The IMO has welcomed the lifting of the HSE’s recruitment embargo. However, it has warned that the retention of a “restrictive staffing ceiling” from December 2023 means that chronic resourcing and staffing issues cannot be adequately addressed, which is a “patient safety issue”.

Dr Rachel McNamara, Chair of the NCHD committee, said: “While the IMO welcomes the lifting of the embargo and the introduction of new development posts, it is disappointing that a staffing ceiling has been set from December last year, which means services can only hire at that resourcing level. This is unsatisfactory as there now cannot be any service expansion at a time when health services are extremely understaffed and under significant pressure to meet rising demand from a growing and ageing population.”

A recent IMO survey demonstrated that 77 per cent of NCHDs are currently working beyond safe and legal hours. “The HSE has itself acknowledged that an additional 800 NCHD posts, targeted to certain sites, are needed to bring this cohort’s working hours back to a maximum of 48 hours per week. This staffing ceiling means this is unachievable and does not bode well for the commencement of NCHD contract talks later in the year. When doctors are overworked and under-resourced, it leads to poorer outcomes for patients, and we will continue to fight for NCHDs to ensure this cultural working environment is changed.”

 She added: “For too many years doctors and other healthcare staff have worked in a system that has significant deficits in terms of capacity and workforce. While this may offer some relief as newly vacant posts can now be filled, it is not the long-term solution we need. It is critically important that healthcare delivery be funded on the basis of service demand. Government and the HSE point to a drop in activity levels, however unless we staff each hospital and every community service appropriately it will simply be impossible to improve patient care and address wait times.”

The Irish Nurses and Midwives Organisation (INMO) has also expressed concern about “extremely limiting caps” on the number of healthcare staff.

INMO General Secretary Ms Phil Ní Sheaghdha said: “The decision by the Health Service Executive to put extremely limiting caps on the number of nurses, midwives and other healthcare professionals that can be recruited into the public system at both community and hospital levels will impact on the ability to provide safe care to patients.

“There have been vacancies across all community settings and in wards in each hospital since the recruitment freeze was imposed last November. The INMO conservatively estimates that there are over 2,000 nursing vacancies alone. When you couple this with the fact that over 3,500 new hospital beds are due to come on stream across the country, it is hard to see how these beds can be opened safely.

“The only way to ensure safe staffing is a given is to pass and enact the Patient Safety (Licensing) Bill in order to give HIQA more powers. This landmark piece of legislation gives HIQA the powers to ensure its recommendations are being enacted by individual hospitals and healthcare settings it inspects.

“The INMO will be meeting the HSE tomorrow morning where we will be setting out the need to ensure that patient safety is at the centre of the lifting of the recruitment moratorium. Our members want to provide safe care in a timely manner, they cannot do that if they are working in a system that is always playing catch up on itself due to self-imposed recruitment controls.”

The IMO has said that further examination into hospital productivity is needed in order to understand the factors influencing productivity and the measures required to improve the situation.

The IMO was responding to the publication today (11 July) by the Department of Health of health service productivity data and insights (available here – https://www.gov.ie/en/collection/e22bb-productivity-and-savings-taskforce-indicator-dashboards/ ).

Prof Matthew Sadlier, Chair of the consultants’ committee of the IMO, said: “While we welcome the publication of this productivity data today, it is important to note that the kind of blanket approach of comparing hospital sites is of little value in terms of understanding what is happening at individual hospital level. 

 “There are multiple factors that could be influencing this trend and which have not been addressed in this report, such as consultant access to clinics, level of MDT supports across all sites; patient treatment complexity and case mix; urgent versus non-urgent care; and access to diagnostics, beds and theatres which may mean that patients are making repeat visits to manage their conditions while awaiting inpatient care.”

The IMO noted correspondence from the HSE in June 2024 which acknowledges that key factors affecting productivity are not considered in the data. It said that “there are a number of reasons why there will be variances [in productivity] between hospitals, within clinical specialties”. These include the delivery of care through multidisciplinary teams; different types of consultant outpatient work; and greater inpatient demands.

 Prof Sadlier said that it was in everyone’s best interests to see productivity improve. “The IMO has repeatedly called for the introduction of measures that will enable consultants to see more patients. The trend identified in this report needs further analysis so that all the factors at play are understood and appropriate supports put in place. Blaming consultants is not the solution.”

