Dáil debates

Wednesday, 6 July 2022

Saincheisteanna Tráthúla - Topical Issue Debate

Health Services Staff

8:37 pm

Photo of Pádraig O'SullivanPádraig O'Sullivan (Cork North Central, Fianna Fail)
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I thank the Minister of State for coming in this evening. I also thank the Ministers of State, Deputies Rabbitte and Butler, for previously taking questions on behalf of the Minister for Health. Some day I might get lucky and he might be able to get here in person to debate these issues.

Our health services are stretched. That is evident in the significant waiting lists in various areas within health. The pandemic has also taken its toll on the workforce and there are significant backlogs on foot of the pandemic. We are facing a cliff edge of GP retirements in the next few years. Many employees are approaching retirement and that is going to create significant challenges for staffing. There are also many younger professionals looking for better working conditions and a better work-life balance. These are all issues the Department of Health and the HSE are juggling. We are also reliant on agency staff in many areas, particularly nursing. Despite all this, we are repeatedly told money is not an issue. That is evidenced by the record budget of €22 billion we had last year. It is an inescapable truth that the HSE is recruiting record numbers of staff. That is a fact. Unfortunately, that recruitment is not keeping pace with demand, the backlog and the waiting lists we are all familiar with. There are difficulties in recruiting consultants, nurses, particularly specialised nurses, therapists and psychologists. There is a significant inability to recruit in those areas.

I have a accumulated some statistics over the past few weeks through responses to parliamentary questions. With regard to clinical genetics in Crumlin and St. James's hospitals, five posts have thankfully been filled but two are vacant. That is nearly one in three posts unfilled. Some 391 Irish doctors were granted working visas in Australia in the last year while 837 consultant posts are not filled on a permanent basis. Nine highly remunerated consultant posts were advertised last year and none were filled. There are 4,787 older people without a carer due to chronic staff shortages. There were five unfilled posts in BreastCheck last year and 63 unfilled consultant psychiatry posts. In the child and adolescent mental health services, CAMHS, waiting lists have increased significantly, by about 23%.

Parliamentary questions always get the same kind of mundane response, detailing long-standing workforce challenges and so on. I was here a number of weeks ago with the Minister of State, Deputy Butler, talking about paediatric patients with type 1 diabetes. The issue there was the delay in getting insulin pumps. Two additional diabetes nurse specialists were advertised in Cork, and one advanced nurse practitioner, but those posts remain unfilled. In 2022, the Cork-Kerry community healthcare area received an additional 14.5 posts for its children's disability network teams, CDNTs. We have no information about any of those posts being filled.

Another issue I raised previously was that of home care workers. At the most recent Cork-Kerry HSE briefing in Ballincollig, we could see from the details presented to us that it takes seven to eight months to hire a home care worker. If I was a home care worker, which is predominantly part-time work, and I was waiting seven or eight months to be told I was getting a job, I would probably have found a different job in that time.

There is clearly an issue here with recruitment. What are we going to do about it?

8:47 pm

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I thank Deputy O'Sullivan for giving me the opportunity to update the House on this important matter. Recruitment and retention of health and social care workers is a top priority. As the Deputy outlined, budget 2022 provided funding for a large expansion of the health workforce, up to an additional 11,369 whole-time equivalents, reflecting the Government's ambition and desire to invest in our health services and to ensure health services are appropriately staffed. The HSE has identified a minimum recruitment target of 5,500 whole-time equivalents alongside a more challenging stretch target of 11,369 whole-time equivalents to be hired in 2022.

Employment levels at the end of May 2022, show there were 134,711 whole-time equivalents, equating to 153,578 personnel, directly employed in the provision of health and social care services by the HSE and the various section 38 hospitals and agencies. This is due to an unprecedented growth rate during the last three years. Since 2019, the workforce has grown by a record 14,893 whole-time equivalents, or 12.4%. In addition to this, approximately 3,000 people were recruited in 2020 and 2021 through third party agencies for Covid-related roles such as vaccinators and contract tracers. The workforce has grown by a total of 2,387 whole-time equivalents in the period between the end of 2021 to the end of May this year, with an increase of 138 whole-time equivalents in May alone.

Officials in the Department are working with the HSE on actions including the HSE's resourcing strategy 2022, which sets out a suite of actions to address recruitment challenges. It sets out the HSE's overarching governance and oversight arrangements which are in place to monitor, on a monthly basis, performance against the target.

