Ms Rachel Kenna:

I thank the Deputy for the questions and the opportunity to go through a site visit we did to UHL in the context of safe staffing. Safe staffing is not a head count or a ratio of nurses to patients. It is an evidence-based approach to determining safe nurse staffing levels in an acute environment and is based on patient need. The indicator we use is nursing hours required to look after certain groups of patients. The evidence behind it comes from hours of observational study in acute medical, surgical and emergency environments. It is a scientific approach.

We saw when we went to UHL that the funding was in place for complete implementation of phase 1 and 2 safe staffing in the appropriate areas. There are additional areas that sit outside safe staffing and use other tools, and additional staffing was applied to those as well, but we focused specifically on the scientific evidence we had for safe staffing. There were enough nursing hours for the care that was needed in UHL at that point in time. We found there were more nursing hours available in some areas and not enough in others. That is not a simple move-around translation; it requires a safe and structured approach to redeploy staff to areas to share nursing hours appropriately, achieve safe staffing and, therefore, get the desired outcomes. We commenced that process and have a list of actions with the staff in UHL. There is an ongoing structured process with them, supported by my team and by colleagues in the HSE, to ensure appropriate nursing hours in all designated areas are applied.

The second thing we found which is probably relevant is that some areas dealing with surge patients, that is patients coming from the emergency department, were not staffed with permanent staff. They were relying on agency staff and, as we all know, that is not a reliable or sustainable way to staff acute hospitals. When agency staff were not available, good decisions were being made about using the resource in the hospital at the time, but staff would be moved from one area to deal with surge patients and spread the care requirements, which can lead, across a hospital, to safe staffing not being felt or delivered. At the time of our visit, additional staffing resources were approved. My understanding is they have almost completed recruitment and there is a permanent staffing base for the surge areas, which is important.

In addition to that, UHL has the IT system behind safe staffing, so we can calculate and look at the nursing hours required in each ward area. If they are under or over nursing hours, that can be done daily and be visible to the staff. To support full implementation of that, we have commenced a training exercise with all ward managers and senior nursing staff in the hospital. That has progressed well. There is also a safe staffing co-ordinator post in the hospital and her or his job is to utilise the IT system and make sure the nursing hours requirement is applied appropriately throughout the hospital. If it is helpful, I can provide the Deputy with a more detailed note on the safe staffing and safe staffing application in the acute hospital environment. UHL has implemented phases 1 and 2.

The safe staffing framework allows for ongoing assessment. On an annual or biannual basis, you can reassess based on need and adjust staffing accordingly. That is in line with the budgeting process every year.