The Irish Nurses and Midwives Organisation has called for the ending of a HSE derogation policy, which allows essential quarantining healthcare workers to return to work before completion of a full 14-day quarantine period. 

Earlier, the Fórsa trade union had also criticised the policy, saying it could be to blame for relatively high levels of Covid-19 infection among health personnel. 

The HSE confirmed this evening that 5,726 cases of Covid-19 in health personnel had been reported to date - though Fórsa Head of Health Eamonn Donnelly said the figure was 9,225 when voluntary hospitals and HSE funded so-called "Section 38" bodies were included. 

The HSE also confirmed that in the week to 1 November, 532 health care workers were reported as close contacts of a Covid-19 case, and would have been advised to restrict their movements for 14 days - though it stressed that not all of those close contacts would have occurred in a healthcare setting.

RTÉ News asked the HSE how it justified issuing derogations allowing healthcare staff who were most likely to be exposed to sick people to have less stringent quarantine restrictions than people with less risk of exposure.

The HSE responded that derogations occurred if the staff in question were identified as "essential to critical service needs". 

It said that would follow a detailed local risk assessment  involving the risk to patient safety due to the absence of an essential healthcare worker.

The derogation policy states: "In the event a derogation is made, the HCW [healthcare worker] will be actively monitored twice daily by their line manager/designate (to include temperature check, which must be < 37.5°c), once prior to starting their shift and at one point during their shift."

The HSE also said it continually reminds staff that if they have symptoms to self-isolate, not to come into work and phone their GP straight away for a free test, as well as adhering to infection control guidelines.

Asked how many derogations had been granted, the HSE said the data was not held centrally, and referred the query to the individual Hospital Groups.

The Irish Nurses and Midwives Organisation said that at recent meetings with the HSE, it had sought the removal of the derogation due to a lack of monitoring. 

It alleged monitoring introduced in the last six weeks was "entirely impractical and unimplementable" due to low staffing levels and cited night duty rosters where managers were not in place. 

The INMO noted that many infected people displayed no symptoms, adding: "... therefore, the strict adherence to self-isolation must be observed most particularly for those that are working with vulnerable people, such as patients in hospital, patients in elder care communities".

INMO Director of Industrial Relations Tony Fitzpatrick said it was simply not acceptable for members to be called into work before their isolation period is completed, as it put at risk not only their own health, but that of their colleagues and patients.  

He said workforce planning over the coming months needed to factor in high numbers of infections among nurses, along with lengthy recovery periods and a "very significant" mental health impact. 

He said this was required to ensure that the service did not have to rely on potentially sick and infectious staff members returning to work before they were ready. 

The INMO said it welcomed public statements by the Chief Medical Officer regarding the need for strict adherence and observation of 14-day isolation for those considered close contacts of infected persons - and urged the HSE to lead by example. 

Fórsa calls for improved tracing for affected staff

In a bulletin to members, Fórsa's Head of Health Eamonn Donnelly criticised the derogation policy.

Mr Donnelly acknowledged that unions had agreed to the policy, as they had to balance the need for people to be at work where they can. 

However, he complained that there did not seem to be a tracking system to link where workers had been given derogations, adding that this would be essential to keep infections under control.

"The unions believe the number of cases, which is among the highest in Europe, is largely down to a 'derogation' policy, which gives local management authority to require staff to return to work quickly after unprotected close contacts at work, including close contacts with known clusters," the Fórsa bulletin states. 

The union fears local managers are issuing derogations to "significant" numbers of staff to alleviate staffing pressures in the health service - and fears this means health workers in close contact with the virus are "frequently not subject to the same infection control measures as others".

Fórsa accused the HSE of "insufficient national governance" on the practice, saying: "As a result, there are no reliable statistics on the numbers granted, where they are in place, or links between derogations and the spread of the virus among staff and others."

The union has demanded a robust testing policy "to counter the relatively lax safeguards applied under derogations" as well as better measurement of related infections among other staff and patients. 

Eamonn Donnelly praised the overall role of the HSE and its staff in responding to the pandemic, but said the "imperfect" derogation policy needs to be reviewed and amended urgently.

"At the very least, we need national oversight to monitor and record all derogations, ensure compliance with policy, and assess the impact of derogations. And we need a robust testing regime to minimise risks to derogated staff, their colleagues and patients," he said.