HSE audit highlights major flaws in recruitment of junior doctors

Major flaws in the recruitment of junior doctors have been highlighted in a series of HSE internal audit reports.

One-quarter of all NCHDs had not fully completed all their occupational health assessments, according to one report, and recruitment procedures are not fully up to date.

A requirement for the hiring consultant to directly obtain a verbal reference for NCHDs recruited abroad was not being adhered to, auditors also found. And because employment record reports are not being reviewed, potential non-compliance issues are not being identified and addressed.

Just one-fifth of applications sampled had the required two references on file, the auditors found.

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Other, systemic issues emerged from audit fieldwork in six hospitals – interview notes not being detailed, required references not being on file, candidates not being required to provide identification at interview stage and the holding of telephone rather than video interviews.

The level of assurance in relation to the recruitment of NCHDs is unsatisfactory, the report concluded.

The audit focused on non-formal training posts, often lasting six or 12 months, not recognised for training and filled by international medical graduates. Many of these have not worked in Ireland before.

“With the short-term nature of the roles, absence of formal designated training, lack of exposure to the Irish acute hospital setting and challenges in performing background checks and verification of international experience [this] leads to increased risks in the recruitment of non-training roles.”

In 2018/19, there were 2,500 non-training NCHDs, compared with 4,000 in training to be consultants.

According to the auditors, University Hospital Limerick, the Mater hospital in Dublin and Cork University Hospital do not have in place Garda vetting for NCHDs, or a structure interview process in line with guidelines. These hospitals, along with Cavan General Hospital and University Hospital Galway, fail to obtain oral references before employing candidates.

The largest hospital in the country, St James’s in Dublin, does not carry out international police checks for an NCHD recruited outside the State, according to a report. Two references were not on file for 40 per cent of cases tested and the hospital does not require candidates to provide identification when they are being interviewed.

In the RCSI hospital group, two of four staff employed were not put on the minimum point of the pay scale, in breach of Government policy. Interview panels were not chaired by a person independent of the hospital group, and interview notes were not available for two of the files reviewed. Probation periods were set at six months rather than the 12 months required nationally.

In Cork University Hospital, Garda vetting was not on file for 40 per cent of the files reviewed and candidates were not required to provide identification at interview stage. For 20 per cent of NCHDs tested there was no record of completing the required English language tests.

The Mater hospital did not have two references on file for almost 60 per cent of cases tested; management said it had been requested on numerous occasions.

Meanwhile, in University Hospital Limerick, 15 out of 20 NCHDs reported working more than 48 hours a week, despite the European Working Time Directive which limits the working week to that period. The extra time worked ranges from eight hours to 35.