The NCHD taskforce recommendations aimed to significantly improve NCHDs’ working lives.
Catherine Reilly examines what has been delivered
“An urgent priority.”
When the NCHD taskforce report was released in February 2024, the Minister for Health was unequivocal on the importance of implementation.
“I am confident that delivery of the taskforce recommendations will support present and future retention of NCHDs in Ireland by making the experience of doctors working in our health service both positive and fulfilling,” said the then Minister Stephen Donnelly.
The Department of Health established the taskforce in late 2022. The remit of the group, comprised of a range of stakeholders, was to develop recommendations to improve NCHD working conditions and work/life balance. In April 2023, it published interim recommendations on areas including induction, medical workforce configuration, infrastructure, medical manpower support, and occupational health.
The final report included 44 recommendations. However, it lacked clear timelines for the completion of implementation, with references to “from 2024” and “from 2025”.
Timely (and legally compliant) rosters; expanding flexible working; establishing benchmarks for safe medical staffing; minimising geographic moves during training; ensuring protected training time; and ICT enhancements, were all encapsulated in the report.
While ambitious in its scope, the report’s fine print acknowledged the ‘realpolitik’. “The taskforce wishes to emphasise from the outset that many of the recommendations of this report will remain ineffective, unless clinical service configuration and infrastructural deficits within the Irish health service are addressed, as these are issues critical to future NCHD workforce retention and wellbeing.”
Working hours
Dr Rachel McNamara, IMO NCHD committee Chair, told the Medical Independent (MI) there had been progress on some of the taskforce recommendations. However, from the IMO perspective, critical items such as excessive working hours have not been addressed.
Dr McNamara said areas of progress include increased training places, enhanced occupational health supports, and the introduction of regional clinical directors for medical education and training. There was improved access to flexible training, but it was still behind comparator countries, she added.
“Illegal and unsafe” working hours remain a major concern. Dr McNamara said there are “numerous” ongoing reports from NCHDs of breaches of the Organisation of Working Time Act (OWTA), 1997.
She emphasised that non-compliance with the OWTA is a breach of the law, and full compliance is imperative.
Twenty-four-hour shifts are still occurring, especially in model 2 and model 3 hospitals. Thirty-six-hour shifts are very common in surgery, but less so in other specialties, she said.
Under the 2022 IMO/health management NCHD agreement, an NCHD who is required to work 10 days in a row is entitled to a day of rest (or two days where required to work 11 consecutive days). “That has still not been facilitated all the time, with the compensatory rest payments being incurred on account of not being able to accommodate one day off, after 10 days on.”
The taskforce recommended electronic time and attendance systems to enable sites to accurately track and report NCHD hours. The IMO was not aware of “meaningful” progress in this area.
The Organisation considers a new NCHD contract as crucial to eradicating illegal working hours and modernising contractual terms. However, Dr McNamara said there has been a “lack of momentum” in contract negotiations, particularly on the side of the employer (HSE).
“The major problem with contract negotiations is they have been repeatedly stalled over the course of the last two years. Part of the 2022 agreement was the HSE, DoH [Department of Health] and IMO would convene on the development of a new NCHD contract, which is overdue, with a view to addressing the issue with NCHDs working illegal and unsafe hours….”
The major problem with contract negotiations is they have been repeatedly stalled over the course
of the last two years
There were some talks in 2024 and 2025. However, overall, “the momentum has not been there in terms of reaching any sort of an agreement. The latest is that we are going to enter negotiations very soon,” said Dr McNamara, who was speaking to MI in late February.
Dr McNamara also expressed dissatisfaction about the failure to establish a policy group to define benchmarks for medical safe staffing levels, contrary to the taskforce’s recommendation.
She said when new hospital wings or units come on stream, it is expected this will come with additional nursing whole-time equivalents. However, this is not the case for medical staffing.
There is “an unlimited number” of patients that an NCHD may be expected to care for.
“We need to be in a position to map [medical safe staffing] if we are ever to achieve safe conditions for patients and reasonable conditions for staff.”
