Dáil Éireann Debate, Thursday - 29 February 2024
4. Deputy Thomas Pringle asked the Minister for Health when the model 3 hospital pilot sites study will commence; how long it will last; how will the results of the study will be assessed by his Department; and if he will make a statement on the matter. [9277/24]
View answerI am taking this question on behalf of Deputy Pringle. It is a specific question on the three hospital sites that are to be picked; when the study on those three model 3 hospitals will begin; how long it will last; and how it will be analysed. I ask that specifically in the context of the study the Minister is aware of and which has highlighted the impending crisis in model 3 hospitals, notwithstanding the fact that they provide, together with the community, more than 50% of the care in Ireland.
I thank the Deputy for the question. The project she referenced, namely, the model 3 hospital project, was initiated by the HSE - the RCSI was heavily involved in it - to investigate exactly these issues: the challenges in recruitment and retention of consultants across specialties in the model 3 hospitals, and then, of course, to make recommendations. I was very happy to launch the report with the NDTP just a few months ago, on 9 November. I acknowledge the significance of the report and the work of all of those involved in it.
The report is pretty stark and highlights the differences between model 3 and model 4 hospitals with regard to recruitment and retention of consultants. As a group, the model 3 hospitals, albeit not all of them, find it harder to recruit consultants in. They find it harder to have the NCHDs apply for jobs that become available. The study shows the consultant posts are not as appealing to candidates in the model 3 hospitals as they are in the model 4 hospitals for quite a broad range of reasons. Part of it is the fact that, generally, younger doctors who are starting their pathways as consultants tend to want to work in larger hospitals. They tend to want to work in bigger, multidisciplinary settings. According to the report, some have the view that the work-life balance is more manageable in a model 4 hospital because you have more staff. What we have in some of the model 3 hospitals in particular specialties is that there may be a very small team. That leads to issues like more time on call.
Specifically, on the question of when we are going to start implementing the recommendations, the answer is that in quarter 2 of this year, on a targeted, site-by-site basis, we are going to begin to roll out the recommendations from the report.
Finally, in the last seven seconds, the Minister told me that he is going to start it in the second quarter. When in the second quarter? When is it going to be finished? What are the three sites? I understand Letterkenny is one of them. I ask that with frustration, having read the reports. The Minister was there at the launch of the reports. There were three forewords and I have read the whole report. The data from this research, building on the research of the Royal College of Surgeons in Ireland, clearly lays out in stark terms for the first time the challenges facing it.
The previous research in 2017 - and this was by Mr. Paddy Kenny - showed an impending surgical workforce crisis in model 3 hospitals, which deliver about 50% of general surgical activity nationally. This second report builds on that report, and so we have Professor Brian Kinirons shining a light on the fragility of the model 3 network, and that the model 3 network has more non-permanent posts and more consultants with general registration than in the model 4 network. There is any amount of facts and figures. The specific question again - if the Minister could address it more specifically - is when is it going to start in the second quarter? I am over time so I will come back.
I will ask the Department to revert to the Deputy with a more detailed timeline both with regard to when in quarter 2, the sites it is going to go to and the recommendations it is starting with. It is important to say that while there is a challenge that has been identified and that challenge is going to be responded to, there are a lot of positive things happening across the health service that will address some of the concerns that the consultants and the NCHDs have in the model 3 hospitals. First and foremost is that the growth in the medical workforce has been highly significant. For example, since 2020, the NCHD workforce has grown by nearly 2,000 doctors. That is a very significant increase that addresses some of the pressures being identified in the model 3 hospitals. Just as importantly, our consultant workforce has now grown since 2020 by 1,000 consultants. It has gone up from about 3,200 to about 4,200. What that has meant is a significant increase in consultants not just in the model 4 hospitals but in the model 3 hospitals, which will help address some of the concerns raised in the report.
The difficulty with politics and answers is all of these general figures. These are two very specific reports with the most recent one building on the other. There are 100 vacant posts in the model 3 hospitals. There are 17 model 3 hospitals in the country. This has 27 recommendations across four themes. The first is about strengthening the consultant workforce, the second is on education and training, the third is on the sites and infrastructure - the standard of some of which is unacceptable - and the fourth is on building the link between model 3 and model 4 hospitals.
With regard to the percentage over 55, 50% are over 55. Have I got that figure right?
There is an impending crisis in relation to retirements. In model 3 hospitals, one third of consultants are over 55 years of age. Model 3 hospitals have more non-permanent consultant posts and more consultants with no registration in a speciality. Of course there are good points. The report gives the good points but it highlights the fragility and the crisis and we need action. Is Letterkenny among those three hospitals? When will it start and when will it finish?
I would challenge the idea that there is a crisis in consultant recruitment here. There simply is not. We have increased the consultant workforce by 1,000 during the lifetime of this Government and there are hundreds more consultant posts in train at the moment. In fact, the conversation I am having with the HSE at the moment is how we are going to fund the consultant posts, given how many are being hired and how quickly it is happening. We now have almost 2,000 consultants on the new public-only contract. I visited Sligo University Hospital in the last few days where I was told that the increase in consultant numbers in Sligo is making a huge difference. It is allowing them to drive down the number of patients on trolleys and the waiting lists. I was in Letterkenny University Hospital not that long ago, where again there has been a very significant increase in the consultant numbers.
We have to take the report seriously, and we do. The Deputy raised four issues, among them the consultant workforce expanding and the NCHD workforce expanding. We are investing in the facilities on the ground for our medical workforce through the NCHD task force. Specifically on Letterkenny and the others, I will ask the Department to come back with a detailed note as to the sites, the timing and the actions being taken first
