In terms of background, the public health sector is the largest employer in the country. At the end of December 2017, the census showed a 131,926 headcount, with whole-time equivalents of 114,297, inclusive of directly employed home helps. The workforce is made up of clinical and non-clinical grades, with more than three quarters of it in the former category. In 2017, a turnover rate of 6% was identified, similar to the 2016 rate and up from a rate of 5.8% in 2015 and 5.4% in 2014. There is significant churn within the public health sector’s workforce, which places demands on attraction, sourcing, recruitment and retention activity. These activities, however, cannot be carried out in isolation from: workforce planning; training and talent development; staff engagement; performance management; and succession management in respect of the workforce. There are significant interdependencies across all those workforce related activities.
The Irish public health sector, in common with all health systems internationally, is facing significant recruitment and retention challenges generally and, more specifically, with certain grades and categories. The workforce has just come through an extended period of retrenchment and pay reductions. One of the most immediate effects on the workforce from the latter issue has been the ageing of the workforce. At the end of 2017, the percentage of employees of 55 years and older stood at 21%, up from a figure of 13% ten years earlier in 2007.
The recruitment and-or talent pool for many grades within the health sector is now increasingly becoming a global one and even within Ireland there is competition between the private and public health sectors as well as internally between hospital groups and community healthcare organisations. Ireland continues to face significant challenges in retaining its trained health professionals as well as attracting back many who emigrated and took up positions in foreign health industries, particularly in the context of the economic crisis of 2008 to 2014. In addition, sourcing and recruitment blackspots will require new assessments and approaches to address changing roles, skill mix and skill transfers in order to overcome such workforce gaps.
The people strategy 2015-2018 articulates and sets out the overall people management ambition, which is underpinned by an approach to the workforce that derives from human capital management which views people and personnel expenditures as investments in human capital rather than costs. Thus this gives greater credence to the adage that our people are our greatest asset which is perhaps more of an enabler than heretofore. It has been identified that health workforce management needs to focus on four main issues: acquisition; maintenance; motivation; and development of the workforce.
While clearly workforce planning is intrinsically linked to issues being addressed here, suffice to say, it is beyond the issue of numbers. Many activities relevant to the planning and management of the healthcare workforce, such as changing the scope of practices, redesigning jobs and transforming skills and roles of professional groups, are prerequisites to progress on major reforms of health systems.
More sophisticated and integrated models of workforce planning that cut across different professional groups and take account of a greater number of factors, such as skill mix, skill substitution, technologies and working practices, appear to offer a better prospect of contributing to the mission of the health system against a backdrop of continuous change and reform.
The next section is on the challenge with which I am sure the committee is very familiar, so I will move on.
The publication in May 2017 of the report of the Public Service Pay Commission, which was tasked with advising Government on public service pay, devoted a full chapter to recruitment and retention in the public service. This report was used to inform negotiations on a Public Service Stability Agreement 2018-2020, as an extension of the Lansdowne Road agreement. Thus the public health sector is likely to face a changing industrial relations environment that may add to the challenges impacting on the overall attracting, sourcing, recruitment and retention activity within public service.
Another significant emerging issue is the possible fallout from Brexit and analysis and assessments of it are still emerging.
Specifically with regard to the recruitment of consultant staff, the document provided at appendix 2, Towards Successful Consultant Recruitment Appointment and Retention, analyses the operational and administrative barriers in assisting with the efficient work of recruitment of the consultant workforce. The national strategy and framework for recruitment sourcing and retention of health workers is provided in appendix 1.
Specific actions have been taken in the HSE in respect of recruiting clinical staff for mental health services and I will summarise these. We have had the New Year-New Career Christmas campaign; the HSE talent pool, with more than 40,000 applicants; an international recruitment agency framework specifically developed for nursing and clinicians, directly targeting nursing schools and visiting all the nursing training colleges; graduate initiatives to retain our graduates; improved use of social media, particularly LinkedIn; a rolling campaign to allow applications 365 days of the year; the introduction of the psychology grade, where we have recently recruited 110 staff; local recruitment initiatives within the CHOs; investment in online technology; and increased use of Skype interviews.
If it is helpful to the committee, I would like to offer it the opportunity to visit some of the sites and perhaps participate in or observe the working of the consultant appointments approval committee, and visit national recruitment service, which is the shared service for recruitment. Perhaps that might inform the debate. I acknowledge also the work of our colleagues in the Public Appointments Service, who undertake the recruitment of consultants for us.
I thank the committee again for the invitation to be here and I am happy to address any of the member's questions or concerns.