According to the taskforce, geographic moves during training should be minimised by training bodies. Dr McNamara said only a small number of training programmes are concentrated in one geographic area. There is an argument that some other programmes could be conducted across one or two areas for their entirety, but there has not been systematic movement towards this, she outlined.
Due to the housing/rental crisis and rotation requirements, some NCHDs are commuting “huge” distances. This will “no doubt” contribute to accidents and “unsafe work practices” because of increased fatigue. Dr McNamara said another huge issue is childcare. The IMO has noted that this area was not “adequately addressed” in the taskforce report.
Dr McNamara highlighted ICT as a crucial area where progress has been underwhelming. This issue was also raised in the Medical Council’s inspection of intern and specialist training at Children’s Health Ireland (CHI) in 2025: “ICT systems were also found to hinder clinical service delivery with potential patient safety implications. Doctors reported on numerous occasions requiring multiple logins to complete routine tasks such as checking the results of investigations and completing discharge letters.”
HSE position
Progress had been made “in a number of areas” highlighted by the taskforce, according to a HSE spokesperson. The spokesperson noted infrastructure improvements in a number of sites, including enhanced rest, food, and IT facilities (the latter including tablets for use on ward rounds, and computers on wheels, as well as better mobile and wi-fi coverage).
In February 2024, the ‘NCHD hub’ was established by the HSE Workplace Health and Wellbeing Unit. This provides a workplace health and wellbeing service and dedicated occupational health support services for NCHDs.
The HSE spokesperson added: “An updated standardised NCHD induction programme was introduced in line with taskforce recommendations and implemented across all sites. Alongside these updates was the introduction of a national NCHD guide as well as local guides that have been developed and published, which provide important information to NCHDs on working in the HSE and living and working in the relevant local area (ie, information on local childcare, banking, housing, etc).”
A standardised programme of clinical skills induction has been introduced as part of an enhanced induction programme for doctors new to the Irish system. This programme has been run on a number of sites. A resource centre is also available on HSeLanD specifically designed to support doctors transitioning to the Irish health system.
As recommended by the taskforce, the HSE has established an updated education and training governance structure within the health regions. Regional Directors of Medical Education and Training have been appointed to all regions and CHI. “This structure will address challenges, share good practices, and promote innovation across the Health Region with the goal of improving and supporting the learning environment for NCHDs.”
The HSE has developed and delivered a bespoke medical manpower course that trains staff from medical HR departments in supporting NCHDs and improving consistency of approach across sites.
“The taskforce recommended the HSE expand the national employment record to address key enhancements identified by NCHDs, including salary details, sick leave, and post-matching details. These changes have been deployed,” the spokesperson added.
Asked by MI how it monitors OWTA compliance at national level, the HSE stated: “A verification group has been established with agreed terms of reference. Membership of this group includes HSE representatives, consultants, NCHDs, IMO and medical manpower managers. Reporting requirements at site level have been expanded for submission quarterly to the OWTA verification group for monitoring. This is in addition to monthly data returns.”
In 2025, the national average for compliance with the maximum 24-hour shift was 91 per cent; and the national average for compliance with the 48-hour week was 77 per cent, according to the HSE’s data.
According to the HSE, it has asked the health regions to “develop an emergency rostering policy for implementation at site level”; while the expansion of flexible working and training was described as “ongoing”. An NCHD survey, released in 2024, indicated 7 per cent of all NCHDs (training and non-training) were working on a less-than-full-time basis. The training bodies “have put policies in place for application for flexible training”.
Asked if it had developed a national framework to optimise NCHD time for direct patient care, the HSE said this recommendation was being examined. It provided the same response on the development of “professionalism frameworks” to support a positive working environment for NCHDs.
The HSE said a NCHD Return to Work Policy is under review for publication in 2026. A bespoke leadership and management training programme for consultants has been developed by HSE Leadership and Capability.
On ensuring protected training time for NCHDs and consultants, the HSE stated: “The approvals process for consultant posts includes the identification of two hours of protected time for teaching. This is also required in consultant work practice plans.