He added that the IMO was increasingly concerned about waiting list numbers and the lack of capacity in the system.

“Our chronic shortage of bed capacity and the ongoing recruitment freeze have resulted in ever-lengthening waiting list numbers which in many cases are resulting in poor patient outcomes. A properly resourced and funded plan is urgently needed to ensure our system can deal with both urgent and non-urgent care and any investigation into hospital productivity needs to take all factors into account.”

The IMO has reiterated the need for urgent cultural and systemic changes to “convince NCHDs to stay practising” in the Irish health system.

Today (8 July) is Changeover Day, which sees NCHDs rotate to new hospitals for either three, six or 12 months. It is also the first working day for interns.

The IMO has said the ongoing recruitment freeze means that NCHDs are being forced to work even longer hours and additional shifts at very short notice. This pressure is exacerbating an “already dismal working environment”, which routinely sees NCHDs obliged to work excess hours in contravention of the European Working Time Directive.

Dr Rachel McNamara, Chair of the NCHD committee, said: “Changeover Day sees thousands of NCHDs rotate around the country with few meaningful practical supports, upending family life and causing a huge amount of frustration. In addition, most graduate doctors are entering the workforce with huge debts which will take years to repay. If we want to retain our doctors and sufficiently recruit for the future, it is imperative that we change the way we treat them.”

Dr McNamara said that a recent survey conducted by the IMO highlighted the poor working conditions facing NCHDs. “The results of our survey were disappointing but not at all surprising. Among the findings were that three-quarters of NCHDs do not feel valued, respected and supported by their employer; over eight-in-ten say they have routinely worked over 48 hours a week in the past three months; and three-quarters are unsatisfied with the work-life balance their current role offers them.”

She said urgent change was needed. “If nothing is done, we will lose another generation of doctors to other health systems that value their contribution and crucially, offer them the kind of work-life balance that should be a feature of our health system. We need action and unprecedented reform in a number of areas, including working hours, supports, and realistic childcare options.”

Most NCHDs continue to be pressurised to fill rota gaps on their rostered days off, heard the NCHD meeting at the IMO AGM on 6 April.

NCHD committee Chair, Dr Rachel McNamara, presented findings of an IMO survey of NCHDs on workplace issues. Some 77 per cent reported being pressurised to work additional shifts in lieu of a locum being found.

“This is something we have seen consistently,” stated Dr McNamara at the meeting in Killarney. “We have seen evidence of [NCHDs] being directly messaged on their days off and very much pressurised – that is how it feels to be told, look, if you don’t come in, your co-SHO or intern colleague will be left to do more work, or they will have to stay on potentially overnight.

“This is very much unacceptable in that there is no other profession, I would think or hope, that would see that level of being pressurised to come into work when you had not been rostered.”

Dr McNamara said the onus contractually is on the clinical director or employer to determine if there is a requirement for a locum and to make the necessary arrangements.

The IMO’s survey also found that 83 per cent of NCHDs reported having to routinely work, on average, over 48 hours per week in the previous three-month period. Dr McNamara said this practice breached the Organisation of Working Time Act and NCHD contractual rights.

Twenty-two per cent of NCHDs reported working more than two 24-hour shifts in a two-week period. Dr McNamara said this figure was somewhat more reassuring, although she added that not all specialties have 24-hour shifts in place.

The 2022 NCHD agreement, which introduced new rostering rules into the NCHD contract, requires that no NCHDs should have to work more than two 24-hour shifts in a two-week period (it allows for a third shift in exceptional circumstances).

The NCHD meeting passed a motion calling on the HSE to immediately rescind the recruitment freeze on NCHD non-training posts to ensure “the integrity” of the 2022 agreement is upheld.

It also called on the Minister for Health Stephen Donnelly and HSE to publish a fully funded implementation plan for the NCHD taskforce recommendations and to engage with the IMO on same.

At the conference, Minister Donnelly said a meeting with the IMO is scheduled in the coming weeks. He said he has asked officials to use this meeting to “work through an engagement process” on a new NCHD contract.

He told IMO delegates he fully endorsed the recommendations in the final report of the NCHD taskforce, published in February, “and we’re getting on with implementing them”.

Speaking to journalists, Minister Donnelly said consultant numbers had grown by 1,000 in the lifetime of the Government. He said as the consultant body grows the “unreasonable asks” of NCHDs, including 24-hour shifts, would decline.