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 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.”

Letterkenny University Hospital (LUH) requires approximately 30 extra NCHDs to implement the IMO/health management NCHD agreement reached in late 2022.

Since October, non-training NCHD posts are subject to the HSE recruitment embargo.

A spokesperson for Saolta University Health Care Group said the terms of the NCHD national agreement are being progressed at LUH. The hospital is also “working proactively” to implement the recommendations of the NCHD taskforce and the Model 3 Hospitals Report.

LUH has been chosen as the pilot site for the Model 3 Hospital Project, which will involve a “significant focus” on recruitment and retention of medical staff.

On 24 July 2023, a meeting of the LUH executive board heard that a “minimum of an additional 30 NCHDs” would be required to comply with the 2022 NCHD agreement, according to minutes obtained under Freedom of Information law.

Saolta’s spokesperson commented: “LUH, similar to all other hospitals nationally, have identified areas where expansion is needed in order to meet the recommendations without impacting on patient care or service activity. This list, which amounted to an additional 30 NCHDs, requires national approval.

“LUH has reviewed the NCHD rosters in all departments in line with the recommendations of the IMO/HSE DOH agreement.

“The hospital is working towards the full implementation of all recommendations and has fully implemented new measures to deal with emergency tax and expenses related to relocation for trainees. Entitlements around leave for mandatory exams and minimum guaranteed entitlement for each six months are also complete.”

In terms of the NCHD taskforce report, LUH has “undertaken steps to enhance the physical environment, health and wellbeing, education and training and ICT for our NCHD colleagues”.

Meanwhile, Saolta is engaging with postgraduate colleges to support NCHD specialist training in LUH. The hospital has recently been approved for core specialist training in emergency medicine and higher specialist training in obstetrics and gynaecology. 

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.