“The Irish public health sector, in common with all health systems internationally, is facing significant recruitment challenges specifically with certain grades and categories,” says a spokesperson for the HSE.
“The recruitment and/or talent pool for many grades within the health sector is now increasingly becoming a global one and even within Ireland there is competition between the private and public health sector,” they admit.
As of October 31st, there were more than 138,000 people directly employed in the provision of health and social care services by the HSE and the various Section 38 organisations. Almost one-third of these are nurses and midwives. Yet significant skill shortages persist in critical areas of the health service, and as Ireland’s population gets older – and sicker – these will need to be addressed.
In the very near future, we just simply won't have enough healthcare professionals
Skills gaps within the health service can partly be attributed to staff turnover rate, says the HSE spokesperson. The executive estimated that for 2018, the adjusted turnover rate was 6 per cent (down from 6.4 per cent in 2017). “This can be for a range of reasons such as simply moving to a new location but still remaining within the sector, as well as retirements, resignations or employee preferences. This means that each year, people will be moving in and out of about one in 16 posts across the health service and as a result a proportion of posts will be vacant at any one time.”
Clinical psychologists
One area with particular challenges is the recruitment of clinical psychologists at staff and senior level, with a number of posts at both grades remaining unfilled across all services. “There is ongoing interaction between the HSE and psychology educators and sponsors to address this matter,” says the spokesperson.
On a positive note, however, they highlight the increase in the number of graduates in physiotherapy, occupational therapy, speech and language therapy over the past number of years – “There is a more than adequate supply of these grades to meet the opportunities available”.
The Royal College of Physicians of Ireland (RCPI) has been working on policy in this area, with a new paper on how to address medical recruitment challenges due to be launched in early 2020.
Ireland is not alone when it comes to the healthcare skills shortage. President of the RCPI Prof Mary Horgan says manpower in health is facing a crisis globally. “In the very near future, we just simply won’t have enough healthcare professionals.” There are a number of reasons for this – the growing population coupled with an increasing ageing population, and growing numbers of technologies and therapies for conditions that heretofore could not be treated, she says.
“Entering the healthcare profession is probably less attractive than it used to be,” she admits.
“We probably need to move a bit more with the times in terms of meeting the needs of the modern-day workforce, being more flexible about how they can work, whether it’s part-time or four days a week. The system needs to adjust to what their needs are. Obviously, in healthcare we can’t work remotely – we need to be onsite looking after patients – so any flexibility within the workplace would be important. Work-life balance is very important to people, especially the younger generation. We need to be innovative within the health service so that we can attract these people.”
Looking within the health service, the paucity of consultants needs to be addressed urgently, says Horgan. “We have a lot of consultant posts that are not filled and that is a new phenomenon, one that didn’t happen before. People aren’t even applying for posts and the HSE needs to ask why this is,” she says, adding that issues such as pay parity need to be addressed as a matter of urgency.
Recruiting and retaining nurses continues to be a significant challenge for the HSE
“We also need to stop spending money on agency staff and properly constrict posts so that people are attracted to those jobs.”
The HSE also acknowledges that medical consultant recruitment remains “challenging in some specialties with the number of applicants reducing”.
“The recruitment of consultant psychiatrists is challenging across all geographical areas. There has been an increase in the number of consultants recruited in 2019 and there are ongoing consultations between the Department of Health and consultants and medics on pay-related issues,” the spokesperson said.
Ireland’s lack of qualified nurses has been well-documented in the media, as many posts go unfilled. “Recruiting and retaining nurses continues to be a significant challenge for the HSE as many of the newly qualified graduates, particularly from the general and mental-health registers, seek to broaden their experience by travelling abroad,” says the HSE spokesperson. They note, however, that by November 1st this year, 702 graduate nurses from the class of 2019 had accepted contracts with the HSE Acute Hospital Service, and this number continues to increase.
According to Dr Mary Rose Sweeney, head of the school of Nursing, Psychotherapy and Community Health at Dublin City University, how nurses are trained in Ireland must now be re-assessed in light of coming changes in how care is delivered.
“We are training nurses now that are competent to work in healthcare delivery as it is currently structured but as care delivery moves more to a primary care model in line with Sláintecare, that means nurses as they are currently trained will not be adequately equipped,” she explains.
‘Skills gap’
“This skills gap will need significant Government investment to get their skills level up to a point where they will be able to take clinical responsibility for their patient group.”
This model of care referred to as advanced nursing practice is currently practised in the US, explains Sweeney. “Our school have already developed a curriculum in advanced nursing practice and is planning to work with other higher-education institutes nationally to upskill the nursing work force. One of the challenges in doing this is that the healthcare system will have to evolve too to allow nurses to take on these advanced roles in terms of governable structures and things like insurance,” she says.
The advantages of a career in healthcare must not be discounted. Horgan is eager to emphasise the high level of job satisfaction that can be derived from working to help patients. “I love my job, it is so diverse and no two days are the same. There is always something new on the horizon and making a difference in somebody’s life for the better, it’s an incredible privilege to be able to do that. I feel lucky to be a in sector that improves people’s lives – how many jobs can you say that about?”