HSE recruitment ban poses risk of longer queues, demoralised staff and public money wastage, report warns

A continued recruitment freeze in the Health Service Executive this year risks increasing waiting times for patients, demoralising staff and providing poor value for public money, an internal draft document has warned.

Last November, the existing recruitment ban in the HSE was extended to almost all staff, with the exception of consultants, doctors in training and 2023 graduate nurses and midwives. Previously, the freeze was only enforced for managerial and administrative roles.

The move, which was criticised by staff and representative unions, was in a bid to tighten expenditure in light of significant budget overruns in 2023.

However, an internal HSE draft risk assessment, entitled Budget 2024: Requirement to Cease Recruitment for Approved Development Posts, reveals a fiscal need to continue the pause on recruitment.

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About 75 per cent of the approximately 28,000 approved posts have been recruited to date, the HSE said, but upwards of 7,400 remained unfilled as of September 2023.

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The jobs, which were approved by the Department of Health in previous years, are connected to 270 different service initiatives to improve and develop the health service. Access to care and the waiting list action plans are most acutely affected by the recruitment freeze, with 776 previously approved roles for this area.

“The volume of these posts and the budget allocated to health for 2024 means the vast majority of these posts are not funded for 2024 and recruitment activity needs to cease,” the document said.

The assessment, conducted in November and obtained by The Irish Times under Freedom of Information laws, said these posts relate to about €480 million in pay.

It highlighted seven risks associated with the continued freeze. It found demand for services would continue to increase in 2024 “increasing demand, capacity gaps and service pressures resulting in longer wait times for triage, assessments and/or services”.

From a regional and local perspective, there were also risks, as hospitals and community services and section 38 organisations would have been planning to grow their workforces, the draft report said.

“The pausing or ceasing of recruitment into overhang posts is likely to have a demoralising effect on staff at local level who are working on service improvement,” the document said.

“It will be difficult for staff to understand why the posts are stopped and staff at local level will need to mitigate risks and deal with the implications of cost and resource effectiveness risks.”

[ Health service guaranteed to have ‘substantial deficit’ in 2024, Oireachtas committee hears ]

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Services and interventions designed to curtail service pressures in emergency departments and facilitate hospital discharge would be rolled out at a slower pace, the document said, “reducing the opportunity to improve patient experience times and alleviate pressures for staff”.

A continued freeze would also mean “inefficient use of new resources and staff where new services are not fully staffed and developments partly implemented, reducing benefits for patients and demonstrating poor value for public money”, the report said.

The assessment also outlines some mitigation measures, such as communication with stakeholders and prioritisation of high-risk areas within the 2024 recruitment ceiling. In Budget 2024, the Government allocated funding for approximately 2,268 posts.

Asked if the HSE would retain the freeze throughout this year, a spokesman said it was currently engaged in the national service planning process and this decision was part of the deliberations.

“When the service planning process is concluded, this detail will then be available,” it added.

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