FULL RECOMMENDATION
INDUSTRIAL RELATIONS ACTS, 1946 TO 1990 SECTION 26(1), INDUSTRIAL RELATIONS ACT, 1990 PARTIES : NORTH WESTERN HEALTH BOARD (REPRESENTED BY THE HEALTH SERVICES EMPLOYERS' AGENCY) - AND - IRISH NURSES ORGANISATION DIVISION : Chairman: Ms Jenkinson Employer Member: Mr Keogh Worker Member: Mr O'Neill |
1. Transfer/staffing of the Alzheimer's Unit, St. John's Hospital, Sligo.
BACKGROUND:
2. The Board is in the process of transferring Alzheimer's patients from St. Columba's Psychiatric Hospital to community based facilities and, to date, 100 patients have been moved to supervised residential units. As part of the process a purpose-build Alzheimer's Unit was opened at St. John's Hospital. The Union raised various concerns regarding the transfer/staffing of the Unit and the matter was the subject of a conciliation conference under the auspices of the Labour Relations Commission arising from which the issue of staffing matters was resolved by the appointment of an agreed expert. The outstanding issue was the time-span for the transition of the management of the Unit from the psychiatric services to the geriatric services. This was complicated by the existence of agreement between the Board and SIPTU, representing the psychiatric nurses, concerning the rotation of the latter through the Alzheimer's Unit as part of their working arrangements. The Board's position was that it could not renege on that agreement, although it was committed to the transfer of the Unit. Following a further conciliation conference agreement was not reached. However, industrial action by the INO was deferred pending the referral of the matter to the Court.
The dispute was referred to the Court, on the 14th of January, 1999, in accordance with Section 26(1) of the Industrial Relations Act, 1990. The Court carried out its investigation, in Sligo, on the 10th of March, 1999.
BOARD'S ARGUMENTS:
3. 1. In order to effect a continuity in patient care, the Board decided that the registered psychiatric nurses should transfer to the new Unit and continue to care for the patients with whom they have built up relationships with over the years. This approach, in terms of care, also allowed for the expressed wishes of the patients and their relatives. In any case, there are significant difficulties in recruiting registered general nurses for the Hospital, as there is nationally.
2. Apart from the need to maintain continuity of care it would not have been feasible to seek to terminate the employment of temporary registered psychiatric nurses considering that the Nursing Alliance was insisting on their being made permanent, whilst, on the other hand, trying to recruit registered general nurses who would likely be unavailable in the current climate.
3. In terms of the continuity of care, the Board applied the same logic of transferring registered general nurses from St. John's Hospital to the other new Alzheimer's Unit, in Carrick-on-Shannon (St. Patrick's).
4. The new Unit in St. John's has been operating since the 18th of July, 1998 and has proven to be efficient and effective in meeting the needs of the patients. Taking into account that the Unit has its own local nurse manager in relation to staff and service issues, there is nothing to be gained by changing reporting relationships at this time.
5. The Board has previously indicated that the management of the Unit could at some further date be transferred to Community Services, but the rationale and appropriate time-frame for such a move is difficult to determine.
UNION'S ARGUMENTS:
4. 1. The Alzheimer's Unit is on campus at St. John's Hospital, which is an elderly care service, and it should be integrated into the services for the elderly, in keeping with the Board's policy on same.
2. It is generally accepted that the patients in the Alzheimer's Unit are primarily cared for by a nursing service with minimal medial input from medical personnel. Therefore, it is only reasonable that this service be integrated with the Geriatric Service under the management of the Co-ordinator of Geriatric Services and the Direct of Nursing at St. John's who is a registered general nurse and a psychiatric nurse. The Unit at St. John's Hospital is no different from the other two units at St. Joseph's Hospital and St. Patrick's Hospital which are both under the management of the Geriatric Service.
3. It is accepted by the Board that the management of the Alzheimer's Unit will become the responsibility of the Geriatric Service, in time. The transition from the Psychiatric Services to the Geriatric Services should begin immediately. This should involve the deployment of registered general nurses into the Unit and the handover of management to the Direct of Nursing, St. John's.
4. The Alzheimer's Units at St. Joseph's Hospital and St. Patrick's Hospital, Carrick-on-Shannon were opened under the management of the Geriatric Services with no transition period.
5. The Board adopted an industrial relations-dominated view that the arrangements were part of an agreed package for compensation for psychiatric nurses re-locating from St. Columba's Hospital. The "years ahead" report states that one of the objectives for services to the elderly should be to provide a high quality of hospital and residential care for elderly people when they can no longer be maintained in dignity and independence at home. The Union is committed to maintaining elderly people with dignity and respect and the high quality care of Alzheimer's patients should be provided in the Geriatric Services. The Board also supports this concept of nursing care for confused elderly dementia patients in all other Units under its remit. This splintered and divided approach from management is unacceptable.
RECOMMENDATION:
The Court is being asked to adjudicate on an issue which is outside the terms of normal industrial relations when it is asked to decide on the location and management of an Alzheimer's Unit. The Court is not competent to deal with the question of how an Alzheimer's Unit should be managed. However, the Court is satisfied that the North Western Health Board appears to have made a decision in the best interest of the patients and, for practical purposes, seems to have made a decision on the staffing of the Unit, which would cause the least possible industrial strife.
However, for management not to have discussed the proposed move from St. Columba's to St. John's with the Union who had directly been involved up to that point and also with other experts in this field, was precipitous and unwise. The consultation process was inadequate. It would appear that the Board was driven by industrial relations considerations and the need to provide for patient care, without causing too much disruption.
At the hearing it was clarified that when vacancies arise for nurses in the new Unit, registered general nurses will be eligible to apply and positions are not just open to registered psychiatric nurses alone. There had been some confusion on this point.
The Court recommends that the current structure should remain in place for a period of 12 months from the date of this Recommendation, after which time the Board should review the position in conjunction with the Union and experts in the field of treatment of Alzheimer's patients. If the parties wish to come back to the Court following this review, they may do so.
Signed on behalf of the Labour Court
Caroline Jenkinson
30th April, 1999______________________
M.K./D.T.Deputy Chairman
NOTE
Enquiries concerning this Recommendation should be addressed to Michael Keegan, Court Secretary.