‘Productivity challenges’ must be overcome following hospital activity report, says Donnelly

Minister of Health says investments in health funding and staff has already resulted in falling waiting lists

The increase in the number of patients treated in the health service is not commensurate with the level of increased resources that has been provided by the exchequer, Minister for Health Stephen Donnelly has said.

Mr Donnelly said the large scale State investment in funding and staffing over recent years was working and that waiting lists were falling, new services were being put in place and the number of patients on trolleys was reducing.

However, he said that “one of the things we have to do to set the health service up for the years to come is to increase productivity”.

Mr Donnelly told the News at One on RTÉ Radio 1 that, for example, the number of out-patient appointments being carried out per consultant in hospitals had been falling.


“Our consultants are working just as hard as they ever have but they are getting less time to spend on out-patients. What we are seeing over a period of time from 2016 onwards is that they are seeing fewer patients in a given year than they use to. Now, that is not their fault.”

He said that doctors accepted that the numbers of medical staff had increased but that they also needed to see the level of support increase with the number of clinical and rooms available rising also. He said that some consultants maintained that infection control measures introduced during the Covid-19 pandemic reduced the number of out-patients they could see.

Mr Donnelly said that additional staffing and funding allocated to the health service had resulted in a vast increase in the number of patients who were being treated. However, he said that this was not commensurate with the amount of additional resources that was being provided.

On Monday, he also confirmed that the health service was seeking to make savings of nearly €430 million this year and to put in place a range of new productivity measures.

Mr Donnelly said it was looking to reduce the dependency on overtime and agency staff as well as seeking savings on the medicines bill and procurement. He said the health service was also looking at costs in publicly-run nursing homes.

The Department of Health said: “These savings are intended to reduce the extent of the financial risk facing the health sector in 2024. They are balanced, however, with the fundamental need to deliver safe and quality care and services to patients.”

Mr Donnelly also published a new report on the impact the billions of euro of additional financial investment and the thousands of additional personnel recruited has had on hospital activity.

He said between 2016 and 2022 the health budget had increased by over €8 billion and staffing numbers by 30 per cent. However, he said the new analysis showed activity was not keeping pace.

“We have 2,500 more doctors, 5,600 more nurses and 3,700 more support and administrative staff. And yet, as this analysis shows, activity in our hospitals has increased by less than 10 per cent over the same period.”

The Irish Times reported on Monday that the report by the Irish Government Economic Evaluation Service (IGEES) found “a large divergence in all sites between the expenditure and workforce provided, relative to the growth in either separate activity metrics or ‘composite’ activity” – an aggregate of in-patients, out-patients, day cases and emergence attendances weighted by unit costs for each area.

“In most cases, the divergence is significant, with the percentage growth in composite activity between 2016 and 2022 either negative, or two times behind workforce growth, and up to three times behind real expenditure growth over the same period,” the report found.

Nurses criticised the report as being divorced from the reality of the lived experience of frontline patient-facing hospital staff.

The general secretary of the Irish Nurses and Midwives Organsiation Phil Ní Sheaghdha said: “This is all about saving money rather than patient safety and investing in services.”

“The reality is we have never denied an increase in the nursing and midwifery workforce however that does not take into account the unprecedented population growth we have seen in the last four years coupled with increased attendances and overcrowding which no public hospital in the State has been immune from.”

Sinn Féin health spokesman David Cullinane argued that “inefficiency in healthcare has been driven by political failure to deliver reform”.

“In the last 13 years, Simon Harris, Leo Varadkar, and Stephen Donnelly all failed to improve hospital efficiency, tackle overcrowding, or end the reliance on expensive agency staffing, management consultants, and outsourcing.

“We need greater productivity and efficiency across the health service, but not at the cost of patient care or patient safety,” Mr Cullinane said.

Meanwhile, the Irish Medical Organisation (IMO) warned that the Department of Health risked repeating the same “regressive mistakes of the austerity years if it planned to move away from health service investment in order to prioritise savings”.

The chairman of the IMO’s consultant committee Prof Matthew Sadlier said the main problem in the health service was “we have neither the beds nor the doctor numbers to meet ever-growing patient demand”.

“While the healthcare budget has increased in recent years, that must be seen in the context of restricted budgets for over a decade and a population that has increased beyond expectations leading to increased demand. The 2024 Budget allocated to the HSE will be challenged in terms of maintaining service levels, never mind expanding services,” Prof Sadlier said.

Martin Wall

Martin Wall

Martin Wall is the former Washington Correspondent of The Irish Times. He was previously industry correspondent