Mr. Peter Hughes:

I thank the committee for this invitation to look at recruitment processes in the area of mental health. I will be addressing the issue of mental health nurses. By way of background, the committee will be aware that there is a major crisis in the recruitment and retention of nurses in the mental health services. This has had a significant impact on the delivery of services resulting in, for example: inadequate child and adolescent mental health services, which was clearly verified by the Ombudsman for Children in his report this morning; a lack of properly resourced community teams; the absence of 24-7 community crisis teams; and admissions reaching 120% of bed capacity in admission units, resulting in the indignity of service users sleeping on chairs and mattresses in Kilkenny and Waterford services.

A recent survey of Psychiatric Nurses Association, PNA, branches suggests there are approximately 500 nursing vacancies in the mental health services. Services with the highest levels of vacancies, equating to 20% of the nursing staff, include: St. Joseph’s in Portrane with 64 vacancies; St. Loman’s at Tallaght Hospital with 52 vacancies; the Louth-Meath service with 38 vacancies; and the Waterford service with 26 vacancies. Nursing shortages in mental health services are expected to exacerbate significantly in the next four years. According to HSE figures in December 2016, 34.2% of the mental health nursing workforce are expected to retire in the next four years, amounting to a total of 1,752 nurses.

Taking into consideration the number of imminent retirements, our understanding of the HSE’s convoluted processes is laid out in appendix 1. I will do my best to talk the committee through it but, as the committee can see, there are many boxes. A nurse vacancy arises through retirement or resignation. An employee HR106 form with an agreed end date is signed in consultation with the manager. This form goes to the area director of nursing for sign-off. It then goes on to the assistant director of nursing managing human resources for the nursing leadership team. The HR106 form is then processed by national personnel records. The assistant director of nursing then completes a business case to have the post replaced, this is known as form B. The submission sheet is completed by the assistant director of nursing and signed by a service manager, which is a grade VIII post. Both forms are sent to the service manager's office, where they are logged.

The submission sheet is endorsed and signed by the head of mental health services. Form B is signed by the head of mental health service and is sent to the pay and number strategy, PNS, group for the community health organisation, CHO, area, including a risk assessment form. The group generally meets on a monthly basis. There are difficulties with having forms signed due to incomplete forms or whatever. If the application is approved, it is signed by the HR, as chairman of PNS group, and then it is signed by the chief officer.

Approval is returned to the head of mental health, the approval is forwarded to service managers and then it is forwarded to the area director of nursing, ADN. Once approval is received by the ADN who manages HR, the pre-placement assessment form is completed. A job order form is completed next and the documentation forwarded to the job orders section.

The next step of the process commences with a unit called health business services, HBS, recruitment. The HBS deals with the recruitment process, job order and documentation and the post is offered to any existing panels. If no panels exist then one must await a new campaign to commence. The waiting time for new campaigns is significant. The post remains vacant unless covered by a specific purpose contract, agency staff or overtime. Specialist and higher posts, such as a clinical nurse manager 3, an assistant director of nursing or a director of nursing are usually filled through a specific purpose contract, which then depletes front-line staffing. As this process develops at a higher level, a domino effect sets in. The person replacing is often at a higher management level. He or she must be replaced and it can take more than six months for each post to be filled.

This process is only dealt with when the postholder has availed of all of his or her annual leave and remaining time owed, and the position is officially vacant. Let us say a nurse hands in his or her resignation. Due to his or her amount of annual leave or time owed, he or she may not come off the books for six to eight weeks. The process, therefore, cannot start until that happens. The timescales vary considerably. For permanent posts with a live current HBS recruitment panel in place, it will take six months plus from securing approval to a person commencing work.

This is a cumbersome and frustrating process. The feedback from our members, including senior nurse managers, is that it can take between six months and a year to replace a nurse leaving the service. We have evidence from CAMHS in the CHO 8 area that two posts, one of which is a development post, still have not been permanently filled after three years. We are also well aware of the crisis in CAMHS.

In summary, my presentation illustrates that 25 steps must be completed to recruit a nurse for mental health services, with a multitude of signatures required to complete the process. We believe that this system of recruitment is totally unsustainable to ensure the delivery of effective mental health services.