HSE told IMO that 800 extra NCHDs needed to be recruited 24 hours before recruitment freeze announced

 Lack of capacity and workforce restrictions preventing Doctors from doing their jobs

 

Wednesday 22nd May 2024.  The Irish Medical Organisation (IMO) will tell an Oireachtas Committee today (Wed) that just 24 hours before the recruitment ban was introduced in the health services, the HSE had advised it (the IMO) that 800 NCHDs would need to be hired if the State was to be able to  bring working hours for NCHDs to legal and safe levels.  The recruitment ban is leading to increasing working hours for NCHDs, Consultants being left with insufficient numbers of NCHDs on teams and significant contract breaches on working hours across the system.

 Later today, the IMO will be address a meeting of the Joint Oireachtas Committee on Health which has been called to discuss Issues relating to the employment of consultants and non-consultant hospital doctors in public hospitals.  The IMO will be represented by Professor Matthew Sadlier, Dr. Rachel McNamara, Dr. Peadar Gilligan, IMO CEO Susan Clyne and IMO Policy Director Ms Vanessa Hetherington.

 In their presentation to the meeting, the IMO will highlight the following points:

• Doctors are not enabled to do the job for which they are trained due to insufficient capacity and workforce restrictions. This has significant consequences for patients whose care is being delayed or compromised.
• The health services have failed to match the growing demands of a rapidly increasing population and the increasing percentage of older people in particular.
• There is a shortage of 5,000 acute hospital beds in the Irish public health system.
• Almost 700,000 people on waiting lists (end April) had not even received a date for their appointment or procedure.
• Impossible working conditions are discouraging applicants to fill key vacancies and encouraging Doctors who are working in the Irish system to emigrate to other countries.
• There are high levels of risk of burnout amongst doctors with increasing levels of emigration of NCHDs.

Consultants

 

In respect of consultants, the IMO team will tell the Committee that because of funding restrictions consultants are often appointed to a position with no admin support, no office, no team members, insufficient or no clinic times, no theatre time and challenges in accessing diagnostics.

 More generally the IMO will tell the committee that consultants are constantly battling in a highly bureaucratic system to get basic resources and are seen very often as a “cost centre” rather than an asset requiring the supports to enable them to see and treat patients.

 

In relation to the consultant workforce, the IMO will tell the committee:

 

• While the number of consultants employed in the HSE has increased, the number of consultants employed still falls far below the numbers required for a consultant delivered service.
• Ireland has one of the lowest consultant: patient ratios in the OECD.
• Of approximately 4,500 approved consultant posts, just 3,700 posts are filled on a permanent basis while an estimated 6,000 consultants are required to provide a consultant delivered health service based on our current population.
• In some specialties (including many of the surgical specialties and psychiatry)the number of consultants employed is up to 50% below the recommended levels resulting in significant waiting lists.

The new Public Only Consultant Contract became effective in March 2023 – and to date 2,229 consultants are on that contract – 470 who are new appointments and 1,759 who have transferred to the new contract.  The contract provides for private practice to be removed from public hospitals and for the ability to roster consultants over an extended working day and week.  However the new contract will not, in and of itself, solve the chronic problems the health service is facing in the context of capacity and workforce requirements as outlined earlier.

NCHDs

The IMO will tell that committee that the recruitment ban is impacting the situation with NCHDs in particular.

 For NCHDs the recruitment freeze has meant:

 

• An increase in Illegal and unsafe working hours with 83% of NCHDs routinely working beyond 48 hours per week. This is this illegal in terms of the Organisation of Working Time Act. It is also unsafe for patients .And it is a breach of contractual entitlements. This risk to both doctors and patients is embedded in the system and has been made worse by the recruitment freeze. The day before the recruitment freeze was announced the HSE advised the IMO that it would take targeted recruitment of up to 800 additional NCHDs to bring working hours to legal and safe levels.
• 68% of NCHDs report that they are regularly working beyond 10 consecutive days - without compensatory pay or additional rest days in almost half of these cases.  Again this  breaches a contractual entitlement designed to improve patient and doctor safety.
• NCHDs are entitled to 10 days guaranteed study leave every 6 months to study and undertake mandatory exams. 65% were unable to take such leave due to gaps in the rota. 
• 77% of NCHDs are being pressurised by their employer to work extra shifts, often at short notice, to cover gaps in the rota.
• The HSE cannot provide even the most basic of guarantees around providing cover for maternity leave which again leaves a gap in the rota requiring the other team members to work those shifts.
• NCHDs are our future consultants yet 75% of NCHDs do not feel valued, respected or supported by their employer.

International Doctors

International doctors (doctors who graduated outside of Ireland) fill 80% of non-training NCHD Service posts.  These doctors, who have made Ireland their home and without whom the health system could not function, are not treated equitably in terms of career progression.  They too leave the system, disillusioned with working conditions and the lack of training and career opportunities. Medical Council figures show that, on average, International Doctors spend six years on the General Division, before moving.

 International Doctors  are frequently here on what are called Critical Skills Permits or Multi-site General Employment Permits, and they are entitled to seek a Joint Family Visa.  However, they and their families experience significant delays in the processing of their visa applications, leaving families separated for long periods.  This country has asked these doctors to work here, we need them to stay so we must do better to support them and enable their families to be with them.

 The IMO will call for the health services to be funded appropriately to meet the needs of patients and to ensure a safe working environment for doctors.