Medical staffing ‘crisis’ threatens patients and services, HSE report claims

The safety of patients in Irish hospitals is being compromised as a result of a “crisis” in medical staffing arising from a reliance on “transient” foreign doctors, according to a new report.

Hospitals are likely to struggle to maintain existing services if the current situation continues and may have to “consolidate” or “discontinue” services, the draft Health Service Executive report warns.

Many hospitals would not be able to operate without foreign doctors, yet they are denied training and opportunities to develop their career. Believing that they being unfairly treated, many quit.

The cost of employing temporary and locum agency doctors will escalate to “unsustainable” levels, it says. Unless hospitals are urgently put on a stable workforce platform, key risks will continue to exist, including:

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- doctors of “unknown professional standard” continuing to work in hospitals;

- "inadequate" clinical oversight and assessment of many junior doctors, resulting in complaints to the Medical Council; and

- no career planning for junior doctors not in training schemes.

The report reveals Ireland’s massive and growing reliance on “non-training-scheme doctors” (NTSDs), which includes any doctor not enrolled in a specialist training scheme (to become a consultant). The number of NTSDs tripled between 2014 and 2018, from about 900 to 2,724.

Qualified overseas

This service-grade category of doctor comprises 50 per cent of all junior doctors, but up to 70 per cent in smaller hospitals. Three out of every four of these doctors have qualified overseas. More trained in Pakistan than in Ireland, for example.

However, 78 per cent of NTSDs leave Ireland within three years, creating a “turnover effect” whereby a significant proportion of Ireland’s hospital doctors are temporary and perpetually less experienced in their role and in the Irish system.

Warning of a “potential cessation” of services, the report says it is likely hospitals, especially regional ones, will find it difficult to find staff as they are currently configured.

It says the “crisis” requires urgent action through the “consolidation” of services and the reconfiguration of the medical workforce, and by increasing trainee places for doctors and increasing consultant numbers.

Services in some hospitals could be “repurposed” as part of a consolidation designed to reduce dependency on non-training scheme doctors.

Locum agencies

The report was drawn up by a working group led by clinical lead Prof Des Carney of the Mater hospital and Prof Frank Murray, director of the HSE National Doctors Training and Planning service.

Doctors do not have to be on a training scheme to work in Irish hospitals, but those that are not tend to move around a lot, working short-term contracts of six to 12 months or through a locum agency.

There is “less rigour” to the process of hiring such non-scheme doctors than in filling a consultant post or creating a training post, the report points out.

Most NTSDs experience “significant barriers” to entering training schemes because they trained in countries whose internships are not recognised by Ireland, leading to their “career stagnation” and frustration.

There are 71 non-training scheme doctors out of 83 junior doctors at South Tipperary General Hospital, and 94 out of 109 at Cavan General Hospital – 86 per cent in both cases.

Because of the lack of career progression, many foreign doctors quit Ireland as early as possible because they feel unfairly treated. They are then replaced by other overseas-qualified “and most likely less experienced” doctors who are new to the system. This results in “much turnaround and instability”, with “potentially negative patient safety effects”.

Most of these doctors are qualified and capable and without them, many hospital departments “would not continue to function”. However, a potential lack of employer due diligence has also led to some “troubling incidents”.

Although NTSDs are required to enrol on a professional competency scheme, only half of them do.

The weekly cost of employing an agency doctor is estimated in the report at €3,315, compared to €1,973 for a registrar.