“The provision of protected training time for NCHDs is managed and monitored at a local level. Consultants are required to meet with NCHDs on appointment to agree rosters and identify protected time. Protected training time includes on-site regular weekly/fortnightly scheduled educational and training activities, including conferences, grand rounds, morbidity and mortality conferences.”
The provision of protected training time for NCHDs is managed and monitored at a local level.
Meanwhile, the taskforce advised that a standardised memorandum of agreement (MoA) on trainee support and training must be developed and agreed.
It recommended that the Forum of Irish Postgraduate Medical Training Bodies and HSE work together to develop and agree this memorandum. The document should clearly set out the key roles and responsibilities of both parties and their remit to deliver an accountable, supportive, and effective training programme and environment.
A Forum spokesperson said: “The Forum and the HSE are in the process of developing an MoA. A draft was completed, but is now under review and re-edit as required to reflect the new HSE structure.”
Department of Health
The taskforce recommended the establishment of a national committee for strategic planning of medical education and training; and separately a multi-stakeholder policy group to define benchmarks for medical safe staffing levels. These actions were assigned to the Department of Health.
The Department confirmed neither of these groups have been “formally established”. The spokesperson added the Department was engaging with key stakeholders to “plan and progress the longer-term vision and future strategic direction of medical education and training”.
They said Budget 2025 and 2026 have provided “substantial funding” to expand postgraduate training places for NCHDs. “Significant increases in NCHD postgraduate medical training places, and the number of doctors in training, have been achieved in recent years including a 29 per cent increase in the total number of doctors enrolled in training programmes over a six-year period from 2019/20 to 2024/25.”
Additional training places are also being delivered within existing resources through conversion of non-training NCHD posts. The Department noted that additional training posts support the targets for increases in NCHD and consultant numbers.
The Department and HSE are also engaging on “permanent and sustainable career options and pathways” for NCHDs not in structured training programmes. This includes exploring the feasibility and potential benefits to the health service of establishing a new permanent grade doctor.
Funding for taskforce recommendations has been “prioritised” as part of the annual estimates process for Budget 2025 and 2026. “Funding of €5 million for implementation of the recommendations on clinical sites was provided for each of these years. Funding was also provided in each of these years to support doctor training, including establishment of postgraduate training posts and the roll-out of the clinical educator programme.”
Meanwhile, the HSE and Department stated they were committed to progressing the NCHD contract negotiations.
The college view
The Medical Independent asked postgraduate training colleges about implementation of several measures in the NCHD taskforce. This is an edited snapshot of responses:
College of Anaesthesiologists of Ireland (CAI)
The NCHD taskforce asked training bodies to introduce recognition of prior learning (RPL) processes for experienced registrars in Ireland. The CAI has recently commenced an RPL pilot programme.
“Recruitment to the SAT [specialist anaesthesiology training] programme is in its final stages with four doctors recently offered a place on the programme for this July via the RPL route and they will accelerate to year three of the SAT programme,” according to CAI CEO Mr Martin McCormack.
SAT trainees are required to spend time in at least three geographical locations as part of meeting the specialist training requirements.
“For our SAT year one to two, we try where possible for trainees to have one move between geographical locations; however, this is impossible for our SAT year three to six,” said Mr McCormack. “We support trainees where possible concerning balancing family priorities and take personal circumstances into consideration when making the allocations. Trainees are advised about the HSE NDTP flexible training scheme that they can avail of. In addition, we offer a swaps policy to trainees who wish to change their allocations with a trainee in the same training year. This has proven to be a tried and tested way to support our trainees with finding a life/work balance.”
Regarding the recommendation to provide pre-defined rotations at the outset of the training programme for a minimum of three years, Mr McCormack said: “Trainees due to commence on the programme in July 2026 will be given their first two-year rotations by the end of March 2026 (14 weeks prior to commencement). A third-year rotation is not possible to provide due to uncertainties regarding successful completion of the MCAI exam for progression to SAT year three and the option for trainees to take unaccredited leave after SAT year two. This has been agreed with and accepted by our specialist anaesthesiologist trainees as appropriate.”
