A system under pressure

Recent research suggests increasing problems with patient safety and an inexorable demand on healthcare professionals

As readers are well aware, working in healthcare is no picnic. Recent research from the think-tank Tasc, which found that 67 per cent of healthcare workers are actively considering leaving their role, paints a grim picture. The research describes a workforce dealing with low morale and working under extreme pressure across Ireland’s health and social care services. Such a huge number of workers actively looking to leave the system points to a serious staff retention crisis in our health system.

The mixed-methods study was commissioned by trade union Fórsa’s health and welfare division, which represents more than 32,000 health and social care staff, including healthcare professionals. Some 3,775 Fórsa members filled in questionnaires and attended focus groups as part of the research project.

The study points to chronic understaffing, ‘top-down’ decision-making, and poor engagement with frontline staff as major contributors to declining morale and a weakening of essential service delivery. Nearly half of respondents reported experiencing burnout “often” or “always”, underscoring the impact of persistent understaffing and intensifying workload demands. Many described a top-heavy system dominated by one-way, top-down communication that leaves staff feeling sidelined and undervalued.

The Tasc research mirrors the findings in the Medical Council’s Medical Workforce Intelligence Report 2024, which was published last year. The findings showed that more than a quarter of doctors struggled to deliver adequate care at least once a week, and in many cases more often. A significant 73 per cent of doctors identified workload pressure as the primary obstacle to delivering high-quality patient care, while 55 per cent pointed to the burden of administrative and bureaucratic duties. Doctors also cited delays in accessing appropriate care and treatment for patients as a major impediment.

The Medical Council report also examined doctors’ average weekly working hours. Nearly one in four doctors reported working more than 48 hours per week on average, in breach of the European Working Time Directive. These figures varied by registration category, with trainee specialists recording the highest proportion working beyond the 48-hour threshold, at 37 per cent. Just over one in five doctors on the general division and just under one in five on the specialist division also reported working in excess of 48 hours per week. That almost half of those exceeding the 48-hour limit were doing so in direct patient care raises serious patient safety concerns.

For the first time, the Medical Workforce Intelligence Report sought doctors’ perspectives on patient safety. Just over a quarter of respondents (26 per cent) said they encountered difficulties providing a patient with adequate care at least once a week, or more frequently. Most of these doctors were registered on the specialist division and were working in general practice, with psychiatry the next most common specialty. When asked to identify the principal barriers to patient care, respondents most frequently cited ‘pressure on workloads’ and ‘time spent on bureaucracy/administration’, followed by ‘delays to providing care, treatment and screening’.

General practice is often underrepresented in broader assessments of workforce challenges, making the Medical Council report’s dedicated analysis of the sector particularly valuable. Just over one in 10 GPs said they worked more than 48 hours in an average week; however, more than half of this group spent 40 hours or less in direct patient care, indicating that at least eight hours per week are taken up by administrative duties or other non-core work. In comparison with other medical specialties, GPs were more likely to report barriers to delivering good-quality patient care. Notably, the report found that 57 per cent of doctors who identified “inadequate access to specialist opinion” and 38 per cent of those citing “inadequate communication between healthcare professionals” as barriers were working in general practice.

Taken together the Tasc and Medical Council reports are part of a worrying trend. Despite the major spending on health in recent Budgets, they suggest increasing problems with patient safety and an inexorable demand on healthcare professionals. Low morale among the workforce will drive many from the health system, while those remaining risk their personal health from occupational stress.

These are urgent lessons for decision-makers. The health service is like a rumbling volcano that could explode at any moment. Doing nothing about patient safety issues and health professional wellbeing is simply not an option.