HSE ‘factored in the cost’ of allowing doctors to work without rest, Oireachtas committee hears

Meeting on impact of recruitment freeze told compensatory rest payments are now ‘embedded in the system’

The Health Service Executive (HSE) has “factored in the cost” of allowing doctors to work without rest by paying compensatory payments, an Oireachtas committee has heard.

The committee meeting on the impact of the recruitment freeze on the health service heard that the compensatory rest payments are now “embedded in the system”.

Susan Clyne, chief executive of the Irish Medical Organisation (IMO), said the HSE has paid over €1 million in compensatory rest payments since an agreement came into force in January 2023.

The agreement was brought in to ensure that doctors are not working more than 10 consecutive days without a day of rest, however, the committee heard that 68 per cent of NCHDs regularly work beyond this, with some working in excess of 20 days in a row.


“The HSE takes the financial hit, so rather than treat the hours as a priority and put in place the systems to allow doctors to take appropriate rest, the HSE has factored in the cost of allowing them to work without rest,” she said.

Ms Clyne said the IMO insisted on penalties within the agreement in the hope that the system “wouldn’t pay the penalties, that it would actually just allow people to work safe hours, but now the system just chooses to pay the penalties, it’s easier.”

A survey carried out by the IMO found that 94 per cent of doctors have experienced depression, anxiety and stress made worse by work, while a further 80 per cent are at risk of burnout.

Ms Clyne told committee members that HSE’s recruitment freeze, which has been in place for seven months, has resulted in an increase in unsafe and illegal working conditions with 83 per cent of NCHDs routinely working beyond 48 hours per week.

However, it is not unusual for some doctors to find themselves on call for 72 hours, with some working over 100 hours per week.

She told the committee that just 24 hours before the recruitment freeze was announced in October, the HSE advised the IMO that it would take targeted recruitment of up to 800 additional NCHDs to bring working hours to legal and safe levels.

The IMO said 65 per cent of NCHDs reported being unable to avail of study leave for mandatory exams due to gaps in the rota despite being entitled to 10 days guaranteed study leave every six months.

Some 77 per cent of NCHDs reported being pressured by their employer to work extra shifts, often at short notice, according to the IMO with Ms Clyne saying it is not unusual for NCHDs to be asked not to let their colleagues down.

Separately, about 80 per cent of interns are emigrating each year after completing a year of work in Ireland, though about 75 per cent are returning, according to the IMO.

Out of 850 interns, committee members heard that more than 700 are emigrating every year.

“We’re not saying they will never come back, we’re saying we can’t assume they will come back,” said Ms Clyne.

She said doctors receive multiple emails each day from headhunters abroad, while ads outside hospitals and bus stops aim to entice them to Australia.

“They have identified why you might leave,” she said adding that a better work-life balance is the main pulling factor, not money.

Meanwhile, the IMO said decades of underfunding has resulted in a need for 5,000 hospital beds, pushing for 1,000 a year over the next five years, which she said is “not overly ambitious”.

However, as the population increases, Ms Clyne said the service is “running to stand still” without significant action.

She said the lack of acute beds is most visible in emergency departments, adding that it is not unusual for patients to receive their entire treatment on a trolley until they are discharged.

“Their whole episode of care can take place beside the toilet in a corridor,” she said adding that it is “quite common” in University Hospital Limerick.

Jack White

Jack White

Jack White is a reporter for The Irish Times