A small HSE subgroup has been established which is developing pathways to fill difficult to fill posts for various categories of health professionals. This includes international pathways together with grow your own strategies where they are not available internationally. The HSE has developed a relocation package to ease international recruitment across all grades and, following a Department of Health business case to the Department of Enterprise, Trade and Employment, the critical skills list has been expanded to facilitate international recruitment of pharmacists, cardiac physiologists, medical scientists, occupational therapists, physiotherapists, podiatrists and chiropodists, psychologists and speech and language therapists. The HSE is reviewing international recruitment for specialist posts, such as nursing and midwifery specialists, with further actions identified to expedite recruitment.

Targeted work is ongoing on the recruitment of medical consultants which includes a streamlining of the recruitment process to reduce the times to hire, focusing on existing consultant posts that are challenging to fill and developing targeted strategies relating to these posts. This includes the development of marketing material to attract applications to certain locations and direct links with the medical training bodies. A microsite is also in development to increase international reach. I conclude by assuring the Deputy of the Minister's ongoing commitment to working with the HSE to address recruitment challenges.

Photo of Pádraig O'SullivanPádraig O'Sullivan (Cork North Central, Fianna Fail)
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I thank the Minister of State for the response. I have two questions on the response and then I will conclude with a few other remarks. The Minister of State said the HSE has identified a minimum recruitment target of 5,500 whole-time equivalents alongside a more challenging stretch target. What is a stretch target? What does that mean? Is the Minister of State telling me that the 5,500 are to keep things running as they are now, which is chaotic at times? We are all familiar with emergency departments over the last couple of weeks, particularly in certain regional hospitals. I would love to know what the definition of "stretch target" is. How do we get from 5,500 to 11,000? Is somewhere in the middle, at 6,000, 7,000 or 8,000 a success? Can the Minister of State provide clarity on that?

The Minister of State said the HSE is reviewing international recruitment to specialist posts such as nursing and midwifery, with further actions identified to expedite recruitment. Will the Minister of State outline those further actions? I would love to know what actions are being taken. Are we going to roadshows across the world? Are we attending exhibitions? Are we at universities? What specific actions are being referred to?

To conclude more generally, the majority of us here hold weekly clinics. I am Fianna Fáil's party spokesperson on special education. It is well documented that people have been waiting for a physiotherapy appointment with a children's disability network team. People may be waiting two, three or four years, if they are lucky, for a speech and language therapist to come to see them. In my opening statement, I acknowledged that the HSE is hiring more staff than ever, but it is clearly not sufficient. Nothing drives me more demented than to see budget underspends and funding not being drawn down. We need to do more. We need to engage internationally and to look at waiving work visas for non-EU applicants. We need to throw the kitchen sink at it. I would appreciate any further feedback.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I understand a stretch target is a target that makes the organisation alter the process to get the result it wants to achieve.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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Is it not shocking that the Department did not provide for an answer for a fairly straightforward question? It is not the Minister of State's fault but whoever writes answers could maybe do a training course in basic English and communication. I recommend that to the HSE and Department officials.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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I will bring the Ceann Comhairle's view on it back to the Department.

Photo of Seán Ó FearghaílSeán Ó Fearghaíl (Kildare South, Ceann Comhairle)
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I thank the Minister of State.

Photo of Frank FeighanFrank Feighan (Sligo-Leitrim, Fine Gael)
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That is what I understand about stretch targets. It sets a parameter that people have to work within to try to achieve the target. "Stretch target" is a first for me too. The continued growth of the health and social care workforce is a top priority for the Department. The Deputy will appreciate that given the competitive international situation and the high demand for skilled health and social care workers, we will probably continue to face ongoing difficulties despite our best efforts. Many factors have impacted international recruitment. We will continue to market Ireland as an attractive destination and we will endeavour to retain as many of our current employees as possible to provide timely and quality health and social care for the citizens of Ireland. It is good to note that recruitment activity and employment levels of those directly employed in the provision of health and social care services shows continued sustained growth in the HSE census figures for each month, with a 1.9% growth increase, equating to 2,387 whole-time equivalents since the end of 2021. Officials in the Department continue to liaise with the HSE and other Government Departments and stakeholders to address recruitment challenges and to ensure we recruit and retain the required workforce to deliver our health services.