Thursday, 22 June 2017
Hospital Consultant Recruitment
I wish to raise the issue of hospital consultant post vacancies that currently exist in hospitals. It is my understanding, from the information I have received, that there are some 400 vacancies for consultant posts. As the Minister for Education and Skills, Deputy Bruton, will remember, in 2011-12 there was a cut in consultant salaries of up to 30%. That has not changed because it was a new form of contract that was offered. We are not, however, competing just in the Irish and UK markets anymore, but the world market. Ireland seems to have huge difficulties now in this regard. Some posts have been advertised and there have been no applicants at all. This is a cause for serious concern. Eight or nine years' ago there was, on average, at least six applicants for every consultant post advertised. This is now down to under two applicants per consultant post advertised. Ireland has waiting lists in hospitals and if we do not have the medical consultants with expertise to provide the care that people require, there is major concern that those waiting lists will continue to grow.What do we need to do in order to deal with this issue? Do we need to change the terms of the contracts that are being offered, and how do we do that? We need to enter into a consultation process regarding the best way forward, because unless these key people are there then our health service cannot progress and improve. It is extremely important that priority is given to this issue.
I thank the Senator for raising this issue. I am replying on behalf of the Minister for Health.
The position is that there are 2,427 approved consultant permanent posts and 201 temporary posts. I am informed by the HSE that there are 392 other approved posts. The current status of these posts has not been reported at this time but it is expected shortly. It points out that this does not mean that those posts are vacant, particularly in the case of specialist and critical posts. Those posts are often filled by locum or agency doctors.
There are very considerable challenges in recruiting consultants at present, and Senator Colm Burke has made that clear. This is due to worldwide shortages and international competition. At the same time there is steady progress in expanding the consultant workforce. It has been increased by 1,000 since 2004. In the last 12 months there were 120 added, and the previous year there were 94 additional consultants. There is a continual process of recruitment and expanding of the consultant base, and indeed during the crash years the embargo which was in place did not apply to consultants. The baseline has increased. The number of non-consultant hospital doctors has also increased by 1,000 posts in the last two years.
To try and deal with the issue of recruitment, a consultant recruitment committee has been established which has focused on trying to streamline the process. A simplified application form is in place, and there is a simplified and individualised induction programme. The evidence from the group is that the number of vacant consultant posts is gradually reducing, but with the desire to expand there are more posts being advertised. To facilitate better movement an esystem has been developed to improve the quality of information available regarding consultant posts and consultants employed in the health service, and each clinical site has had training as to how to match consultants employed at their sites to the posts to try and make this a more effective process.
The final piece of the jigsaw is that the group chaired by Professor Brian MacCraith of DCU was established to carry out a strategic review of medical training and career structures and to examine and make high-level recommendations relating to training and career pathways for doctors in response to recruitment and retention challenges, both in non-consultant hospital doctors, NCHDs, and at consultant level. That group made 25 recommendations in June 2014, and those are being pursued. There is an implementation group, with a monitoring group established to oversee that. A careers and training website has been launched. The majority of training programmes now offer pre-defined rotations of at least two years. Revised pay rates for new entrants were sanctioned in 2015, substantially reversing the 30% cut imposed in 2012.
The issue of pay is a wider one and applies beyond the health sector, and the Senator will know that the Public Service Pay Commission identified staffing shortages as reported in submissions from the health sector. The commission noted in its report that there are recruitment problems in specialist groups, including groups that are internationally in demand, such as consultants. It has recommended that consideration be given to commissioning a more comprehensive examination of underlying difficulties in recruitment and retention in those sectors and employment streams where difficulties are clearly evident. This exercise is due to be completed by the end of 2018.
The Minister for Health, Deputy Harris, is satisfied that the HSE is focused on filling all consultant posts and doing so in an efficient and effective manner. The full implementation of the consultant recruitment group will achieve this.
I thank the Minister. I am afraid I do not necessarily agree with the contents of the reply. The information that I have is that we still have a major problem in that the number of people applying for posts is drastically reduced, and the number of posts advertised which attracted no applicants.
I have been consistently looking for exact details of vacancies in hospitals since 2012. I got a reply from the HSE less than 12 months ago that it could not give me that information. We are talking about a national organisation and between 2,500 and 2,800 posts, and yet the HSE could not give me a breakdown of the vacancy levels. It has now put a mechanism in place to compile all the information.
If we go back 15 or 20 years ago, when it was known that someone was retiring, a post would be advertised before the vacancy arose. The HSE seems to have developed a policy, especially over the last five to ten years, of allowing the vacancy to occur first before advertising it. As a result we are paying for locums and agency doctors. I have no evidence that this has changed since I raised this issue over two years ago. I know of positions that have arisen and six month later the advertisements are in the newspapers for a new consultant. That has not changed and is an issue that should be taken back to the Minister.
Those are fair points. The Senator should realise that if the advertising of vacancies is advanced there will be a surge in the number of vacant posts in the short term. If the Senator is tracking the number of vacant posts he will, by his own suggestion, see a big increase in them. Notwithstanding that, it is probably a good idea to plan and anticipate workforce planning. I will alert the Minister for Health, Deputy Harris, to the Senator's concern that the vacancy data is only being compiled and that efficient workplace planning would require anticipation of these posts arising in the future. It is not in dispute that there is a problem with recruitment and the fact of small numbers of applicants for vacancies is the reason the considerable efforts of Professor MacCraith and the consultant group has been put in place.