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Failure to recruit and retain medical staff across all disciplines including consultants, junior doctors, GPs, specialist and general nursing, diagnostics and therapists, is a significant impediment to providing a quality health service in Ireland.
Working in the Irish health service is not seen as an attractive career option, especially to those who have trained in Ireland and know its deficiencies at first hand.
Irish-trained medical staff are of a very high standard, yet they leave Ireland at the first opportunity to work in foreign health services, which offer better working conditions, job satisfaction and career opportunities. The ties that bind graduates to home are often insufficient to retain them in Ireland and in many cases are not strong enough to entice them to return in the future. Thus we are leaking the very people who could save our health service while we trawl the world to recruit foreign staff to replace them. The failure of repeated recruitment initiatives is a stark illustration of how graduates and specialists view the Irish health service. We are in a global market regarding medical staff and thus we have to innovatively compete and win the hearts and minds of our own graduates as well as attracting the highest calibre of foreign graduates to develop our health service into one in which we can take pride.
Ireland’s reliance on internationally qualified medical doctors is among the highest in OECD countries, according to Irish Medical Council 2016 statistics, with 38 per cent qualifying from medical schools outside Ireland, most commonly Pakistan, Sudan, UK, South Africa and Romania. Some 77 per cent of junior hospital doctors (not in training) graduated overseas. Ireland is highly reliant on overseas doctors to run our health service.
A new ICGP survey on GP trainee and recent graduate working intentions found that one-third of GP trainees are considering emigration, while almost 10 per cent of recent graduates do not see themselves working in general practice in any capacity in five years time. Some 18 per cent of recent graduates have already emigrated and a further 17 per cent of recent graduates definitely and possibly will emigrate. Financial prospects and quality-of-life were the main reasons cited by survey respondents for emigration.
GP contract responsibilities and lack of resources in primary care are also a significant inhibiting factor for new graduate GPs not taking up public contracts. Single-handed practice is not seen as a preferred career option. One-third of our GPs are within 10 years of retirement, which has manpower implications that the HSE continues to passively ignore. This is a significant issue for future workforce planning. The GP service is in danger of collapsing unless urgent action on new contract arrangements are negotiated. The traditional model of general practice will not work in the new dynamic of the Irish health service where universal free GP care is Government policy. The medical needs of a population is significantly dependent on the financial viability of their local general practice.
FEMPI, which was disproportionately applied to general practice fees, has ensured the non-viability of many general practices as funded under the present contract arrangements.
Worldwide, nurses are regarded as a scarce commodity with a premium value. Irish nurses were sacrificed during the austerity years and the profession has not recovered numerically from the prolonged recruitment embargo, short-term contracts, pay reductions, poor working conditions and lack of professional development. Irish nurses, like Irish doctors, emigrate to benefit from better working conditions, career opportunities and job satisfaction. Sustaining and expanding a nursing workforce is fundamental to all health systems. There is a significant shortage of nurses in Ireland resulting in critical inefficiencies and poorer outcomes for patients. New hospital beds and new services can’t be opened due to lack of staff.
Ireland has one-third less consultants than recommended by the Hanly report of 2003. In some specialities we have only half the number of consultants recommended internationally. Consultants who have completed their training abroad are not returning home and of those who do, many are not retained as their Irish working conditions, support structures, payment scales and job satisfaction are not competitive with international alternatives. Thus we are losing specialist consultants, which are difficult to replace with those of a similar calibre. Without senior decision-makers providing consultant-delivered health services our hospitals work less efficiently and effectively.
Within our hospital and community services there is a chronic shortage of physiotherapists, occupational therapists, speech therapists, psychologists, counsellors, public health nurses and other health professionals. There is international competition for all these disciplines, resulting in major gaps in our ability to provided rehabilitative and community support services leading to extra pressure being placed on our overstretched hospital sector.
We educate the medical graduates to make our health service work efficiently and effectively yet the Department of Health and the HSE are unable to create an environment and ethos that will act as a magnet to attract, recruit and retain frontline staff; making working and living in Ireland an attractive and self-fulfilling career option.