Irish Medical Organisation

IMO on Emergency Department Proposals

Update - 4 February 2016

The IMO has reached agreement in the Workplace Relations Commission on IMO participation in new local Emergency Department forums and Group Wide Executive Forum to deal with overcrowding issues. A process has been agreed which will ensure clinician input in the decision making process. Additionally it has been agreed that consideration will be given in regard to membership of the ED Taskforce Implementation Group so as to include representatives from the IMO and other health unions.

The IMO has written to the HSE, Work Realations Commission and SIPTU today on the proposals put forward on Emergency Departments - details set out below.

It would not be normal practice for the Irish Medical Organisation (IMO) to comment on a proposal that is subject to a ballot of a sister trade union; however, as the proposal – although not yet agreed - has been implemented and together with events at the end of last week involving SIPTU we believe it is essential that the HSE is fully aware of the potential industrial relations issues that the WRC proposal hold for IMO members and the Lansdowne Road Agreement (LRA). We are aware that SIPTU has been in contact with the HSE and also the WRC.

There are a number of areas within the WRC proposal that would be unacceptable to the IMO and directly impinge the clinical autonomy of our members, especially Consultants. It is unusual for a proposal to be implemented that directly impact IMO members, and members of other unions, when

  • we:were not party to the negotiations;
  • are not involved in any of the group wide or local hospital mechanisms set out in the proposal.

We set out below our main issues/ observations (this is not an exhaustive list).
Group Wide Executive Forum –

The CEO/ staff side may require the attendance of other senior managers or “clinicians” from individual hospitals. The IMO cannot agree to our members being requested by representatives of any other union to attend the Group Forum. Any discussion on issues should be through the normal reporting channels, or with the involvement of the IMO;

To issue a weekly report to the joint chairs of the ED Taskforce. In addition to attending the Forum the IMO should be provided with copies of all reports;
If the final bullet point in this section extends beyond nursing staff then it is a breach of the Lansdowne Road Agreement. The Forum has no jurisdiction to consider the staffing/proactive rostering of clinical teams. Any proposed changes to rostering arrangements has to be subject to local agreement with the clinicians and if no agreement is achieved it is referred in to the dispute resolution mechanism of the LRA.

Hospital Level Forum –

  • Final bullet point refers to the senior nurse manager having “autonomy to immediately address all (IMO emphasis)issues to ensure patient flow”. This implies that the nurse manager has the right to overrule decisions on patient flow made by the ED Consultant/ NCHDs. This is unacceptable and intrudes on the clinical autonomy of the ED Consultant.

Health and Safety –

  • The reference to prioritising staffing of the ED detracts from the wider issues impacting the ED crisis. Prioritising staffing in other parts of the hospital to allow the movement of patients out of the ED should have an equal if not higher priority;
  • Listing specific areas where care should be provided in a timely manner undermines the role of the Consultant and/ or NCHD who have a duty to prioritise care as determined by their clinical experience.

Job Descriptions –

  • If the content is restricted to nursing staff then reference to developing policies, etc. may be acceptable, but this requires clarification;
  • The ADON ED Job Description includes “influence the prioritisation of patient access to diagnostic facilities”. We accept this appears to only talk about engage and influence, however, priority of patient care is for the clinician to determine, not the ADON;
  • The ADON also will use data from patterns of attendance to establish patterns of inappropriate attendance. Again, if limited to nursing staff ok, but if it impinges on clinical staff then it is unacceptable;
  • The same can be said for the last two bullet points in the ADON description.

Notwithstanding the above comments the IMO does not believe that this level of concentration on the ED, while not providing the same focus on all other recommendations in the ED Taskforce Report, is simply wrong. It will not resolve the crisis.

It is essential that the IMO has:

  • a representative on the ED Taskforce Implementation Group (we have raised this with you previously); 
  • representatives on the Group Wide Executive Forum and each Hospital Locum Forum;
  • is fully consulted on any proposed change that has the potential to impact our members, either directly or indirectly.

In the meantime, we will confirm with the WRC that the IMO, along with SIPTU, are seeking any early intervention on this issue.

Yours sincerely
Steve Tweed
Director, Industrial Relations

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