Opening of cystic fibrosis ward stalled again at CUH
If ever there was a press release greeted with relief all round, it was the one issued on February 27 last year by Munster-based cystic fibrosis charity, Build4Life.
Headlined “Agreement reached between Build4Life and HSE on dedicated CF facilities at CUH”, it signalled the end of a long-running and bitter row that had delayed the creation of a much-needed 20-bed adult respiratory ward at CUH.
The new ward, 5B, would replace the respiratory service traditionally based on ward 3A, where doctors had struggled for a number of years to accommodate patients in just 11 beds.
This struggle is encapsulated in the statement of need drawn up around Project Ward 5B which said that with the appointment of two additional respiratory consultants in 2006 and 2007 “this 11 bedded allocation has become even more inadequate to accommodate ever increasing numbers of respiratory inpatients”.
Despite the strain on the service, the hospital was not in a position financially to provide a new respiratory ward itself. So when Build4Life stepped in with an offer to do it, there was grateful acceptance.
The issue was personal for Build4Life. Set up in 2007 by Kerryman Joe Browne, its members were either adults with CF or the parents of children with CF, all with first-hand experience of the inadequate accommodation for CF patients at CUH.
Joe’s own 14-year-old son Pádraic has CF and a good friend, Mary Hand from Dingle, died of CF at the young age of 23 in 2006. Joe had visited her in CUH, where he says she was exposed to constant infection.
He made a promise to himself when she died that his son would have access to state-of-the-art facilities if the time came that he required hospitalisation.
And so the back-breaking fundraising began, with an initial goal of raising €1m for an adult inpatient unit for CF patients, and then, on the back of Joe’s obvious talent for pulling money in, the ultimate goal of covering the entire construction costs and equipping of 5B to the tune of €2.3m. The money was duly raised, with other funds along the way going towards, inter alia, an outpatient clinic for children with CF and an adult outpatient clinic.
RELATED: Staffing shortages delay opening of €2.3m CF unit
The very first meeting of the project group set up to drive the development of ward 5B took place on December 7, 2011. Consultant respiratory physician Dr Barry Plant, head of the adult unit for CF at CUH, outlined how 10 of the beds on the ward would go to the respiratory service (for patients with lung disease other than CF) and 10 to the CF service.
Build4Life fundraised in the belief that the 10 CF beds would be ringfenced. But when the time came for the funds to be handed over so construction work could begin, the hospital backtracked, offering instead “priority access”.
Relations with Build4Life took a nosedive. The row eventually went legal on foot of the hospital’s continuing refusal to ringfence 10 beds. Joe was adamant that funds could not be handed over without a legal guarantee that the €2.3m would be used for the purpose intended.
He was incensed that despite funding the entire 20-bed ward, the hospital wouldn’t commit to earmarking half of them for CF patients. A very public spat followed until eventually, after a four- month delay, the agreement heralded in the press release of February 27, 2014 was reached.
The hospital agreed to 10 designated single inpatient rooms for adults with CF, eight on ward 5B and two in the cardiac renal centre. Four single en suite inpatient rooms in 5B would be ring-fenced for adult CF patients, but if the number of CF admissions exceeded this, CF patients would have first call on the remaining six designated CF beds.
The contract was signed on June 24, 2014 and €1.8m was handed over to the hospital on a phased basis once construction work on the ward began in July 2014. Joe Browne described the handing-over of the money as “a major milestone”.
The ward was completed in January this year. It had been expected it would officially open “within a month of completion” of construction. But it didn’t happen. And the project has been delayed once again.
The hospital is blaming “reorganising of services within the hospital”, but what it boils down to is inadequate staff numbers. The hospital argues that if it was to transfer CF patients to the new ward at this time, it would “mean a loss of eight medical inpatient beds across the CUH hospital system”. This is because the new CF beds have higher staffing requirements.
Mr Browne is apoplectic. The HSE, he says, have known since this project got off the ground in 2011 that they needed to plan for staffing. Indeed staffing requirements have been on the agenda of the project group’s monthly meetings since January 2012.
There was even a member of hospital staff sitting on the project group for that specific purpose — to identify the number of staff that would run the new ward.
Mr Browne says they “may as well have had crayons and a colouring book”, and that no staff number was even given.
Mr Browne has shown the Irish Examiner a series of emails in which he has repeatedly asked how many staff will be assigned to the new ward. Initially, the best the hospital could come up with was “there will be the required level of nursing and support staff to provide the necessary skill mix to deal with the needs of the patients when the ward is opened”.
This answer was trotted out several times. When the Irish Examiner asked the HSE the same question on May 15, no response was forthcoming until June 25.
When it did come, it was no more informative than “the ward will open at existing level of service”.
The HSE has consistently failed to define what that “existing level” is. Build4Life has been driven to sending in a Freedom of Information request in a bid for answers.
The ward, which should have opened in March 2014, remains closed. The number of patients requiring hospitalisation continues to rise.
January 2013: Stage 1 cost estimates completed.
April 2013: Stage 2 detailed design completed.
May 2013: Tenders returned and recommendation issued (3-4 week process).
July 2013: Commence build programme.
End of December 2013 /January 2014: Complete build programme.
End of January 2014/ February 2014: Commission the new facility.
March 2014: Open new facility
Projects funded to date by Build4Life
€400,000 Children’s out- patient cystic fibrosis clinic.
€300,000 Children’s inpatient cystic fibrosis ward and currently fundraising for an additional €300,000 to complete the ward
€300,000 Adult cystic fibrosis clinic which opened in 2011.
€150,000 Additional funds requested by CUH to complete the clinic.
€2.3m ward 5B: Adult respiratory ward (€1,800,000 for construction and €500,000 for equipment)
Extracts from minutes of monthly meetings of the adult respiratory ward project group
Staffing requirements, nursing: “Ms S Scanlon is presently collating the nursing requirements which will be needed.”
Staffing requirements, nursing: Ms S Scanlon is presently collating the nursing requirements.”
Staffing requirements: “Discussion took place in relation to the staffing implications and requirements and the following was noted:
“Ms V Deane said that progress on identifying the staffing for the ward is not progressing due to overall staffing issues within the hospital.
“Dr B Plant advised this is not a new service and there is a need to quantify the present staffing levels associated with the cystic fibrosis and respiratory service.”
“A preliminary outline of the present staffing and the staffing required to fully commission the ward is required for the next meeting.”
“Professor Gallagher highlighted that there were significant deficits in the multi-disciplinary team staffing numbers. He stated there was a need to immediately formally assess the deficits in staffing and put a plan in place to address.”
“Dr Plant explained that a document is in development to address this topic through the newly established Medical Directorate with a planned submission to the executive management board of CUH shortly.
“Tony McNamara (hospital CEO) and Gerry O’Dwyer (then HSE regional director) fully supported this plan of action with regard to same.”
Staffing requirements: “It was agreed that a number of the members of the group would meet with the director of nursing in relation to the nurse staffing requirements. It was noted that discussion will also need to take place in relation to support services
RELATED: Staffing shortages delay opening of €2.3m CF unit
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