patients also described how staff were “busy” and “doing their best” and that the number of patients attending the hospital, especially the emergency department was “greater than what the hospital could manage”.

Similar to previous inspection findings in 2022, patients said they received no information about the hospital’s complaints process and or independent advocacy services.

While the governance arrangements for assuring the delivery of high quality, safe and reliable healthcare were described as ‘partially compliant’ the service providers plan to achieve high quality, safe and reliable healthcare objectives was deemed ‘non-compliant’.

The inspection did identify an issue where four of the nine executive management positions were unfilled.

The report indicated that staff attendance and the monitoring of uptake of staff training had improved since HIQA’s last inspection. However, at the time of the inspection, there was a significant difference in the funded and actual number of staff in managerial, nursing and midwifery positions.

This breaks down to a 13% shortfall in nursing staff, 20% shortfall in midwifery staff and 13% in healthcare assistant staff. That was managed in the short-term through staff redeployment and the use of agency staff, but the report states that that was “not a reliable and sustainable way to manage the issue staff resourcing issues in the quality and safety department” and “impacted on the delivery of healthcare services”.

Inspectors were also concerned about the senior executive management out-of-hours cover arrangements and the reliance on agency staff to fill staffing shortfalls in the medium and longer term were escalated after the inspection to the HSE Dublin and Midlands health region’s IHA manager.

Of the 40 patients registered in the emergency department, 50% were there for more than six hours (the national target is 70%), which represents an increase on the 35% found in 2022, a further 40% were there for more than nine hours (where the national target is 85%), which was similar to the findings (39%) of 2022.

The HIQA report identified a lack of privacy, dignity and confidentiality for patients on trolleys and chairs in the emergency department’s public corridors.

Overall, the report found hospital management and staff promoted a culture of kindness, consideration and respect for people accessing and receiving care.