Dr. Clive Kilgallen:

I thank the Chair and members of the committee for the invitation to discuss the welfare and safety of both staff and, most important, patients in our public health services. Patient safety and staff welfare are ongoing issues throughout the year and do not just happen during the winter, when everything gets much worse than it otherwise is. Our hospitals are full all year round and there is simply no excess capacity to deal with the increased demand, as we saw recently this winter and, indeed, all winters.

We know there are risks to patients from overcrowding and staff burnout. Delays in admission from the emergency department are associated with increased mortality for patients. It is estimated that up to 400 people could die each year as a result of emergency department overcrowding. That is an extrapolation based on figures from the UK. Studies have shown that emergency department overcrowding is associated with delays in receiving pain relief, medication errors, and greater lengths of hospital stay. Sometimes patients even leave the emergency department without having been seen because they simply cannot deal with the situation they are in. Hospital overcrowding contributes to the spread of healthcare-associated infections and adverse events due to the shortage of resources and elevated stress levels. Long waiting lists and delays in diagnosis and treatment inevitably mean patients are treated at a more advanced and complex stage of illness and overcrowding can lead to the further cancellation of non-urgent care.

Healthcare settings are inherently hazardous environments and as we have heard, staff face risks of violence, accidents, healthcare-associated infections and poor mental health outcomes from the stress. The HSE has failed to address the issues of chronic understaffing and capacity. We need to emphasise this. It is why we are here today. As part of our work, the IMO has surveyed our members in relation to their mental health and well-being. Our most recent survey, carried out last year, revealed that long-standing issues of staffing shortages, the backlog and the waiting lists have had an effect on the well-being of our doctors. Some 94% of doctors reported having experienced some form of depression, anxiety, exhaustion or emotional stress while 81% of doctors are at risk of burnout. Further, 62.3% of doctors have had their working week extended beyond their normal contractual hours by 11 hours or more.

Some 72% of doctors are not able to take their scheduled breaks during the working day, and 59.3% reported not being in a position to take two consecutive weeks off over the past year. Really, short-term solutions are not enough at this stage.

We recommend investing in bed capacity and ensuring that our hospitals operate at the safe occupancy levels of 85%; determining and resourcing appropriate and safe staffing levels based on population needs; creating a better working environment, which actually benefits doctors, nurses and patients themselves; ensuring clear policies and procedures are in place so all healthcare professionals feel able to take breaks and take time off when ill; and increasing the efficiency of our service by investing, an example of which would be e-health and electronic health records; risk assessments for both patient and staff welfare; and that all healthcare workers should have access to appropriately resourced, fully consultant-led occupational health services, including mental health supports. Many doctors are suffering and it is not only doctors; all healthcare staff are suffering. It is not just doctors who are suffering. A lot of the time, people feel fearful of bringing this forward to the hospital or whatever. We need to really address the stigma and encourage the use of support services and enhance those services.