The CAI has adopted wellbeing standards produced by the Forum of Irish Postgraduate Medical Training Bodies in late 2023. “Since then, the College has incorporated the standards into our site accreditation processes and continue to ensure our trainees have adequate access to resources to support them during their training. The College along with all the other training bodies provide progress reports to the Forum on this area as required.”
The CAI undertook a training capacity review in 2024. On foot of a business case, the SAT programme was able to increase intake from 40 to 60 candidates. There is further capacity, but facilitating more places would require additional funding.
RCSI
The RCSI said it is committed to “supporting trainees where possible to ensure certainty of location during their training”.
“Core surgical training is a two-year programme and so pre-defined rotations for three years is not possible. With respect to higher surgical training, the RCSI provides trainees with at least three years of pre-defined rotations where feasible. This is also subject to meeting progression metrics in their specialty year-on-year and is reviewed at their annual review of competency progression each year.
“The RCSI continues to work with the specialties and the Irish surgical training group to ensure the best training experience for all trainees.”
In line with the taskforce recommendations on RPL for experienced registrars , the RCSI’s multispecialty working group has recommended a RPL process and framework.
“With 11 specialties it is important to engage and agree standards of application along with flexibility across the specialties. We anticipate the process to go live in June 2026.”
RCSI has a “robust health and wellbeing programme” which includes a health and wellbeing officer, a confidential health and wellbeing email address, and a “large number of resources” publicly available to trainees and trainers.
“The College is currently working to improve integration and alignment between the RCSI criteria and standards for accreditation of surgical training posts and the Forum [of Irish Postgraduate Medical Training Bodies] health and wellbeing standards to ensure consistent reporting.”
The College has made “significant progress” on the taskforce recommendations. It remains “committed to the continuous improvement and integration of these recommendations into surgical and emergency medicine training”.
RCPI
The RCPI releases a minimum of three years of rotations at point of entry onto a training programme, said a spokesperson.
“Training intentions surveys are used at later stages of the programme to ensure that both curriculum requirements and the career direction of the trainee are taken into account. The RCPI will only adjust rotations based on trainee need, or in instances where local staffing changes mean that suitable training supervision cannot be provided.”
The RCPI set up a Health and Wellbeing Department in 2018 to help trainers and trainees get the most out of their training experience by enhancing their wellbeing and professional conduct.
The spokesperson said “significant progress” has been made in regard to the taskforce recommendations in areas such as RPL, trainer development and trainer support infrastructure, and training capacity and geographic rotations.
The College continues to work with the HSE and the Department to address “consistent access to dedicated time for trainers and fully implement and embed agreed geographic training structures across all sites”.
Irish College of Ophthalmologists (ICO)
The ICO is in the process of approving its RPL policy and process. This will ensure doctors who secure a place on the programme “will be able to apply to have prior training recognised and thus shorten their time on the programme”, stated ICO CEO Ms Siobhan Kelly.
On the geographic structure of training, Ms Kelly stated: “A number of years ago we did a reconfiguration of the rotations to reduce the number of geographic moves. There are only a limited number of training sites in ophthalmology with a significant concentration of sub-specialty work in Dublin (although that is changing). A strictly geographically focused rotation to cover the full programme is not yet possible, but the number of geographic moves is minimised.”
Regarding wellbeing standards, Ms Kelly said: “As part of our training programmes’ structures, we have six-monthly one-on-one meetings with trainees where any issues are discussed. Issues identified are addressed as they arise. We also include a closed meeting with trainees as part of our site accreditation process. More recently the College has participated in the development of the Forum [of Irish Postgraduate Medical Training Bodies] wellbeing standards and is currently reviewing how any additional requirements can be tracked and addressed as required.”
Commenting on overall progress associated with the taskforce recommendations, she said: “There has been a good focus on developing and expanding support both for trainees and trainers and this is positive. Further work is needed on expanding training numbers with a focus necessary on how to ensure increased numbers of trainees can access good quality training opportunities and that there is capacity and resources for the off-clinical site training requirements.”
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